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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 44 out of 150

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VAERS ID: 1334527 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-04
Onset:2021-05-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / -

Administered by: School       Purchased by: ?
Symptoms: Abnormal behaviour, Blood potassium decreased, Blood test abnormal, Computerised tomogram, Cough, Death, Dyspnoea, Echocardiogram, Haemoptysis, Heart rate increased, Infection, Malaise, Mobility decreased, Pallor, Pulmonary oedema, SARS-CoV-2 test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 5
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: No
Current Illness: may be high blood pressure
Preexisting Conditions: No
Allergies: Seasonal allergies only
Diagnostic Lab Data: Yes, blood work, ECHO, CAT, and Covid test that was negative, potassium was low, HR was elevated to 200bpm Blood work showed infection.
CDC Split Type:

Write-up: My brother got the Pfizer 5/4 and started getting sick with a cough on the 7th and by the 10th he was getting more and more sick and ye was taken to the ER on the 14th and he started coughing up blood, he was out of it and pale and not able to move much. On 5/15 in the hospital he was having a hard time breathing and they were trying to give him meds to make him better, they gave him antibiotics because his blood work showed infection, and Precedex to help him rest, and he passed away the same day, he was in good health before. They also said his heart rate was 201/123 and the doctors said pulmonary anema. It escalated so quickly.


VAERS ID: 1334600 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-13
Onset:2021-04-30
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Concussion, Death, Fall, Resuscitation, Somnolence, Syncope, Thrombosis, Traumatic haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient has passed away. Wife reports patient was on Plavix and medications for high cholesterol, high blood pressure, and Type II Diabetes. He also took immunotherapy every 6 months (an injection) for prostate cancer.
Current Illness: history of prostate cancer, high blood pressure, high cholesterol, Type II Diabetes, heart failure, past heart attack with stents
Preexisting Conditions: see item 11
Allergies: Bumex
Diagnostic Lab Data: Wife reports a head CT was performed on 4/29/21 in the emergency room. She is unsure if labs were drawn as she was not allowed to be in the room the entire time.
CDC Split Type:

Write-up: Patient passed away on 4/30/21. Wife reports that on 4/29/21, she found him in the garage in a "pool of blood, face down" after a fall. Upon finding him on 4/29/21, she took him to the emergency room where he had a CT scan. Patient was diagnosed with a "concussion" and sent back home, and was instructed to follow-up with his primary care provider on 4/30/21. On 4/30/21, patient was "sleepy all day." On his way out of the house around 3:30, he suddenly put his hand on his wife and proceeded to collapse. The wife also fell, and by the time she gathered herself and went to check on her husband, he had passed away. An ambulance came to the house; CPR was performed for 40 minutes but "they could not get him back." He was not transported to a medical center. An autopsy was not done, but the coroner informed patient''s wife that he likely died from a "clot, maybe a PE." Wife wonders how this could be, since he was on Plavix for 5 years. Wife does not feel that the COVID vaccine is to blame, but thought she should report the issue just in case. This writer is assisting wife of patient to fill out electronic report.


VAERS ID: 1334684 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: death (unknown cause)-Severe, Additional Details: Patient was found deceased roughly an hour and a half after receiving Moderna vaccine. He waited 20 minutes at the pharmacy and left however later died. Details are unknown. Sister may have more information.


VAERS ID: 1334827 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
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: Asthenia, Dyspnoea, Feeling abnormal, Pyrexia, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D [COLECALCIFEROL]; MELATONIN
Current Illness:
Preexisting Conditions: Comments: Reporter stated that the patient had a history of "health problems." No specifics were provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: "severe reactions"; very weak; Felt Bad; shortness of breath; Fever; This spontaneous case was reported by a patient family member or friend and describes the occurrence of VACCINATION COMPLICATION ("severe reactions") and ASTHENIA (very weak) in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Reporter stated that the patient had a history of "health problems." No specifics were provided. Concomitant products included COLECALCIFEROL (VITAMIN D [COLECALCIFEROL]) and MELATONIN for an unknown indication. In April 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. In April 2021, the patient experienced VACCINATION COMPLICATION ("severe reactions") (seriousness criterion death), ASTHENIA (very weak) (seriousness criterion death), FEELING ABNORMAL (Felt Bad), DYSPNOEA (shortness of breath) and PYREXIA (Fever). On 06-May-2021, FEELING ABNORMAL (Felt Bad), DYSPNOEA (shortness of breath) and PYREXIA (Fever) outcome was unknown. The patient died on 06-May-2021. The cause of death was not reported. An autopsy was not performed. Patient had no symptoms or side effects after the 1st dose. Patient was never hospitalized for the reported events. A 71-year-old male patient who received mRNA-1273 experienced Pyrexia, Feeling Abnormal, Dyspnea, Asthenia and Vaccination Complication and died on an unknown days after the second dose of vaccine. Patient had a history of unspecified health problems which may confound the event. Unlikely that the events are related to the vaccine. Very limited information has been reported at this time. Further information is not expected.; Sender''s Comments: A 71-year-old male patient who received mRNA-1273 experienced Pyrexia, Feeling Abnormal, Dyspnea, Asthenia and Vaccination Complication and died on an unknown days after the second dose of vaccine. Patient had a history of unspecified health problems which may confound the event. Unlikely that the events are related to the vaccine. Very limited information has been reported at this time. Further information is not expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1334834 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Death, Fall, Loss of consciousness, Skull fracture
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Caller stated his wife passed out and hit her head on the floor; hit her head on the floor and split it open; transferred to hospital due to cardiac complications; fall; His wife passed away; This spontaneous case was reported by a patient family member or friend (subsequently medically confirmed) and describes the occurrence of DEATH (His wife passed away), LOSS OF CONSCIOUSNESS (Caller stated his wife passed out and hit her head on the floor), SKULL FRACTURE (hit her head on the floor and split it open), CARDIAC DISORDER (transferred to hospital due to cardiac complications) and FALL (fall) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Caller stated his wife passed out and hit her head on the floor) (seriousness criteria hospitalization and medically significant), SKULL FRACTURE (hit her head on the floor and split it open) (seriousness criteria hospitalization and medically significant), CARDIAC DISORDER (transferred to hospital due to cardiac complications) (seriousness criterion hospitalization) and FALL (fall) (seriousness criterion hospitalization). On 04-Apr-2021, LOSS OF CONSCIOUSNESS (Caller stated his wife passed out and hit her head on the floor), SKULL FRACTURE (hit her head on the floor and split it open), CARDIAC DISORDER (transferred to hospital due to cardiac complications) and FALL (fall) outcome was unknown. The patient died on 04-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment information was not provided. On 03 Apr 2021, the reporter stated approximately 45 minutes after receiving the COVID-19 vaccine, the patient passed out in the parking lot and hit her head on the floor which caused it to split open. The patient was taken to a hospital but had to be transferred to another hospital after experiencing cardiac complications. On 04 Apr 2021 at 4:00 am, the patient passed away. Very limited information regarding this events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1334843 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 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: unknown--pharmacy only given Moderna vaccine
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Informed of patient recently passing within 24 -36 hours of vaccine administration. patient had no signs of adverse side effects while at pharmacy.


VAERS ID: 1334884 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-13
Onset:2021-02-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Biopsy bone marrow abnormal, Capsule endoscopy, Clamping of blood vessel, Colon operation, Colonoscopy, Death, Dizziness, Fatigue, Gastrointestinal arteriovenous malformation, Gastrointestinal haemorrhage, Haematochezia, Haemoglobin decreased, Internal haemorrhage, Intestinal resection, Large intestinal haemorrhage, Melaena, Myelodysplastic syndrome, Occult blood positive, Platelet count decreased, Red blood cell count decreased, Transfusion
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Blood premalignant disorders (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (narrow), Vestibular disorders (broad), Malignant lymphomas (broad), Myelodysplastic syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Jardiance, Omeprazol, Metformin, Isosorbide, Metoprolol, Atorvastatin, Nitroglycerin, B12, Multi-Vitamin, Krill Oil, CoQ10 Aspirin, Culturelle
Current Illness: MDS: Myelodysplastic Syndromes
Preexisting Conditions: Heart, Sleep Apnea, Diabetes, High Blood Pressure
Allergies:
Diagnostic Lab Data: Multiple tests and lab reports. May check with the following doctors for their reports. 3/13/2021 COVID-19 vaccine, Moderna, 00LB21A, shot, left arm, 2 Second shot for Moderna vaccine was given after consulting with three health providers who all assured him the vaccine was safe. I believe they really thought it was safe, although I feel they may answer differently today. I know I would.
CDC Split Type:

Write-up: Dad had been feeling dizzy and tired much of the time when he first knew something was not right and went to his primary doctor and his heart doctor. From the date of 02/13/2021,the first COVID-19 vaccine shot, Dad?s condition worsened but once he was administered the second dose of the COVID-19 vaccine it quickly accelerated. One month and one day after the second vaccination shot he was dead from internal bleeding, an excellerated decrease in hemoglobin, red blood cells, platelets, and the complications this caused after surgery which removed a portion of his colon to stop the bleeding. Following is a chronological list of occurrences to the best of my recollection: 1) 2/25/2021 NP, received lab results which she had ordered earlier. Red blood cells 2.21 MIL/uL, hemoglobin 6.7 GM/DL, platelets 92 THOUS/uL. 2) 2/28/2021 admitted to the hospital to receive 3 units of blood and a bone marrow biopsy. Discharged 3/2/2021. 3) 3/3/2021 diagnosis: anemia, unspecified Melena, and ocult blood in stools. 4) 3/5/2021 Dr. with lab results: red blood cells 2.7 MIL/uL, hemoglobin 8.6 GM/DL, platelets 56 THOUS/uL. 5) 3/10/2021 Video Capsule Endoscopy. 6) 3/12/2021 Outpatient blood transfusion. 7) 3/15/2021 Dr. with bone marrow report. Diagnosed with Myelodysplastic Syndromes. Received first shot of ARANESP with orders to receive the ARANESP shot every two weeks and see a specialist at Hospital. 8) 3/16/21 transported to ER by ambulance with GI bleed. Received blood transfusions and admitted. Received several more tests and blood transfusions. Diagnosis: Arteriouvenous Malformation in descending colon. Treatment: 4 clamps in bleeding veins. Discharged: 3/19/2021. 9) 3/29/2021 Dr. office visit, labs, and second ARANESP shot. Ordered transfusion, no blood match. 10) 3/29/2021 Taken from Dr. office to ER and admitted to Hospital. Transfusions and additional tests performed. Test showed additional bleeding in colon. A colonoscopy was performed and several areas in the colon were sealed. 11) 4/2/2021 Discharged 12) 4/4/2021 Hemorrhaging from colon. Transported by ambulance to Hsopital. More transfusions and tests. 13) 4/5/2021 Performed surgery to remove part of colon. My dad continued to worsen over the next 9 days. 14) 4/14/2021 My dad died.


VAERS ID: 1334886 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-23
Onset:2021-04-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Patient died 72 hours after receiving the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Patient died 72 hours after receiving the vaccine) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046a21a) for COVID-19 vaccination. No Medical History information was reported. On 23-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 26-Apr-2021 The patient died on 26-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication was not provided, Treatment medication was not reported. A 79-year-old female patient who received mRNA-1273 died 3 days after the first dose of vaccine. No medical conditions or concomitant medications were reported. Very limited information has been reported at this time. Further information is being followed up.; Sender''s Comments: A 79-year-old female patient who received mRNA-1273 died 3 days after the first dose of vaccine. No medical conditions or concomitant medications were reported. Very limited information has been reported at this time. Further information is being followed up.; Reported Cause(s) of Death: Died 72 hours after receiving the vaccine.


VAERS ID: 1334899 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-01
Onset:2021-04-21
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Encephalopathy, Generalised tonic-clonic seizure, Magnetic resonance imaging head abnormal
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: 2021-04-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keppra; phenobarbital; cozaar; pristiq; invega
Current Illness: none
Preexisting Conditions: Seizure disorder; mental retardation; cerebral palsy
Allergies: none
Diagnostic Lab Data: ER; CT head 4/21/21 MRI brain 4/22/2021
CDC Split Type:

Write-up: Grand mal seizure; encephalopathy


VAERS ID: 1336097 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiac arrest, Electrocardiogram abnormal, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood pressure medication
Current Illness: None
Preexisting Conditions: HTN
Allergies: Nkda
Diagnostic Lab Data: Sociable rhythm in field, STEMI on EKG
CDC Split Type:

Write-up: Vfib arrest


VAERS ID: 1336534 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-05-10
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac failure, Death, Pancreatic carcinoma
SMQs:, Cardiac failure (narrow), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA Acute Systolic AFIB Pancreatic cancer Heart Failure


VAERS ID: 1336582 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-05-17
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery disease, Death, Peripheral arterial occlusive disease
SMQs:, Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

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

Write-up: NA PAD, Coronary Artery Disease


VAERS ID: 1336695 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-25
Onset:2021-04-11
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Death, Hyponatraemia, Pneumonia
SMQs:, Supraventricular tachyarrhythmias (narrow), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 10
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. Diagnoses were pneumonia, A-fib and hyponatremia. Patient died on 4/21/2021


VAERS ID: 1336767 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-03
Onset:2021-04-30
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: School       Purchased by: ?
Symptoms: Bradycardia, Cardiac arrest, Cardiogenic shock, Dizziness, Myocarditis, Oropharyngeal pain, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cetirizine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented 5/16/2021 with 1 week dizziness, fever and sore throat, found to have acute myopericarditis c/b cardiogenic shock and bradycardic arrest.


VAERS ID: 1336774 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-05-13
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Cellcept, prednisone and cyclosporine
Current Illness: Hx of double lung transplant in 2005 (chronic rejection) and ERSD on hemodialysis
Preexisting Conditions:
Allergies: Codeine, Morphine, Percocet
Diagnostic Lab Data: SARS CoV-2 PCR 5/13/21 Positive
CDC Split Type:

Write-up: Patient developed fever, dyspnea and headache on 5/12/2021; tested positive for COVID-19 on 5/12/2021; patient died on 5/20/21


VAERS ID: 1337019 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-02
Onset:2021-05-17
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown, none reported on pre checklist
Preexisting Conditions: unknown, none reported on checklist
Allergies: none reported
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown


VAERS ID: 1337021 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram abdomen abnormal, Death, Dehydration, Diarrhoea, Duodenitis, Lactic acidosis, Multiple organ dysfunction syndrome, Nausea, Renal failure, Toxicity to various agents, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Drug abuse and dependence (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a patient with long time diabetes and hypertension. She received the Moderna vaccine last Thursday. She had some nausea and vomiting and later some diarrhea. Unfortunately, she continued to take her diabetic meds and antihypertensives. Her CT abdomen showed duodenitis. She presented with multisystem organ failure and severe lactic acidosis. Despite aggressive treatment, she died less than 24 hours after admission. She was a complex patient and the renal failure and metformin toxicity seemed to be the terminal event, the vaccine may have started the process with some dehydration from nausea and vomiting.


VAERS ID: 1337058 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERER8727 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERER8727 / UNK UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Brain stem haemorrhage, Cardiac arrest, Death, Gait disturbance, Mechanical ventilation, Respiratory arrest, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: none
Preexisting Conditions: alcoholism
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient had Covid 19 from approximately January 28, 2021 through early February 2021. He received the first dose of the Pfizer Vaccine on March 26, 2021. On March 27, 2021 at approximately 7:30 PM, the patient suddenly became unable to speak clearly and walk normally. The ambulance was called at approximately 7:45 PM. The patient was evaluated and placed in the ambulance by approximately 8:15 PM. He stopped breathing in the ambulance. He was resuscitated and placed on a ventilator at some point. After evaluation at the hospital, it was found that he had suffered a pontine hemorrhage. He was kept alive until his heart stopped on March 29, 2021.


VAERS ID: 1337097 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac assistance device user, Death, Dyspnoea, Resuscitation, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt received Johnson and Johnson vaccine on 5/21/2021, PT had been complaining of shortness of breath since getting the vaccine yesterday and today, pt collapsed at home, wife started CPR, EMS continued compessions and ACLS protocol when they arrived to ED he was in Vfib, After multiple shocks, Epinephrine, bicarb, lidocaine and multiple other life saving medications were administered to no avail, pt expired on 5/21/2021 at 1729


VAERS ID: 1337198 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-05-07
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood urine present, Cerebral haemorrhage, Cerebral mass effect, Death, Haematochezia, Haemoptysis, Immune thrombocytopenia, Immunoglobulin therapy, Mental status changes, Petechiae, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tamsulosin, hydrocodone-APAP, ibuprofen , ondansetron .
Current Illness: Left sided renal stone and mild hydronephrosis week prior to admission for ITP. (went to ED on 4/30). No other PMH prior to this.
Preexisting Conditions: None.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to ED after receiving covid vaccination the month prior, with hemoptysis, petechiae, blood in stool and urine, and platelets . Prior to this, patient presented to the ED on 4/30 with kidney stone, no other significant PMH and prescribed medications mentioned on prior page. Suspected ITP, patient received IVIG x 3 days and prednisone x 4 days while admitted. On morning of 5/11, patient had AMS, became unresponsive and was evaluated for stroke. Patient had large intra-axial hemorrhage with significant midline shift, transferred to the Hospital and died the same day.


VAERS ID: 1337251 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-15
Onset:2021-05-16
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood glucose increased, COVID-19, Chest pain, Computerised tomogram abdomen normal, Computerised tomogram head abnormal, Cyanosis, Death, Dyspnoea, Endotracheal intubation, Haemorrhage intracranial, Hypotension, Hypoxia, Intensive care, Mental status changes, Platelet count normal, Pulmonary embolism, Troponin normal
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 4
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vyvanse, naporxen, vilazodone, ibuprofen
Current Illness: none
Preexisting Conditions: Anxiety Depression sleep apnea
Allergies: NKA
Diagnostic Lab Data: Troponin neg 5/16 Glucose 374 5/16 Platelet 248 5/16 CT of head 5/16 Negative CTA of lungs 5/16- saddle embolism extensive involvement of pulmonary artery branch all lobes, pulmonary emboli main right and left pulmonary arteries. Significant clot burden Ct of abdomen neg CT of head 05/18/2021 r/o hemmorhagic conversion- large parenchymal hemorrhage 7cm range, midline shift with cerebral herniation.
CDC Split Type:

Write-up: To ED via ambulance for chest pain and shortness of breath. Decompensated during transport, hypoxic, cyanotic, hypotensive. Intubated in ED. CTA of chest positive for saddle embolism. 1/2 TPA/heparin given. Admitted to ICU. Change in mental status, CT of head showed intracranial hemorrhage. Patient had reportedly been sick about a week or 2 earlier, covid positive PCR on admission to hospital.


VAERS ID: 1337366 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-05-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Death, Respiratory rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident received vaccine at 10am and was observed for 15 minutes post vaccine with no reaction noted. Pre and post vitals were at baseline. Upon rounds at 12pm, nurse noted resident with increased respirations and an elevated temperature (Resp 40, Temp 103.5). Nurse notified nursing supervisor and MD called. Patient was transferred via 911 to Hospital at 12:25pm.


VAERS ID: 1337439 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-28
Onset:2021-05-11
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Encephalopathy, Headache, Nausea, Visual impairment, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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 (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE PER DAD
Preexisting Conditions: NONE PER DAD
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: ACCORDING TO DAD, HE GOT THE VACCINE ON 4/28/21. ON MAY 11 HE WAS COMPLAINING OF N/V, LATER HEADACHE AND ALTERED VISION, ENCEPHALOPATHY, CARDIAC ARREST AND DEATH.... AFTER MULTIPLE LOCAL ER VISITS. HE NEVER HAD FEVER. I WAS CALLED ON HIS CASE DUE TO CONCERN FOR CNS INFECTION. HE WAS ADMITTED ON 5/18 AND DIED ON 5/20 THIS MAY OR MAY NOT BE RELATED TO THE COVID VACCINE, BUT IT IS IMPORTANT IT IS REPORTED JUST INCASE IT IS AND MAY HELP SOMEONE.


VAERS ID: 1337481 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Seizure like phenomena
SMQs:, Convulsions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Celexa 20mg po daily Famotidine 20mg po daily Plavix 75mg po daily Lorazepam 0.25mg po at bedtime PRN sleep Levothyroxine 75mcg po daily Metoprolol 12.5mg po TID Prilosec 20mg po daily
Current Illness: Resident had been experiencing a cognitive decline over approximately the last month. Treated for UTI on 4/29/21.
Preexisting Conditions: Hypertensive Heart Disease, Chronic Kidney Disease, Atrial Fibrillation, Peripheral Vascular Disease, Gout, Hypothyroidism, Congestive Heart Failure
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident had been experiencing cognitive decline over approximately the last month. Resident was treated for UTI on 4/29/21, labs were obtained on 5/3/21 and were unremarkable. Resident had seizure like episode at approximately 0830, resident was DNR Comfort Measures and resident''s family did not want resident sent to hospital. Resident expired at 0920 on 5/21/21.


VAERS ID: 1337502 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Furosemide
Current Illness: no
Preexisting Conditions: Hypothyroidism
Allergies: Macrodantin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death, code blue at home, received COVID vaccine 5/20/21. No known health issues


VAERS ID: 1337556 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-05-14
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pancreatic carcinoma metastatic
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stage IV Pancreatic Cancer


VAERS ID: 1337585 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-04-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Death, Extranodal marginal zone B-cell lymphoma (MALT type), Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Malignant lymphomas (narrow), Haematological malignant tumours (narrow)

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

Write-up: NA COPD, MALT lymphoma, HTN


VAERS ID: 1337619 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-21
Onset:2021-05-14
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Diabetes mellitus, End stage renal disease, Neuromyopathy
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre syndrome (broad), Chronic kidney disease (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NA End Stage Kidney disease DM Neuromuscular disease


VAERS ID: 1337634 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-14
Onset:2021-05-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   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: Levothyroxin Valium Multi vitamin Coreg Lisinopril Protonix Asprin Mecline Lipitor
Current Illness: None.
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: ?

Write-up: had second dose on 5/14/21, passed away during the night of 5/15/21. Found dead on 5/16/21 morning


VAERS ID: 1337675 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-05-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Death, Lung neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow)

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

Write-up: NA Left Upper Lobe Lung CA COPD


VAERS ID: 1337689 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-26
Onset:2021-05-21
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Crestor, Trazadone, Lexapro, Seroquel
Current Illness:
Preexisting Conditions: Severe arthritis, vision problems, depression, high cholesterol
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Health district notified by Police Dept. that a homebound resident who received first dose of Moderna on 4/26/21 and was due for second dose moderna on 5/24/21 was found deceased at home on 5/21/21.


VAERS ID: 1337701 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-16
Onset:2021-05-18
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Death, Dyspnoea, Hospice care, Pneumonia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   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: Unknown- received vaccine outside of hospital
Current Illness: Unknown- vaccine elsewhere
Preexisting Conditions: Chronic kidney disease, Congestive heart failure, Diabetes mellitus, blood clots
Allergies: No known allegries
Diagnostic Lab Data: Tested positive for COVID- expired
CDC Split Type:

Write-up: 64 y.o. female who presented with SOB. She has a history of CAD, diabetes, CHF, CKD and DVT presents to the ED in respiratory distress. Patient was brought in by EMS from nursing home. Patient had reported onset of shortness of breath and respiratory distress over the last 6-7 hours. Patient has O2 sat of 90% on 6 L. Patient only uses 2 L nasal cannula oxygen all day long. Patient is coherent and initially was placed on BIPAP but then stated she wanted to go back, now after ER doc spoke to her she is ok with being admitted but does not want BIPAP or to be placed in the ICU. She is DNR/DNI. She is working hard to breathe currently. Patient is unsure if she is making urine at this time. Workup in the ER revealed AKI on CKD and covid + pneumonia. Patient elected hospice and expired 5/20/2021. It was reported that patient had received vaccines at Walmart.


VAERS ID: 1337723 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-13
Onset:2021-05-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 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: 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: 05/13-DISCUSSED WITH PHARMACIST A TOPICAL ALLERGIC REACTION HE HAD BEEN HAVING FROM A NEW BODY SOAP. PHARMACIST RECOMMENDED TOPICAL HYDROCORTISONE CREAM AND ORAL BENADRYL TO HELP MANAGE SYMPTOMS.
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT WAS IMMUNIZED 5/13. PATIENT WAS FOUND DECEASED IN THEIR APARTMENT ON 5/18. FAMILY LAST SAW HIM ON 5/16 WHEN THEY DROPPED HIM OFF AT HIS APARTMENT. MEDICAL EXAMINER HAS NOT YET DETERMINED CAUSE OF DEATH OR EXACT DATE OF DEATH.


VAERS ID: 1337728 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-27
Onset:2021-04-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Death, Gastrointestinal necrosis
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 19
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: Metformin januvia vitminc supp simvastatin synthroid
Current Illness: Nonetype
Preexisting Conditions: Type 2 diabetic
Allergies: None
Diagnostic Lab Data: Intestines died
CDC Split Type:

Write-up: Intestinal distress ending in dead gut sundrome


VAERS ID: 1337755 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-29
Onset:2021-05-09
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L2OA / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Cardiac failure chronic, Death, Ejection fraction decreased, Follicular lymphoma, Hypoxia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Respiratory failure (narrow), Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Vaccinated on 1/29/2021 and 2/26/2021 with Moderna; tested positive for COVID-19 on 4/17/2021 by rapid PCR; admitted to the hospital on 4/14/2021 and died on 5/9/2021.
CDC Split Type:

Write-up: Person died on 5/9/2021, with death note listing acute and chronic respiratory failure with hypoxia, COVID-19, paroxysmal atrial fibrillation, chronic heart failure with reduced ejection fraction, follicular lymphoma, history of CABG, hyperglycemia, and type 2 diabetes.


VAERS ID: 1337780 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-08
Onset:2021-05-07
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Hypoxia, Respiratory failure, SARS-CoV-2 test positive, Thrombocytopenia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 31 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: type 2 diabetes; hypertension; GERD
Allergies: unknown
Diagnostic Lab Data: Received COVID-19 Janssen vaccine on 3/8/2021; tested positive for COVID-19 on 3/26/2021 by rapid antigen and PCR; was seen in ER on 3/29/2021 but not admitted to hospital; then admitted to hospital on 4/6/2021 with increased/worsening symptoms; died on 5/7/2021.
CDC Split Type:

Write-up: Person died on 5/7/2021 with death note stating acute respiratory failure with hypoxia, thrombocytopenia.


VAERS ID: 1337824 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Foaming at mouth, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Convulsions (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: foaming at the mouth and had a heart attack


VAERS ID: 1337918 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-05-14
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unaware of any adverse events between administration and death. Reporting agency became aware of patient''s expiration on 05/14/2021.


VAERS ID: 1337951 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-12
Onset:2021-05-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A2113 / 2 RA / IM

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

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: Hydromorphone 2 mg 1 tablet q 4 hours as needed ASA 81 mg daily Calcium Acetate 667mg ( 2 capsules TID ) Coreg tablets 25 mg ( 1 tab BID ) Entresto tablets 49-51 mg ( 1 tab BID ) Folic acid tablet 1 mg ( 1 tab OD ) B Complex tablet ( t
Current Illness: UNKNOWN
Preexisting Conditions: CHF Essential HTN NON Ischemic cardiomyopathy Cardiac LV EJECTION FRACTION 21-40% COVID-19 Virus infection ( march 2020
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient expired 1 day after receiving 2nd dose of Moderna vaccine


VAERS ID: 1338341 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-05-11
Onset:2021-05-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 2nd COVID vaccine completed on 5/11/21 Acetaminophen Acetylcysteine Solution 20 % Allopurinol Tablet 300mg Bactrim DS Cipro 500mg Colchicine Tablet 0.6mg Duoneb Furosemide Magenesium Metformin Metoprolol Promethezine Protonix Pulmicort Riv
Current Illness: See below
Preexisting Conditions: CANDIDIASIS, UNSPECIFIED(B37.9), GOUT, UNSPECIFIED(M10.9), HYPOMAGNESEMIA(E83.42), ESSENTIAL (PRIMARY) HYPERTENSION(I10), HYPERLIPIDEMIA, UNSPECIFIED(E78.5), UNSPECIFIED HEMORRHOIDS(K64.9), MUSCLE WEAKNESS (GENERALIZED)(M62.81), NEED FOR ASSISTANCE WITH PERSONAL CARE(Z74.1), DIFFICULTY IN WALKING, NOT ELSEWHERE CLASSIFIED(R26.2), UNSTEADINESS ON FEET(R26.81), GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS(K21.9), CANDIDAL STOMATITIS(B37.0), THROMBOCYTOPENIA, UNSPECIFIED(D69.6), FACIAL WEAKNESS(R29.810), OTHER VOICE AND RESONANCE DISORDERS(R49.8), OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED(N13.9), OTHER PERSISTENT ATRIAL FIBRILLATION(I48.19), ACUTE RESPIRATORY FAILURE WITH HYPOXIA(J96.01), MALIGNANT NEOPLASM OF LARYNX, UNSPECIFIED(C32.9), TYPE 2 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION(E11.69), DEPENDENCE ON SUPPLEMENTAL OXYGEN(Z99.81), ENCOUNTER FOR ANTINEOPLASTIC RADIATION THERAPY(Z51.0), ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY(Z51.11), URINARY TRACT INFECTION, SITE NOT SPECIFIED(N39.0), INFECTION AND INFLAMMATORY REACTION DUE TO INDWELLING URETHRAL CATHETER, SUBSEQUENT ENCOUNTER(T83.511D), GASTROSTOMY STATUS(Z93.1), DYSPHAGIA, OROPHARYNGEAL PHASE(R13.12), ANEMIA, UNSPECIFIED(D64.9), OCULAR HYPERTENSION, UNSPECIFIED EYE(H40.059), OTHER PANCYTOPENIA(D61.818), UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION(E43), TRACHEOSTOMY STATUS(Z93.0), CYTOMEGALOVIRAL DISEASE, UNSPECIFIED(B25.9), BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS(N40.0), DYSPHAGIA, ORAL PHASE(R13.11), DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE(R13.14
Allergies: Brimonidine
Diagnostic Lab Data: None. Patient Deceased
CDC Split Type:

Write-up: Resident was found deceased in the evening of 5/11/21.


VAERS ID: 1338394 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-05-07
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Chest pain, Death, Fatigue, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death N17.9 - Acute kidney failure, unspecified FATIGUE CHEST PAIN NAUSEA


VAERS ID: 1338572 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-05-03
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death, Hyponatraemia, Pneumonia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death E87.1 - Chronic hyponatremia N17.9 - AKI (acute kidney injury) (CMS/HCC) J18.9 - Pneumonia of right lower lobe due to infectious organism


VAERS ID: 1338590 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-04-29
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dizziness, Headache, Subdural haemorrhage, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Thrombocytopenia Subdural bleeding HEADACHE DIZZINESS


VAERS ID: 1338605 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-03-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 46
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Acute kidney injury


VAERS ID: 1338610 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-20
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death J18.9 - Pneumonia, unspecified organism


VAERS ID: 1338617 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011AZ1A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Metformin Hydrochloride, Flomax, Diltiazem, Ferrous Sul, Lipitor, Tramadol.
Current Illness: N/A
Preexisting Conditions: Diabetes, a-fib, obesity.
Allergies: N/A
Diagnostic Lab Data: No tests performed following death.
CDC Split Type:

Write-up: Death of patient two days after second injection.


VAERS ID: 1338618 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-05-14
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - Acute kidney failure, unspecified


VAERS ID: 1338625 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Death, Decreased appetite, Eye movement disorder, Fall, Injection site pain, Malaise, Nervousness, Respiratory arrest, Resuscitation, Seizure like phenomena, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 03/31/21 Moderna dose #1 -Had first dose Moderna Vaccine 3/31/21. She described body aches and mild fever ? ?like I had COVID ag
Other Medications: Acetaminophen
Current Illness: none known
Preexisting Conditions: Had positive COVID test Nov 28, 2020 at Hospital. Was followed with daily phone calls from Health Nursing throughout isolation period. Cough, fever, body aches for first several days. Released from isolation Dec 11. Suffered assault Feb 11 with blunt trauma to head and face. Seen in ER 2/14 with facial bruising and swelling. Head CT showed no intracranial injury. Required operative drainage of forehead hematoma 2/23
Allergies: none known
Diagnostic Lab Data: Office of Medical Investigator will perform
CDC Split Type:

Write-up: Outcome: unexpected/unexplained death Had first dose Moderna Vaccine 3/31/21. She described body aches and mild fever ? ?like I had COVID again for a day? ? lasting about 36 hours, and then felt fine. Had dose # 2 Moderna vaccine about 6:50 PM at Community vaccination site. She was driver, received left deltoid injection from Doctor. During observation period reported no symptoms, was happy and talkative with family and staff. Family reports later that evening she did not feel well ? ?just not hungry? and wanting to lie down. Slept well, then woke up feeling better except for left arm achiness at injection site. Did not report redness, rash, or any difficulty breathing. Was talkative, walking around, took a shower, and was planning to drive to the grocery store later that day. Mid morning ? maybe beginning about 11 AM, family said she went in and out of bathroom several times. She told them she had vomited three times and was feeling shaky. Her oral temperature was 101.3. About 1:30 PM, she was in her room and called out for her mother. When family went into the room, she was shaking ?like she was having a seizure? and then her eyes rolled back and she fell to her side and stopped breathing. Family called 911 and started CPR. CPR was continued by EMT?s once they arrived, but they were not able to resuscitate her.


VAERS ID: 1339062 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-15
Onset:2021-05-04
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Death, Electrocardiogram, Inflammation, Pneumonia, Sepsis
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

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: Insulin, Aricept, KLONopin, Trazodone, Zoloft, Depakote, Hytrin
Current Illness:
Preexisting Conditions: Diabetes, dementia
Allergies: Penicillin, anti-psychotics
Diagnostic Lab Data: Bloodwork, CT, EKG
CDC Split Type:

Write-up: Patient appeared to have had suffered a stroke. Admitted to hospital, tests determined no stroke. Patient had pneumonia, and severe inflammatory response. Sepsis.


VAERS ID: 1339098 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-22
Onset:2021-04-11
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cerebral artery embolism, Cerebrovascular accident, Death, Intensive care, Loss of consciousness, Thrombectomy
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 6
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: Pradaxa, Adult vit, amlodipine bestlate, atorvastatin, duloxetine, hydrochlorothiazide,
Current Illness: none
Preexisting Conditions: consequences from left side clot (stroke) in Jan 2006
Allergies: none
Diagnostic Lab Data: Surgery to remove clot successful on 04/12/2021. In ICU until we pulled left support. She passed away.
CDC Split Type:

Write-up: Massive stroke from huge clot right of brain. Never regained con..


VAERS ID: 1340228 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210536600

Write-up: DEATH; This spontaneous report received from a consumer concerned four female patients. The patient''s weight, height, and medical history were not reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total dose was administered, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company was unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On unspecified date in 2021, the patients died from unknown cause of death after vaccination. The autopsy details were not provided. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20210320422.; Sender''s Comments: V0- 20210536600- Covid-19 vaccine ad26.cov2.s-death.This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1340339 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Massachusetts  
Vaccinated:2021-04-18
Onset:2021-03-28
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Foetal growth restriction, Maternal exposure during pregnancy, Ultrasound scan
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ESTRACE; PROGESTERONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210426; Test Name: ultrasound; Result Unstructured Data: Test Result:baby stopped growing 5 days after shot; Test Date: 20210506; Test Name: ultrasound; Result Unstructured Data: Test Result:baby stopped growing 5 days after shot
CDC Split Type: USPFIZER INC2021512724

Write-up: Baby stopped growing 5 days after shot, confirmed with ultrasounds on 4/26 and 5/6; Maternal exposure during pregnancy, first trimester; This is a spontaneous report from a contactable consumer (fetus''s mother). This consumer reported information for both mother and fetus. This is the fetus report. A patient (fetus) mother (35-years-old ) received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 18Apr2021 09:15 (Batch/Lot Number: EW0164) at the age of 35-years-old as single dose, dose 1 via an unspecified route of administration, administered in Arm Left on 28Mar2021 15:00 (Batch/Lot Number: Er8732) at the age of 35-years-old as single dose for covid-19 immunisation. Route of the administration for fetus was provided as Transplacental. The patient''s mother medical history was not reported. The patient''s mother''s concomitant medication included estradiol (ESTRACE) taken for an unspecified indication, start and stop date were not reported; progesterone taken for an unspecified indication, start and stop date were not reported. The patient''s mother did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The baby experienced maternal exposure during pregnancy, first trimester from 28Mar2021 15:00. On 23Apr2021, 14:00, the mother experienced miscarriage, the baby stopped growing 5 days after shot 23Apr2021 14:00, confirmed with ultrasounds 26Apr2021 and 06May2021, the event resulted in doctor or other healthcare professional office/clinic visit, there was no treatment for event. Mother''s Last menstrual date was 10Mar2021. The outcome of the events was fatal.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2021509131 mother case; Reported Cause(s) of Death: Baby stopped growing 5 days after shot, confirmed with ultrasounds on 4/26 and 5/6; Maternal exposure during pregnancy, first trimester


VAERS ID: 1340500 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-02
Onset:2021-03-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aspiration, Blood cortisol, Blood test, Full blood count, Generalised tonic-clonic seizure, Investigation, Lung disorder
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: CLOBAZAM; LAMOTRIGINE; ESCITALOPRAM; AMITRIPTYLINE; LEUCOVORINE; LORAZEPAM; MESALAMINE; FIORICET; VITAMIN B2 [RIBOFLAVIN]; COQ10 [UBIDECARENONE]; L-CARNITINE [LEVOCARNITINE]; B COMPLEX [VITAMIN B COMPLEX]; VITAMIN A [RETINOL]; VITAMIN C [AS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiomyopathy (A467T mutation in the polymerase gamma gene); Epilepsy
Allergies:
Diagnostic Lab Data: Test Name: cortisone level; Result Unstructured Data: Test Result:200; Comments: Her cortisone level usually runs about 200, with metabolize of 700; Test Name: blood test; Result Unstructured Data: Test Result:Unknown results; Test Name: CBC; Result Unstructured Data: Test Result:normal; Test Name: lamotrigine level; Result Unstructured Data: Test Result:4; Comments: her lamotrigine level runs about between 4 and 8.5
CDC Split Type: USPFIZER INC2021550162

Write-up: She aspirated and she was dead within week on respirator; she aspirated and she had pulmonary problem to begin with; 3 convulsions within 24 hours of having her first Pfizer / three grand mal compulsive seizures; This is a spontaneous report from a contactable physician. A 55-years-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 02Mar2021 (Batch/Lot number was not reported, vaccinated at the age of 55 years old) as single dose for covid-19 immunisation. Medical history included epilepsy, myocardial metabolism disorder. She has a myocardial metabolism disorder, very specific one and it is A467T mutation in the polymerase gamma gene and that is because of her epilepsy. It was because of that it''s a progressive disease get involved with many part of the body that is all so causes seizure. Concomitant medications included clobazam; lamotrigine; escitalopram; amitriptyline; calcium folinate (LEUCOVORINE); lorazepam; mesalazine; butalbital, caffeine, paracetamol (FIORICET); vitamin b2 [riboflavin] (VITAMIN B2 [RIBOFLAVIN]); ubidecarenone (COQ10 [UBIDECARENONE]); l-carnitine [levocarnitine]; vitamin b complex (B COMPLEX [VITAMIN B COMPLEX]); vitamin a [retinol]; vitamin c [ascorbic acid], all taken for an unspecified indication, start and stop date were not reported. The patient previously took sulphur, nepatop, dilantin [phenytoin], prednisone, and lidocaine and all experienced hypersensitivity. The patient had received 3 convulsions within 24 hours of having her first Pfizer and she had epilepsy like she has been suffering from years and she aspirated and she was dead within week on respirator. She had three grand mal compulsive seizures and because of the seizures; she aspirated and she had pulmonary problem to begin with. She was put on a respirator and she was on respirator from the day she was admitted and she probably died within about two days. when the vaccination was, precise 24 hours later she had three grand mal compulsive seizures and because of the seizures she aspirated and she had pulmonary problem to begin with. She had 3 convulsive seizures that stayed for about 10 minutes and she had not, she normally would have the focal seizure just in her left arm. She has not had it big seizure in probably 20 years. The physician stated that don''t know what killed her was not seizure when she wasn''t he hospital she was intubated and she was alive. What killed her was she was aspirated and they could not get her off the respirator and she did not have COVID. When she was admitted to the hospital they did a lot of blood test. Before that, her cortisone level usually runs about 200, with metabolize of 700, and her lamotrigine level runs about between 4 and 8.5 of all other routine her Full blood count (CBC) routine is quite normal. It was not reported if an autopsy was performed. Outcome of events Grand mal seizure and Pulmonary disorder was unknown. Information on batch number has been requested.; Sender''s Comments: Based on the available information and known product profile, the causal relationship between the reported seizures along with the consequent aspirations which lead to death and the use of BNT162B2 cannot be fully excluded. However, it is noted that the patient has multiple comorbidities which confound the reported drug event pairs. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: She aspirated and she was dead within week on respirator


VAERS ID: 1340510 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Death
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021557124

Write-up: deceased alone at home; Constant Complains of severe chest pains after taking the first shot and she was found deceased alone at home clutching a hot water bottle to her chest; This is a spontaneous report from a contactable consumer. A 79-years-old female patient (not pregnant) received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on Feb2021 (Lot Number: EL8982) as 1ST DOSE, SINGLE for covid-19 immunization. The patient medical history was none. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient''s concomitant medications were not reported. On Feb2021, the patient experienced constant complains of severe chest pains after taking the first shot and she was found deceased alone at home clutching a hot water bottle to her chest. Since the vaccination, the patient has not been tested for COVID-19. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of chest pain was not recovered.; Reported Cause(s) of Death: deceased alone at home


VAERS ID: 1340513 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Death, Hypersensitivity, Loss of consciousness, Pain in extremity, Peripheral swelling
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: Medical History/Concurrent Conditions: Allergy; Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021561326

Write-up: lose his life after the vaccine; Passed out; swelling and pain in his side of his arm; swelling and pain in his side of his arm; asthma trigger; allergies; This is a spontaneous report from a contactable consumer (patient''s wife). A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) dose 1 via an unspecified route of administration on Apr2021 (Batch/Lot number was not reported) as 1st dose, single for covid-19 immunisation. The patient medical history included bad allergies and has asthma. Concomitant medications were not reported. He lose his life after the vaccine in Apr2021. He took the vaccine in Apr2021. After 3 days he took the vaccine on Tuesday, then Friday he was gone, that first dose. That day he died, he had like the asthma trigger like 10 minute after then he passed out but Thursday he was saying that he had like swelling and pain in his side of his arm. He had night shift and then morning came, Friday came home and then he ate and then he slept and then he woke up at 10 am just to go to kitchen and thought he was saying like having had allergies and 10 minutes then he passed out and then that was it. The reporter was just wondering how come, he still passed. Seriousness for lose his life after the vaccine was reported as death. The outcome of event lose his life after the vaccine was fatal and other events was unknown. The patient died in Apr2021. The cause of death was unknown. It was unknown if an autopsy was performed. Information on the Lot/Batch number has been requested.; Reported Cause(s) of Death: lose his life after the vaccine


VAERS ID: 1340672 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Brain oedema, Cerebral endovascular aneurysm repair, Cerebral haemorrhage, Cerebral mass effect, Computerised tomogram head abnormal, Craniotomy, Death, Headache, Intensive care, Intracranial aneurysm, Ischaemic stroke, Laboratory test, Ruptured cerebral aneurysm, Somnolence, Subarachnoid haemorrhage, Vasospasm, Ventricular cisternostomy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   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: Tylenol PRN Multi vitamin QD
Current Illness: No illnesses.
Preexisting Conditions: None.
Allergies: Flexeril - made her feel funny
Diagnostic Lab Data: Between the dates of 4/4/21 and 5/10/21 patient has had multiple CT scans and CTAs of the brain. numerous laboratory results. A lengthy stay in the SICU at hospital.
CDC Split Type:

Write-up: Patient went to ER 4/4/21 with severe headache, inability to stay awake. CT scan of the head revealed multiple areas of SAH (unexplained no head injury) and a very large ruptured MCA aneurysm. Patient was COMPLETELY asymptomatic prior to vaccination. The aneurysm was repaired with success but the cerebral hemorrhages kept appearing - unexplained. Cerebral edema became so severe (midline shift up to 9-10mm) neurosurgery ended up performing a burr hole craniotomy to relieve pressure as well as placement of a ventriculostomy. This patient later ended up with severe vasospasms which results in an ischemic stroke of the L frontal lobe. Patient later died in a rehabilitation facility, all of this secondary to the Janssen vaccine. This vaccine should not be administered until further studied. This was a healthy 63 year old woman. Vitals always WNL labs WNL very active, BMI WNL. Absolutely NO comorbidities. A lifelong nurse who raised 2 nurses of her own. These events took place for over a month. The trauma not only the patient has experienced but her family is unforgivable.


VAERS ID: 1340758 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-04-09
Onset:2021-05-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardiac flutter, Death, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Flomax, Flonase, Furosemide, macrobid, methenamine hippurate, multivitamin, potassium chloride, Shingrix intramuscular injection, triamcinolone, vitamin C, Vitamin D
Current Illness:
Preexisting Conditions: abdominal aortic aneurysm, hypertensive disorder, malignant tumor of prostate, nocturia, urinary tract infection
Allergies:
Diagnostic Lab Data: My dad was referred to a cardiologist and had an appointment a few days before he died. I''m not sure what they found out, but they had scheduled him for follow up appointments for more tests.
CDC Split Type:

Write-up: My dad started having breathing problems and heart fluttering shortly after getting his first covid vaccination on April 9, 2021. He had contracted Covid back in October 2020. He never told us he was getting the vaccination until we got a call on his cell phone from Public Health the day after he died of a pulmonary embolism. When he started complaining of symptoms, his doctor referred him to a cardiologist at a Clinic. He had an appointment with them a few days before he died. Apparently, they didn''t find any blood cllots, possibly because they were looking for heart issues. Either way, I believe that my dad died from side effects of the Moderna vaccine. My dad died on May 1, 2021 of a pulmonary embolism. The coroner and County Sheriff both said it was one of the biggest blood clots they had ever seen. Since he had no history of blood clots, I thought it important that I report it.


VAERS ID: 1340773 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-03
Onset:2021-05-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

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

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:

Write-up: Pulmonary Embolism, Died on way to hospital, medical examiner report pending


VAERS ID: 1340821 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-06
Onset:2021-04-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   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: Please learn from her doctors.
Current Illness: She was vaccinated March 8 with the first Pfizer vaccine. She had reactions fairly quickly and ended up getting diagnosed with endocarditis. Nevertheless, they did a second shot April 6, both probably at an unspecified Medical Center.
Preexisting Conditions: You would have to ask her doctor. I am a high school friend of the patient. When I heard she had died at only 60 years old, I learned of her vaccination status and found out it was quite recent to her shocking and unexpected death. I am doing this report as I understand any citizen is permitted to if they suspect a vaccine may have caused an injury. There is an OBiT with other details. This can possibly be a duplicate as I don''t know if her doctors filed a report or not.
Allergies: Please learn from her doctors.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Please check with her doctors. I know she mentioned Myocarditis. She was vaccinated I am correct, on March 8 and April 6, 2021


VAERS ID: 1341218 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-19
Onset:2021-02-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 AR / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 AR / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, Epidural analgesia, Inflammation, Magnetic resonance imaging, Sciatica
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram, Simvastin, Eliquis, Lisinoprel, Vit d3,
Current Illness: None
Preexisting Conditions: Spinal stenosis.
Allergies: None
Diagnostic Lab Data: MRI, epidural, multiple interventions of PT, Chiropractor, medications, etc.
CDC Split Type:

Write-up: Within hours of receiving the second Moderna vaccine, the patient began experiencing excruciating pain in his lower back and sciatica. Consensus among the health professionals he saw is that the second vaccine triggered an inflammatory response. The pain did not respond to medication physical therapies.


VAERS ID: 1343001 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Death, General physical health deterioration, Pain, Skin discolouration
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 3
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: None
Diagnostic Lab Data: Multiple tests were done. To many to write down. I have a complete medical record of all treatments provided.
CDC Split Type:

Write-up: Went to er on March 3rd around 2am with discoloration on body with confusion and pain. Was told possible ttp. Condition quickly declined and was transferred to hospital main campus around 12pm. Condition continued to rapidly decline and passed away on March 4th at 11am. There is much more to tell about this. To much to write down. I have called several times no one has called me back.


VAERS ID: 1343241 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-29
Onset:2021-05-03
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone Ipratropium bromide and albuterol sulfate Fenobribrate Acetylcysteibe Rybelsus Humalog Levemir Metformin
Current Illness:
Preexisting Conditions: Chronic Obstructive pulmonary disease ( 2 years) Diabetes (3 years) Patient died of Cardiopulmonary arrest being that his heart was in excellent conditions according to recent testing
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Outcome : patient died Cause : cardio respiratory arrest Had previously tested for any heart problem but his heart was in excellent conditions


VAERS ID: 1343266 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-01
Onset:2021-04-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Cardiogenic shock, Chest discomfort, Death, Myocarditis, Pericardial drainage, Pericarditis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen prn for back pain, tums very rarely
Current Illness: none
Preexisting Conditions: none
Allergies: Cipro
Diagnostic Lab Data: Pericardiocentesis, many blood tests, medical records available upon request
CDC Split Type:

Write-up: On 4-18-21, 17 days after 1st dose of Moderna, he developed upper abdomen pain, chest discomfort. He thought it was indigestion and treated it as such. When he got no relief he went to Emergency room where a cardiac alert was initiated. After he died I was told he had developed myocarditis,/pericarditis and they had to remove a liter of blood from the sac around his heart, but that his heart had gone into cardiogenic shock and that he died. They were prepared to insert a stint thinking he had a blocked coronary artery, but his arteries were clear and they had no idea what had caused this to happen. When he died so soon after the vaccine there were people who wanted to blame the vaccine but I checked into it and there were NO links between the vaccine and myocarditis, pericarditis or cardiogenic shock. Within a few weeks of his death, there began to be possible links between the vaccine and myocarditis. I know 55 is older than what is being looked at, but he had absolutely no previous cardiac history prior to this and this case should e looked at as well


VAERS ID: 1343315 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-22
Onset:2021-05-20
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral infarction
SMQs:, Ischaemic 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: 2021-05-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: - Lansoprazole DR 30mg - Aspirin 81mg - Metoprolol succinate ER 50mg - Simvastatin 40mg
Current Illness:
Preexisting Conditions: - HTN - HFpEF - HLD - Atrial fibrillation - OSA
Allergies: Allergies: o azithromycin: Rash o Diflucan: Unknown o Zithromax: Unknown o nystatin: Unknown Intolerances: o codeine: Nausea/Vomiting
Diagnostic Lab Data:
CDC Split Type:

Write-up: left MCA infarct


VAERS ID: 1343387 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-11
Onset:2021-05-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of a myocardial infarction.


VAERS ID: 1343436 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-10
Onset:2021-02-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angina pectoris, Cardiogenic shock, Death, Hepatic failure, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Other ischaemic heart disease (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD and AFIB
Allergies: Penicillin and Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2-27-21 Heart pain, transported to ER 2x in 2 days. Within 2 days, her Liver and Kidney function failed. and Acute Hypoxic Respiratory Failure and Cardiogenic Shock were listed as cause of death on 3-3-21


VAERS ID: 1343471 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-24
Onset:2021-05-07
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 AR / IM

Administered by: Other       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: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, Head and Neck radiation for Merkell Cell Cancer, G-tube, Renal Cell CA with mets to spine
Allergies: NKA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 Days


VAERS ID: 1343488 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-24
Onset:2021-05-10
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, Non-Hodgkin''s Lymphoma; Pancreatitis; Prostate Cancer
Allergies: Sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 days


VAERS ID: 1343500 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-03
Onset:2021-04-15
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Asthma, Bronchitis, CHF, COPD, Home oxygen, Cardiac disease with stents, CABG, and MI. HTN
Allergies: Latex, Paxil, Plavix
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 Days


VAERS ID: 1343514 (history)  
Form: Version 2.0  
Age: 104.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-25
Onset:2021-04-25
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: CKD stage III; HLD; HTN; Hypothyroidism; Gout; GI Bleeds; Colon Cancer
Allergies: NKA
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 Days


VAERS ID: 1343527 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-19
Onset:2021-05-08
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 AR / IM

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

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Codeine, Levaquin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 days


VAERS ID: 1343543 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-23
Onset:2021-04-13
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Anemia, Asthma, diabetes, dyslipidemia, Heart Disease, HTN, Open Heart Surgery, Stroke, Thyroid dysfunction, Dementia, Afib, CKD stage 4, infrarenal AAA, chronic hyponatremia, TIA
Allergies: Beta-blockers; Cipro; Hydrochlorothiazide; Rubella Vaccine; Tetanus Toxoid
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death within 90 Days


VAERS ID: 1343571 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-07
Onset:2021-04-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, COVID-19 pneumonia, Chills, Cough, Death, Dyspnoea, Exposure to SARS-CoV-2, General physical health deterioration, Hypoxia, Malaise, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Type II, obesity, Hypertension, Lipidemia,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received their J&J vaccination on 4/7/2021. The patient''s wife tested positive on 4/12/2021. The patient tested positive on 4/23/2021. The patient presented to the ER with a severe progressive cough (starting one week prior), worsening shortness of breath, a high fever, chills, myalgias, and malaise. The patient was diagnosed with COVID pneumonia and ARDS with hypoxia and given Lovenox, remdesivir, and dexamethasone, tessalon, and Brovana. The patient was admitted on the 23rd and continued to decline until their eventual passing on 4/28/2021.


VAERS ID: 1343614 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-05-18
Onset:2021-05-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Confusional state, Death, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   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: xarelto, methadone, morphine, prochlorperazine, lorazepam, ondansetron, protonix
Current Illness: fibrolamellar hepatic carcinoma with metastatic disease
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED dept confused, incr n/v, weakness. Received palliative carex4 days. deceased 05/24


VAERS ID: 1343926 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-05-07
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED on 5/7/21 with CVA. He was hospitalized on 5/8/21 for 12 days, and died on 5/20/21.


VAERS ID: 1344052 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-05-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium increased, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Carbon dioxide increased, Condition aggravated, Glomerular filtration rate normal, Metabolic function test, Unresponsive to stimuli, Ventricular fibrillation, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute renal failure (broad), Hyperglycaemia/new onset diabetes mellitus (broad), 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), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   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: Outpatient Medications Marked as Taking for the 2/18/21 encounter (Continuing Care) Medication Sig Dispense Refill ? Bisacodyl (DULCOLAX) 10 mg Rect Supp Unwrap and insert 1 Suppository rectally as needed 12 Suppository 0 ? Melatonin (MELAT
Current Illness: No acute illnesses
Preexisting Conditions: Patient Active Problem List LONG TERM CUSTODIAL CARE FACILITY PATIENT [Z59.3] Entered facility SNF 2/6/16 Major drivers are morbid obesity and OHS, bipap dependent with PHTNMosty bedbound except gets out of bed with hoyer for bingo and showers; Sister is DPOAHC; No children Full Code, but no prolonged life support CHRONIC HYPERCAPNIC RESPIRATORY FAILURE [J96.12] Does retain CO2; O2 at 1 l with O2 sats at rest 89-90%; COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) [J44.9] ENTEROCOCCUS INFECTION [A49.8] 2 episodes a year apart with Enterococcal bacteremia presenting with fever, rapid improvement. No source on TTE, attempt at TEE unsuccessful; CT Abd and Pelvis not revealing; Treated with 6 weeks IV antibiotics second episode (2 wks the first episode) BPAP DEPENDENCE [Z99.89] SUPPLEMENTAL OXYGEN DEPENDENCE [Z99.81] Retains Co2; Limit O2 to least amount needed to maintian O2 greater than 88% POLST FORM ON FILE FOR LIFE SUSTAINING TX [Z78.9] Current POLST in HC not valid; (full code/Limited) Would want initial attempts to resuscitate, but no prolonged life support; No feeding tube unless clearly temporary; POLST updated at SNF -- still needs to be uploaded; CANDIDA INTERTRIGO [B37.2] Severe under breasts especially; PULMONARY HTN [I27.20] secondary INSOMNIA [G47.00] CORONAVIRUS COVID-19 PNEUMONIA [U07.1, J12.82] ACUTE ON CHRONIC RESPIRATORY FAILURE [J96.20] HX OF CORONAVIRUS COVID-19 DISEASE [Z86.16] Collected: 12/29/20 Reported: 12/31/20 KIDNEY LESION [N28.9] HX OF MRSA [Z86.14] MRSA nares 12/14/18. Contact precautions needed at WCR for 90 days. After 90 days please continue isolation if there is still active/suspected infection and/or if the patient is on dialysis. BILAT EXUDATIVE AGE RELATED MACULAR DEGENERATION [H35.3230] HX OF SEPSIS [Z86.19] SEPSIS WO ACUTE ORGAN DYSFUNCTION [A41.9] ? HX OF SEPSIS [Z86.19] MACROCYTOSIS [D75.89] SEVERE OBESITY (BMI $g= 40) [E66.01] PREVIOUSLY UNIDENTIFIED PATIENT -CLINICAL INFORMATION EXISTS IN ANOTHER MRN [ADMIN CODE] HYPERTROPHIC NONOBSTRUCTIVE CARDIOMYOPATHY [I42.2] Echocardiogram report from 4/28/2015 reviewed: Normal LV systolic function with a visually estimated ejection fraction of 60%.Mild concentric left ventricular hypertrophy.Septal motion paradoxical-RV pacemaker. Pacemaker/AICD/catheter was visualized in RA cavity and RV Severe mitral annular calcification.Mild aortic stenosis is present with a mean gradient of 10 mmHgSevere left atrial enlargement.The estimated pulmonary artery systolic pressure is elevated at 40-50 mmHg. I reviewed her echocardiogram and see no evidence of hypertrophic obstructive cardiomyopathy (though the lateral and posterior wall thickness is difficult to measure because of image quality there may be some left ventricular hypertrophy.) The LVOT gradient at rest is 4mmHg. The rhythm appears paced so I cannot assess diastolic function VITAMIN D DEFICIENCY [E55.9] ATHEROSCLEROSIS OF AORTA [I70.0] PRESENCE OF AICD [Z95.810] Implant 1/13/1998. Single Chamber ICD Patient is not pacemaker dependent Instruction for surgery: 1. Place magnet over device during surgery Warranty: 7 yrs Additional notes: Patient must remain on cardiac monitor the entire time magnet is in place over ICD, as magnet suspends tachyarrhythmia detection. When magnet removed, ICD will resume normal detection and therapy. Has potential for RF remote monitoring (daily when connected & in proximity) BILAT LEG LYMPHEDEMA [I89.0] Severe requiring metolozone and lasix to control HTN (HYPERTENSION) [I10] HYPERLIPIDEMIA [E78.5] LUMBAR SPONDYLOSIS [M47.816] hx of MRI. hx of injections: 2-3 per year, last 3/2014. OSTEOPENIA [M85.80] Hips. CAD (CORONARY ARTERY DISEASE) [I25.10] From records: ECG: 2/15/2012- SB 46 normal QTc ECG: 8/30/2010- SR 65, PR 180, QTc 443, normal STT Cath 1998 RCA 60% Echo 5/25/06- nl LV size, LVH 1.1,LAE 4.5, EF 65-70%, 1+MR, 2-3+TR, PAP 48, LVOTG 24/12m after valsalva maneuver, 11/6m at rest. HX OF SUSTAINED VENTRICULAR FIBRILLATION [Z86.79] =$gCardiac Arrest -- $g prompting AICD insertion in 2001. SUPRAVENTRICULAR TACHYCARDIA, PAROXYSMAL [I47.1]
Allergies: No known allergies
Diagnostic Lab Data: See above; Last labs: 03/29/2021 BMP ( COMPARISON: 03/19/2021 ) GLUCOSE = 116*H ( 91 ) SODIUM = 148 *H ( 144 ) POTASSIUM = 4.0 CHLORIDE = 101 ( 92 ) CO2 = 37 *H ($g 45) BUN = 26 *H ( 19 ) CREATININE = 0.8 (0.6) BUN/CREATININE RATIO = 33 ( 32 ) eGFR = $g 60 ( $g 60 ) CALCIUM = 10.2 (9.3 )
CDC Split Type:

Write-up: Complicated young elder with AICD for recurrent Vtach who was found unresponsive around 20 hours after vaccine; Based on the defibrillator interrogation she had sustained ventricular tachycardia that was properly identified and treated by the device but which did not respond to device discharge, degenerated into ventricular fibrillation and unfortunately could not be terminated by her ICD. Not clear related to vaccine


VAERS ID: 1344055 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-29
Onset:2021-02-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Death, Intracardiac thrombus, Malaise, Myocardial infarction, Pneumonia, Thrombolysis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: scans of the heart
CDC Split Type:

Write-up: one week after 1st vaccine shot, mom started to feel sick around lunch. Took mom to hospital she had a heart attack. They dissolved the blood clot and found out she also had pneumonia with no symptoms. She died 2 weeks later. She had dementia but health was fine until she received the covid 19 vaccine.


VAERS ID: 1344282 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-21
Onset:2021-05-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Apixaban, Atorvastatin, Calcium gluconate, Meropenem, Vancomycin, Epogen, Benadryl
Current Illness: Pulmonary HTN, CKD (HD 3x a week), cirrhosis (paracentesis 2 days prior to hospital admission), patient developed fever of 103 & chest tightness while at dialysis,, CHF, pneumonia
Preexisting Conditions: aortic valve replacement 2018, aortic tricuspid regurgitation, pancreatitis, home oxygen use 4L/hr, crack use 2018, CHF, BMI 31.3kg
Allergies: Spironolactone, Zofran, Solumedrol
Diagnostic Lab Data: Patient had anemia of chronic disease/CDK, high serum creatinine (HD)
CDC Split Type:

Write-up: received the vaccine as an inpatient in our hospital on 5/21/21. Patient went into cardiac arrest on 5/22/21 at approximately 9:00am


VAERS ID: 1385652 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-29
Onset:2021-04-21
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic 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: 2021-05-19
   Days after onset: 28
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: simvastatin, aspirin, cholecalciferol,, metoprolol, lasix
Current Illness: NKA
Preexisting Conditions: CHF, HTN, CAD, (S/P CABG), hyperlipidemia, 555 (S/P Pacemaker)
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: -Resident was admitted to facility on 4/14/2021 from hospital. Resident had been vaccinated prior to admission to facility on 3/10/21 and 3/29/21 which was given at another clinic/facility. Resident had history of (+) COVID-19 test results on 1/2021 and 4/9/2021 (Test done at facility). Facility is still doing a weekly routine COVID-19 Testing/Surveillance and on 4/21/20, resident was incidentally found to be still (+) COVID-19 (PCR Test). During that positive result (test date:4/21/21) the resident was asymptomatic at that time, and, Quarantine period completed 5/6/21. Resident expired on 5/19/2021


VAERS ID: 1345714 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210538222

Write-up: HEART ATTACK; This spontaneous report received from a consumer via a company representative, concerned a female patient of unspecified age, race and ethnic origin. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration was not reported, batch number: unknown and expiry: unknown) dose and therapy start date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, in 2021 (11 hours post vaccination), the patient died due to heart attack. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of heart attack was fatal. This report was serious (Death).; Sender''s Comments: V0 20210538222-covid-19 vaccine ad26.cov2.s-Myocardial infarction. 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: HEART ATTACK


VAERS ID: 1345716 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210538476

Write-up: DEATH; This spontaneous report received from a consumer via social media concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, frequency one total ,start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the reporter reported that one patient died post vaccination from unknown cause of death. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died due to unknown cause on an unspecified date. This report was serious (Death). This case, from the same reporter is linked to 20210536753.; Sender''s Comments: V0: 20210538476-COVID-19 VACCINE AD26.COV2.S-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1345770 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210541733

Write-up: DEATH; This spontaneous report received from a consumer by a other manufacturer company (Pfizer Inc.) via social media post, was received on 14-MAY-2021 and concerned multiple patients (more than 3000). The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown) dose, start therapy date were not reported, frequency 1 total dose administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Non-company suspect vaccine included: MRNA 1273 (form of admin, route of admin, and batch number were not reported), dose, start therapy date were not reported for an unspecified indication; and BNT 162 (form of admin, route of admin, and batch number were not reported), dose, start therapy date were not reported for an unspecified indication. No concomitant medications were reported. It was reported that on an unspecified date, more than 3000 patients died from vaccine. The cause of death was unknown. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210541733-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1345808 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001121A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Anaemia, Asthenia, Azotaemia, Blood culture, Blood gases, Blood pressure measurement, Blood test, Body temperature, Brain natriuretic peptide, Chest X-ray, Chest pain, Computerised tomogram, Dyspnoea, Echocardiogram, Heart rate, Hyperkalaemia, Hyperphosphataemia, Hyperuricaemia, Hyponatraemia, Lethargy, Malnutrition, Metabolic acidosis, Metabolic encephalopathy, Multiple organ dysfunction syndrome, Nausea, Oxygen saturation, Prothrombin time, Respiratory rate, SARS-CoV-2 test, Troponin, Urine analysis, Waist circumference increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sepsis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
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: Acute renal failure (Due to Foley catheter placement); Breast cancer stage IV; COPD; GERD; Hypertension; Metastatic bone disease prophylaxis (Lumbar spine pelvis and proximal femurs); Peritoneal carcinomatosis; Tobacco user; Transaminases increased
Preexisting Conditions: Medical History/Concurrent Conditions: Pneumonitis
Allergies:
Diagnostic Lab Data: Test Date: 20210312; Test Name: Blood culture; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 20210312; Test Name: VBG; Result Unstructured Data: Compensated mixed respiratory and Metabolic alkalosis; Test Date: 20210312; Test Name: Blood pressure measurement; Test Result: Inconclusive ; Result Unstructured Data: 96/52 mmHg; Test Date: 20210312; Test Name: Blood pressure measurement; Test Result: Inconclusive ; Result Unstructured Data: 100/50 mmHg; Test Date: 20210312; Test Name: Blood pressure measurement; Test Result: Inconclusive ; Result Unstructured Data: 88/58 mmHg; Test Date: 20210312; Test Name: Blood work; Result Unstructured Data: WBC-2.9 Normal, Hg-Normal, Platelet count-Normal; Test Date: 20210312; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: 36.1degrees Celsius; Test Date: 20210312; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: 35.9 degrees Celsius; Test Date: 20210312; Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: 36.2degrees Celsius; Test Date: 20210312; Test Name: BNP; Result Unstructured Data: normal; Test Date: 20210312; Test Name: Chest X-ray; Result Unstructured Data: No acute thoracic pathology; Test Date: 20210312; Test Name: CT of chest/abdomen/pelvis; Result Unstructured Data: revealed a right sided pleural effusion bony metastatic disease and hepatic metastatic disease, as well as small amount of ascites in the upper abdomen; Test Date: 20210312; Test Name: Echocardiogram; Test Result: Inconclusive ; Result Unstructured Data: Ejection fraction 60-65% and otherwise no significant findings; Test Date: 20210312; Test Name: Heart Rate; Test Result: Inconclusive ; Result Unstructured Data: 92; Test Date: 20210312; Test Name: Heart Rate; Test Result: Inconclusive ; Result Unstructured Data: 86; Test Date: 20210312; Test Name: Heart Rate; Test Result: Inconclusive ; Result Unstructured Data: 90; Test Date: 20210312; Test Name: SpO2; Test Result: Inconclusive ; Result Unstructured Data: 96 percent; Test Date: 20210312; Test Name: SpO2; Test Result: Inconclusive ; Result Unstructured Data: 93 percent; Test Date: 20210312; Test Name: SpO2; Test Result: Inconclusive ; Result Unstructured Data: 98 percent; Test Date: 20210312; Test Name: Prothrombin time; Result Unstructured Data: normal; Test Date: 20210312; Test Name: Respiratory rate; Test Result: Inconclusive ; Result Unstructured Data: breaths per minute; Test Date: 20210312; Test Name: Respiratory rate; Test Result: Inconclusive ; Result Unstructured Data: breaths per minute; Test Date: 20210312; Test Name: Respiratory rate; Test Result: Inconclusive ; Result Unstructured Data: breaths per minute; Test Date: 20210312; Test Name: Covid-19 test; Test Result: Negative ; Result Unstructured Data: Negative; Test Date: 20210312; Test Name: Troponin; Result Unstructured Data: normal; Test Date: 20210312; Test Name: Urinalysis; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Shortness of breath increasing; lethargy; Hyperkalemia; Acute kidney injury; metabolic encephalopathy; Uremia; metabolic acidosis; protein calorie malnutrition; Hyperuricemia; Hyperphosphatemia; Hyponatremia; Anemia; Substernal chest pain aggravated; increasing abdominal girth; Abdominal Pain; Weakness; Nausea; multiorgan failure; This spontaneous case was reported by a physician assistant (subsequently medically confirmed) and describes the occurrence of MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiorgan failure), DYSPNOEA (Shortness of breath increasing), LETHARGY (lethargy), HYPERKALAEMIA (Hyperkalemia), ACUTE KIDNEY INJURY (Acute kidney injury), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy) and AZOTAEMIA (Uremia) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 001121A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Breast cancer stage IV since March 2019, COPD since an unknown date, GERD since an unknown date, Hypertension since an unknown date, Tobacco user since an unknown date, Transaminases increased since an unknown date, Peritoneal carcinomatosis since an unknown date and Metastatic bone disease prophylaxis (Lumbar spine pelvis and proximal femurs) since an unknown date. Concurrent medical conditions included Acute renal failure (Due to Foley catheter placement) and Pneumonitis. On 28-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiorgan failure) (seriousness criteria death and medically significant), DYSPNOEA (Shortness of breath increasing) (seriousness criterion hospitalization), LETHARGY (lethargy) (seriousness criterion hospitalization), HYPERKALAEMIA (Hyperkalemia) (seriousness criterion medically significant), ACUTE KIDNEY INJURY (Acute kidney injury) (seriousness criterion medically significant), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy) (seriousness criterion medically significant), AZOTAEMIA (Uremia) (seriousness criterion medically significant), METABOLIC ACIDOSIS (metabolic acidosis), MALNUTRITION (protein calorie malnutrition), HYPERURICAEMIA (Hyperuricemia), HYPERPHOSPHATAEMIA (Hyperphosphatemia), HYPONATRAEMIA (Hyponatremia), ANAEMIA (Anemia), CHEST PAIN (Substernal chest pain aggravated), WAIST CIRCUMFERENCE INCREASED (increasing abdominal girth), ABDOMINAL PAIN (Abdominal Pain), ASTHENIA (Weakness) and NAUSEA (Nausea). The patient was hospitalized on 09-Mar-2021 due to DYSPNOEA and LETHARGY. The patient died on 13-Mar-2021. The reported cause of death was Multiorgan failure. It is unknown if an autopsy was performed. At the time of death, DYSPNOEA (Shortness of breath increasing), LETHARGY (lethargy), HYPERKALAEMIA (Hyperkalemia), ACUTE KIDNEY INJURY (Acute kidney injury), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy), AZOTAEMIA (Uremia), METABOLIC ACIDOSIS (metabolic acidosis), MALNUTRITION (protein calorie malnutrition), HYPERURICAEMIA (Hyperuricemia), HYPERPHOSPHATAEMIA (Hyperphosphatemia), HYPONATRAEMIA (Hyponatremia), ANAEMIA (Anemia), CHEST PAIN (Substernal chest pain aggravated), WAIST CIRCUMFERENCE INCREASED (increasing abdominal girth), ABDOMINAL PAIN (Abdominal Pain), ASTHENIA (Weakness) and NAUSEA (Nausea) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 12-Mar-2021, Blood culture: negative (Negative) Negative. On 12-Mar-2021, Blood gases: abnormal (abnormal) Compensated mixed respiratory and Metabolic alkalosis. On 12-Mar-2021, Blood pressure measurement: 96/52 (Inconclusive) 96/52 mmHg, 100/50 (Inconclusive) 100/50 mmHg and 88/58 (Inconclusive) 88/58 mmHg. On 12-Mar-2021, Blood test: normal (normal) WBC-2.9 Normal, Hg-Normal, Platelet count-Normal. On 12-Mar-2021, Body temperature: 36.1 (Inconclusive) 36.1degrees Celsius, 35.9 (Inconclusive) 35.9 degrees Celsius and 36.2 (Inconclusive) 36.2degrees Celsius. On 12-Mar-2021, Brain natriuretic peptide: normal (normal) normal. On 12-Mar-2021, Chest X-ray: normal (normal) No acute thoracic pathology. On 12-Mar-2021, Computerised tomogram: abnormal (abnormal) revealed a right sided pleural effusion bony metastatic disease and hepatic metastatic disease, as well as small amount of ascites in the upper abdomen. On 12-Mar-2021, Echocardiogram: inconclusive (Inconclusive) Ejection fraction 60-65% and otherwise no significant findings. On 12-Mar-2021, Heart rate: 92 heart beats per minute (Inconclusive) 92, 86 heart beats per minute (Inconclusive) 86 and 90 heart beats per minute (Inconclusive) 90. On 12-Mar-2021, Oxygen saturation: 96 (Inconclusive) 96 percent, 93 (Inconclusive) 93 percent and 98 (Inconclusive) 98 percent. On 12-Mar-2021, Prothrombin time: normal (normal) normal. On 12-Mar-2021, Respiratory rate: 16 (Inconclusive) breaths per minute, 18 (Inconclusive) breaths per minute and 19 (Inconclusive) breaths per minute. On 12-Mar-2021, SARS-CoV-2 test: negative (Negative) Negative. On 12-Mar-2021, Troponin: normal (normal) normal. On 12-Mar-2021, Urine analysis: normal (normal) normal. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered MULTIPLE ORGAN DYSFUNCTION SYNDROME (multiorgan failure), DYSPNOEA (Shortness of breath increasing), LETHARGY (lethargy), HYPERKALAEMIA (Hyperkalemia), METABOLIC ENCEPHALOPATHY (metabolic encephalopathy), AZOTAEMIA (Uremia), METABOLIC ACIDOSIS (metabolic acidosis), MALNUTRITION (protein calorie malnutrition), HYPERURICAEMIA (Hyperuricemia), HYPERPHOSPHATAEMIA (Hyperphosphatemia), HYPONATRAEMIA (Hyponatremia), ANAEMIA (Anemia), CHEST PAIN (Substernal chest pain aggravated), WAIST CIRCUMFERENCE INCREASED (increasing abdominal girth), ABDOMINAL PAIN (Abdominal Pain), ASTHENIA (Weakness) and NAUSEA (Nausea) to be possibly related. No further causality assessment was provided for ACUTE KIDNEY INJURY (Acute kidney injury). Concomitant medications were not provided. Treatment for the events included proton pump inhibitors, oxygen, Tylenol, and comfort care. Company comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: multiorgan failure


VAERS ID: 1345844 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Colorado  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Patient died 2 hours after getting the vaccine; This spontaneous case was reported by a non-health professional and describes the occurrence of DEATH (Patient died 2 hours after getting the vaccine) 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant products were reported. The reporter was worried about the administration of the vaccine and wanted to know if there was a way for someone to help their community. Reporter had contacted everyone in Public health department of the rural hometown. With the amount of adverse reactions with vaccine reporter was concerned that the vaccine was not being stored properly or not been given properly and further reported that one person died and they were not reporting it because they did not trust the government. A patient died two hours after getting the Moderna vaccine. No treatment information provided. This is a case of sudden death in a female patient who died 2 hours after receiving a dose of vaccine. Very limited information regarding this event has been provided at this time.; Sender''s Comments: This is a case of sudden death in a female patient who died 2 hours after receiving a dose of vaccine. Very limited information regarding this event has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1345947 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-25
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210545044

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer by a other manufacturer company (Pfizer Inc.) received on14-MAY-2021 and concerned multiple (few) patients. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) frequency 1 total, dose, start therapy date were not reported for prophylactic vaccination. No concomitant medications were reported. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. Reporter stated that Johnson and Johnson vaccine caused blood clots and few people died. It was not reported whether autopsy was performed. On an unspecified date, the patients experienced blood clots. On an unspecified date, the patients died from blood clots. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0; 20210545044-covid-19 vaccine ad26.cov2. s Blood clots. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: BLOOD CLOTS


VAERS ID: 1346604 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-05-12
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Bilateral pneumonia


VAERS ID: 1346657 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, Blood immunoglobulin E increased, Death, Histology, SARS-CoV-2 test negative, Seizure, Toxicologic test, Tryptase
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: Clonidine, Vyvanse, Vraylor
Current Illness: none
Preexisting Conditions: Autism and ADHD
Allergies:
Diagnostic Lab Data: Autopsy with histology, toxicology, postmortem Covid-19 PCR test negative, post mortem Tryptase normal and elevated elevated IgE, cause and manner of death undetermined, Covid-19 not suspected cause, suspected cause heart arrhythmia (family history, history of chest pain, and medications) or seizure.
CDC Split Type:

Write-up: Found deceased in bed, no known symptoms, undetermined cause and manner of death


VAERS ID: 1346714 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-26
Onset:2021-05-07
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Pneumonia, unspecified organism shortness of breath chest pain


VAERS ID: 1346723 (history)  
Form: Version 2.0  
Age: 102.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-25
Onset:2021-05-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone, potassium chloride, furosemide, metoprolol succinate, dabigatran
Current Illness: None. Other than being 100 years old, patient was in relatively good health. Did have a diagnosis of atrial fibrillation and essential hypertension.
Preexisting Conditions: Atrial fibrillation and essential hypertention.
Allergies: nuts
Diagnostic Lab Data: See above.
CDC Split Type:

Write-up: Patient contracted covid 2 months after receiving the full vaccine series. He was admitted the hospital and subsequently passed away. Variant testing was conducted (results are pending) and antibody testing was done. Antibody testing showed no antibodies were produced in response to the vaccine.


VAERS ID: 1346731 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-06
Onset:2021-05-15
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Ascites, Death, Dyspnoea, Peripheral swelling, Systemic inflammatory response syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death R65.10 - SIRS (systemic inflammatory response syndrome) (CMS/HCC) N17.9 - Acute kidney failure, unspecified SHORTNESS OF BREATH LEG SWELLING ASCITES


VAERS ID: 1346738 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-05-16
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death, Hyponatraemia, Hypoosmolar state
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death E87.1 - Hypo-osmolality and hyponatremia N17.9 - Acute kidney failure, unspecified


VAERS ID: 1346804 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-05-12
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - Acute kidney injury WEAKNESS - GENERALIZED


VAERS ID: 1347081 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-27
Onset:2021-04-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Fatigue, Malaise, Pain in jaw
SMQs:, Osteonecrosis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nicorette Gum
Current Illness:
Preexisting Conditions: Charcot Marie Tooth Disease (form of Muscular Dystrophy) Respiratory Distress hospitalized 3x in 5 years
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complained of exhaustion and malaise within 24 hours of receiving the dose. This never resolved. Three weeks later he complained of the same exhaustion and malaise. Jaw pain was reported on 5/23/2021. Patient found deceased 5/24/2021 at age of 53.


VAERS ID: 1347105 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-20
Onset:2021-05-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal, zestoretic
Current Illness: Had seizure 3.5 years prior, had "night time seizure in mid march.
Preexisting Conditions: elevated BP, seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead on May 3, 2021. Question day of death 05/01/2021. Medical examiners case. Cause pending, possible SUDEP.


VAERS ID: 1347148 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-30
Onset:2021-03-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Asthenia, Cardiac failure, Chest pain, Death, Dyspnoea, Heart rate irregular, Peripheral swelling
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart pain/ chest pain. Hard to breathe Lack of energy Swollen legs Erratic heart rate Outcome: death 3 days after. Heart failure


VAERS ID: 1347160 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-02
Onset:2021-05-19
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Angiogram cerebral abnormal, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure acute, Cardiac failure congestive, Cerebral haemorrhage, Cerebral mass effect, Cerebral thrombosis, Cerebrovascular accident, Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Depressed level of consciousness, Fall, Hemiplegia, Left ventricular failure, SARS-CoV-2 test positive, Troponin increased
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedidol 3.125 bid; lisinopril 5 mg; furosemide 20 mg daily; spironolactone 12.5 mg daily
Current Illness: DM - diet controlled; systolic heart failure; Rheumatoid arthritis; meth and alcohol abuse
Preexisting Conditions: DM - diet controlled; systolic heart failure; Rheumatoid arthritis; meth and alcohol abuse
Allergies: cephalexin
Diagnostic Lab Data: CT Imaging shows a very large right MCA stroke with small areas of hemorrhage. He does have 6 mm of shift and small petechiae. CT angiogram shows clot at the bifurcation with complete opacification. He is Covid positive, and chest x-ray shows significant Covid pneumonia. He has a history of CHF, and his BNP is 25,000, up from his baseline of 7000. His troponin is also positive at 0.18. I assume that this is from a type II NSTEMI.
CDC Split Type:

Write-up: fall on May 19 and admitted to ER May 22 with subacute R MCA stroke resulting in obtundation and left sided hemiparalysis. Complicating his presentation is acute COVID 19 infection with pneumonia along with acute on chronic systolic congestive heart failure.


VAERS ID: 1347172 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-03-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: alcohol
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexpected Death


VAERS ID: 1347211 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-26
Onset:2021-04-18
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xalatan, Neurontin, Vitamin D, Acetaminophen, Mirapex, Levodopa, carbidopa, Lexapro, Cetaphil cream, Dialogistic.
Current Illness: Unknown.
Preexisting Conditions: Skin cancer, hypotension, convulsions, Alzheimer, respiratory problems, glaucoma, vitamin D deficiency, Parkinson, heart attack, mayor depression.
Allergies: Unknown.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dies at the Hospital do to a respiratory arrest.


VAERS ID: 1347521 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER1742 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Interstitial lung disease, Pneumonia
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 69
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort Atorvastatin Eltroxin Insulin :Levemer, Januvia, Vit D & Vit C
Current Illness:
Preexisting Conditions: COPD Diabetes Atopic Dermatitis
Allergies: Metformin Adhesive
Diagnostic Lab Data: No one connected the vaccine with new diagnosis only concern in hospital was if he had received the vaccine
CDC Split Type:

Write-up: Starting having trouble breathing 1 week later 2 weeks later diagnosed with pneumonia 10 days later admitted to hospital with interstitial lung disease (never before diagnosed with that) Needed 24/7 oxygen Passed away May 10/21


VAERS ID: 1347530 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-05-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       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: 2021-05-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg 1 tab daily Bacitracin Oint 2 x''s daily / topical Calcitriol .25mcg 2 x''s daily Cetirizine 10mg 1 tab daily Zyrtec Escitalopram 20 mg 1 tab daily Lexapro Flonase 50mcg 1 spray 2x''s daily HCTZ 25mg 1 tab daily Lisinopril 40
Current Illness: Last Medical Appointment with Primary, Dr. - (4/21/21) physical Covid Vaccination - May 18, 2021
Preexisting Conditions: Pt. is diagnosed with retinitis pigmentosis and drying of the cornea. Pt. is also diagnosed as being legally blind. Pt. uses a guide stick to assist him with walking throughout his home and community. Pt. is being treated for high blood pressure and cholesterol. No Known allergies
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 days after COVID-19 vaccine, patient had a sudden unexpected cardiac arrest and died at his home after long resuscitation attempts by EMS.


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