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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 48 out of 150

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VAERS ID: 1385476 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-05-24
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident passed away at 12:40pm on 05/24/2021 at Care and Rehab .


VAERS ID: 1385943 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-27
Onset:2021-04-28
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest tube insertion, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypotension, Hypoxia, Leukocytosis, Lung infiltration, Mechanical ventilation, Pneumothorax, Pulmonary haemorrhage, SARS-CoV-2 test positive, Septic shock, Superinfection bacterial
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: History of Prostate Cancer status post radiation
Preexisting Conditions: dyslipidemia, hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: 04/28/2021: Patient transferred from Hospital with shortness of breath, COVID-19 Positive 4/30-5/16: Patient condition deteriorated. Had repeated episodes of hypoxemia and hypotension - was intubated on mechanical ventilation, eventually switched to pressure control inspiratory pressure, extubated, had to be reintubated. Developed A-fib, leukocytosis worsened, Xray showed tension pneumothorax on right side - chest tube placed. 5/17: Family counseled - patient placed on comfort care, remained on ventilator. Time of Death: 05/17/2021, 16:00 Causes of Death: Bilateral Pulmonary infiltrate, Acute hypoxic type 1 respiratory failure, ARDS, Right Pneumothorax, Acute COVID-19 viral pneumonitis with probable bacterial superinfection, Atrial fibrillation with rapid ventricular response, Septic Shock, Bleeding rom lung/ETT - resolved, Possible Mucor in mouth, Candida tracheobronchitis, Previous history of prostate cancer status post radiation, dyslipidemia, hypertension present at admission.


VAERS ID: 1385984 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-25
Onset:2021-06-07
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Glaucoma; hypertensive and atherosclerotic cardiovascular disease
Allergies: Unknown
Diagnostic Lab Data: Autopsy done on 5/29/2021
CDC Split Type:

Write-up: Second dose of Moderna COVID-19 vaccine administered 5/25/2021 at ~1300 h. Was last seen alive later that day and seemed to be in her usual state of health. Was then found dead at home on 5/28/2021. Unknown when death actually occurred.


VAERS ID: 1386054 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-14
Onset:2021-06-06
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   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: VANAFLAXINE BUSPIRONE ABILIFY SPRINTEC
Current Illness: CHLAMYDIA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: AUTOPSY 6/8/21
CDC Split Type:

Write-up: DEATH FROM BLOOD CLOT


VAERS ID: 1386097 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-11
Onset:2021-05-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   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: vancomycin HCI 125mg capsules, Spironolactone tablet 50mg,SI Tagliptin Phosphate tablet 25mg, multi-vitamin, Midodrine HCI tablet 2.5, Melatonin tablet 5mg, Levothyroxine sodium tablet 25 MCG, Heparin Sodium solution 1000 unit/ml, Glimepiri
Current Illness: enterocolitis due to clostridium difficile, cerebral infarction, chronic congestive heart failure, DMII with diabetic neuropathy, chronic kidney disease, atherosclerosis of native arteries of right leg with ulceration of lower leg, HTN, Asthma, Hypothyroidism, other symptoms and signs involving cognitive functions following cerebral infarction, Anemia, Hyperlipidemia, cardiomegaly, Anxiety disorder, schizoaffective disorder, muscle weakness, lack of coordination, need for assistance with personal care, Nonrheumatic Aortic (valve) stenosis, Hypotension, Cardiac murmur, Orthopnea, long term current use of anticoagulants, long term use of insulin, personal history of Covid-19, Tubal ligation status.
Preexisting Conditions: diabetes type 2 with neuropathy chronic congestive heart failure
Allergies: no known allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient died of cardiac arrest that night in hospital


VAERS ID: 1386215 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-23
Onset:2021-05-02
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 60 days of vaccination


VAERS ID: 1386331 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-04-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RL / -

Administered by: Public       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Death, Extra dose administered, General physical health deterioration, Interchange of vaccine products, SARS-CoV-2 test positive, Vaccination error
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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:
Current Illness: Exposed to COVID during outbreak at her skilled nursing facility
Preexisting Conditions: past medical history of chronic anemia, chronic kidney disease, COPD, dementia, rheumatoid arthritis and anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: There are two adverse events. First is that the skilled nursing facility (SNF) clinical staff incorrectly listed the patient as unvaccinated when requesting SNF patients be vaccinated by the local health department. The patient was previously vaccinated with Moderna on 1/26 (Lot # 004M20A). This should be listed as a vaccine administration error. Second- Approximately, 1 week after being vaccinated with Janssen on 3/24/2021, the patient tested positive for COVID-19 (4/1/21). At the time, the patient was documented to have an asymptomatic infection, picked up on weekly surveillance testing due to a large outbreak at the nursing facility. I was informed on 6/9/21 that the patient had been referred to hospice on 5/4/21 and died on 5/6/21. The medical records are not yet available (pending from the SNF and hospice agency) but the referral was made due to her COVID illness leading to worsening of her general health status. During this period from 4/1 to 5/4, she remained at the SNF. Notably, she was not hospitalized and did not present to the emergency department for care.


VAERS ID: 1386585 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-08
Onset:2021-06-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood chloride normal, Blood creatine increased, Blood glucose increased, Blood potassium decreased, Carbon dioxide decreased, Cardiac arrest, Chest X-ray abnormal, Death, Eosinophil percentage decreased, Glycosylated haemoglobin increased, Haematocrit normal, Haemoglobin normal, High density lipoprotein decreased, Lung opacity, Lymphocyte percentage decreased, Monocyte percentage increased, Neutrophil percentage increased, Platelet count decreased, Troponin I increased, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   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: aspirin, atorvastatin, gabapentin, Lispro insulin, clopidogrel
Current Illness: Diabetes, Hypertension, PVD
Preexisting Conditions: SEE # 11
Allergies: Sulfa, citrus.
Diagnostic Lab Data: 06/08/21. WBC 12.4, Hgb 15, HCT 44, PLT 132, K+ 3.1,CL 101, GLUCOSE 405, CREATININE 1.35, CO2 18, TROPI 0.59, AST 114, ALT 81, ALP 152, ALB 2.4.
CDC Split Type:

Write-up: 06/08/2021-Received vaccine at Urgent Clinic. Pt found down at home. Brought to Hospital ED, with cardiac arrest (STEMI), where she later died.


VAERS ID: 1386631 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-12
Onset:2021-04-26
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiogenic shock, Death, Electrocardiogram ST segment elevation, Eye movement disorder, Headache, Malaise, Neck pain, Pain in jaw
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Osteonecrosis (broad), Ocular motility disorders (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol metformin Lipitor Metholtrexate Folic acid Calcium
Current Illness: Rheumatoid Arthritis coronary artery disease & DM type 2
Preexisting Conditions: Rheumatoid arthritis The DM & CAD
Allergies: NKA
Diagnostic Lab Data: 4/26 Acute cardiac ST elevation that led to cardiogenic shock resulting in death on 4/27 Lifelined to hospital on 4/26 from HCF
CDC Split Type:

Write-up: My father had an acute myocardial infarction. He was perfectly fine the Sunday before and earlier the day of. On Monday April 26th he had sudden onset of c/o a headache didnt feel well that then led to c/o jaw neck pain. He sat down eyes rolled back 911 EMS dispatched


VAERS ID: 1386841 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Condition aggravated, Death, Headache
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   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: Adderall
Current Illness: Headache, upset stomach
Preexisting Conditions: ADHD
Allergies: NKDA
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Prodrome of headache and gastric upset over 2 days following second dose. Then felt fine. Found the following day dead in bed. Autopsy pending


VAERS ID: 1387032 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-05
Onset:2021-03-16
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Death, Dizziness, Fatigue
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood pressure med.
Current Illness: Low Kidney funtion
Preexisting Conditions: blood pressure and kidney function issues
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Dizziness, loss of memory, fatigue, and death 10 days later


VAERS ID: 1387202 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-16
Onset:2021-05-31
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   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: T4 Thyroid, blood pressure medication
Current Illness: None, excellent health
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Inital Fever followed by severe fatigue for 2-3 weeks followed by death


VAERS ID: 1387512 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-06
Onset:2021-02-18
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Dizziness, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: USMODERNATX, INC.MOD20210

Write-up: Dizziness; Aches; Weak; Fever; Nausea; DIED; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (DIED) in a 62-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. No Medical History information was reported. On 06-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 DIZZINESS (Dizziness), PAIN (Aches), ASTHENIA (Weak), PYREXIA (Fever) and NAUSEA (Nausea). The patient died on 18-Feb-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DIZZINESS (Dizziness), PAIN (Aches), ASTHENIA (Weak), PYREXIA (Fever) and NAUSEA (Nausea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. It was reported that the vaccine was not the cause, he had other medical issues too. This is a case of sudden death in a 62-year-old male patient with unknown medical, who died 12 days after receiving first dose of vaccine. Very limited information has been provided at this time. Most recent FOLLOW-UP information incorporated above includes: On 03-Jun-2021: New event (death) and narrative was updated.; Sender''s Comments: This is a case of sudden death in a 62-year-old male patient with unknown medical, who died 12 days after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1387779 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-02-02
Onset:2021-02-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   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: Medical History/Concurrent Conditions: Bipolar disorder; COPD; Diabetes; Seizure
Allergies:
Diagnostic Lab Data: Test Date: 20210210; Test Name: defibrillator reading; Result Unstructured Data: Test Result:no adverse defibrillator reading recorded; Comments: no adverse defibrillator reading recorded
CDC Split Type: USPFIZER INC2021606315

Write-up: HEART... SUDDEN DEATH 20 DAYS AFTER; BREATHING ISSUES; This is a spontaneous report from a contactable consumer (patient). An 85-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection, Lot Number: EL1284, expiry date not provided) via an unspecified route of administration, administered in left arm on 02Feb2021 as first dose, single dose for covid-19 immunisation. Medical history included diabetes, bipolar, seizure disorder and COPD (chronic obstructive pulmonary disease), all from an unknown date and unknown if ongoing. The patient''s concomitant medications included unspecified medications reported as patient received within 2 weeks of vaccination. The patient previously took buproprion hydrochloride (WELLBUTRIN). Patient receive any other vaccines within 4 weeks prior to the COVID vaccine. The most recent COVID-19 vaccine was administered in a hospital. Prior to vaccination, the patient was diagnosed with COVID-19. On 10Feb2021 10:00, the patient experienced heart (also reported as sudden death 20 days after), and immediately had breathing issues, no arrhythmia, no adverse defibrillator reading recorded. Family saw decline immediately after injection, did not request autopsy and adverse medical decline reported to doctor following injection. The events resulted to doctor or other healthcare professional office/clinic visit. Treatment receive in response to the events and treated with cardiologist. The patient died on 10Feb2021. The causes of death were heart (heart disorder) and breathing issues. An autopsy was not performed. Since the vaccination, the patient has been tested for COVID-19.; Reported Cause(s) of Death: HEART... SUDDEN DEATH 20 DAYS AFTER; BREATHING ISSUES


VAERS ID: 1387787 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021613680

Write-up: gave my mom the COVID vaccine and now she is dead; This is a spontaneous report from a non-contactable pharmacist. This pharmacist reported on behalf of a pharmacy technician''s mother (the patient). An elderly female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, lot unknown, unknown if first or second dose) solution for injection intramuscular on an unknown date as a single dose for COVID-19 vaccination. Medical history was not reported. Concomitant medication included unspecified medication but has never taken morphine sulfate. The pharmacy technician stated, " I gave my mom the COVID vaccine and now she was dead." The outcome of the event was fatal. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: The information currently available is limited and does not allow a meaningful case evaluation. However, based on chronological connection to the vaccine a causal relationship between event of death (unknown cause) and BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE) cannot be completely excluded. The case will be reevaluated should additional information become available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: gave my mom the COVID vaccine and now she is dead


VAERS ID: 1387983 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-05-14
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood osmolarity decreased, Hyponatraemia
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), 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: 2021-06-04
   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: - Acute kidney failure, unspecified - Hypo-osmolality and hyponatremia


VAERS ID: 1387996 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-05-10
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 17
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: Non-ST elevation (NSTEMI) myocardial infarction RESPIRATORY DISTRESS


VAERS ID: 1388002 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-05-25
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   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: Nontraumatic intracerebral hemorrhage, unspecified


VAERS ID: 1388005 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-05-03
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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: 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: J18.9 - Pneumonia, unspecified organism


VAERS ID: 1388011 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-02-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Atypical pneumonia
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 90
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: J18.9 - Atypical pneumonia


VAERS ID: 1388042 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-23
Onset:2021-06-07
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain oedema, Cerebral infarction, Computerised tomogram head abnormal, Decompressive craniectomy, Haemorrhage intracranial, Intracranial pressure increased, Intraventricular haemorrhage, Ventricular drainage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Headache started around 3 weeks prior to event that delayed dose of second vaccine. Headache was very severe and she saw PCP for it twice and it lasted a week. It then resolved and she got her second vaccine.
Preexisting Conditions: None except obesity with BMI 39
Allergies: None
Diagnostic Lab Data: CT scans 6/7 and 6/8
CDC Split Type:

Write-up: Patient had massive acute intracranial hemorrhage. Was found down in bathroom. In ED CT scan showed large intraventricular hemorrhage, EVD placed, patient progressed to massive brain swelling and infarctions, decompressive craniectomy, unable to control intracranial pressure, parents agreed to DNR status and patient is not expected to survive.


VAERS ID: 1388057 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-05-26
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, Gastrointestinal haemorrhage, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted 5/26 from outside facility for GI bleed, cardiac arrest and severe sepsis. COVID+. Treated with tocilizumab, vit C, vit D, alinia, zinc. Family opted for comfort care and W/D life support. Expired 6/5.


VAERS ID: 1388093 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-04-08
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Bilevel positive airway pressure, COVID-19, COVID-19 pneumonia, Cardiac arrest, Cerebral infarction, Cerebral mass effect, Cerebrovascular accident, Computerised tomogram head abnormal, Computerised tomogram head normal, Convalescent plasma transfusion, Death, Endotracheal intubation, Gastrostomy, Hemiparesis, Hypoxia, Intensive care, Oedema, Pneumonia aspiration, Resuscitation, Subcutaneous emphysema, Tracheostomy, Tracheostomy malfunction
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented on 4/8 to Hospital for COVID pneumonia, transferred to another hospital on 4/21/2021. At Hospital, she was treated with convalescent plasma, course of remdesivir, and dexamethasone. She was requiring HFNC during day and BiPap overnight. She began to improve with decreasing O2 requirements on 4/15. On 4/17, she was found to have L-sided deficits and increasing hypoxia, which required emergent intubation. Dexamethasone was increased to 6 mg BID and she was started on Levaquin and Flagyl for aspiration penumonia, consolidated to ertapenem on 4/20. She had been on Eliquis prior to this, but this was discontinued after she developed the stroke sx on 4/17, switched to Lovenox. Initial head CT negative, but repeat head CT on 4/19 showed large R sided MCA territory infarct. She was placed on ASA. 4/21 head CT showed edema and mild midline shift. Neurology was consulted, who recommended hyperventilation, 3% saline, and elevating HOB $g 30 degrees. She was then transferred to St. Mary''s ICU on 4/21. At Hospital, patient was treated for aspiration pneumonia (cefepime 2g Q8H on 4/22-4/25, meropenem 2g once on 4/22, tobramycin 400mg daily on 4/22-4/23) and COVID. However, she had significant difficulty weaning from mechanical ventilation. Given her prolonged course and her right MCA CVA with significant deficits it was predicted that she would need long term ventilatory support therefore PEG and tracheostomy were placed on 4/29. She remained relatively stable until 5/2 AM when she suddenly developed massive subcutaneous emphysema and hypoxia. It was suspected that her tracheostomy had become dislodged. Patient was re-intubated orally with difficulty however there was no color change with EtCO2 and patient was in cardiac arrest. CPR was briefly performed however code status was clarified and patient was DNR. Trauma surgeon and intensivist were in agreement that any other interventions would be futile. Time of death was 0645 on 5/2/21.


VAERS ID: 1388182 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-12
Onset:2021-03-26
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray abnormal, Death, Heart rate increased, Infection, Mechanical ventilation, Oxygen saturation decreased, Pneumonia, Pneumonia necrotising, Pneumonia pseudomonal, Respiratory failure, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Aleve
Current Illness:
Preexisting Conditions: COPD
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two weeks after receiving the final injection, my father was admitted to the hospital with pneumonia. He had poor oxygen saturation which prompted a visit to the ER. Upon x-ray he was found to have a large pneumonia in his left lung. After 10 days at the local hospital, and being placed on a ventilator, he became septic and was air lifted to one of our area''s larger hospitals. There, he was diagnosed with necrotizing pneumonia caused by pseudomonas aeruginosa. He also had heart rate accelerations that would climb into the 150s and they could never figure out why. He was treated aggressively with antibiotics and was successfully weaned off the vent. However, his body was unable to fight off the infection and he ended up passing away from necrotizing pneumonia that caused his respiratory system to fail. My father had underlying COPD that was well-managed at home and he did not require oxygen. I was questioned several times as to whether he''d gotten into or been around anyone or anything different from his usual, but he had not. The only thing out of the ordinary he had was the Moderna injections.


VAERS ID: 1388287 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Condition aggravated, Confusional state, Electrocardiogram, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine furosemide
Current Illness: intractable vomiting pericardial effusion COPD Hypothyroid Dementia
Preexisting Conditions: pericardial effusion COPD Hypothyroid dementia
Allergies: sulfa drugs
Diagnostic Lab Data: EKG Chest XRay
CDC Split Type:

Write-up: vomiting, confusion


VAERS ID: 1388373 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UK / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 13
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication Others Unknown
Current Illness:
Preexisting Conditions: History of Stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was unable to get out of bed within 12 hours, and needed assistance to use the restroom until her death


VAERS ID: 1388528 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-26
Onset:2021-06-08
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram, Angiogram pulmonary abnormal, Anticoagulant therapy, Atelectasis, Atrial enlargement, Cardiac arrest, Computerised tomogram head normal, Death, Gallbladder disorder, Hypoxia, Lung consolidation, Multiple organ dysfunction syndrome, Neurological decompensation, Pulmonary embolism, Pulmonary infarction, Renal cyst, Resuscitation, Scan with contrast abnormal, Shock, Thrombectomy, Ultrasound Doppler, Ultrasound scan normal, Ventricular enlargement
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Gallbladder related disorders (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atenolol 25 mg twice daily fluticasone propionate 50 mcg/act nasal spray 2 sprays in each nostril daily hydrochlorothiazide 50 mg daily losartan 100 mg daily paroxetine 40 mg daily trazodone 200 mg daily
Current Illness: unknown and unable to assess
Preexisting Conditions: hypertension, hyperlipidemia
Allergies: cephalexin (reaction unknown)
Diagnostic Lab Data: 6/8 at 0449 - US venous duplex lower bilateral extremities: no evidence of acute deep vein thrombosis 6/8 at 0519 - CTA chest, abdomen, pelvis with contrast: IMPRESSION: 1. Large left central pulmonary embolism with moderate right lower pulmonary embolism. The right lower lobe pulmonary embolism extends into an area of posterior mid and upper infiltrate or consolidation for pulmonary infarcts. Small bilateral pleural effusions. Dependent atelectasis in the bilateral lung bases. Enlargement of both the right atrium and right ventricle concerning for right ventricular heart strain. There is reflux of contrast material into the inferior vena cava and hepatic veins. 2. Distention of the gallbladder with marked gallbladder wall thickening or pericholecystic fluid. Mild free fluid adjacent to the liver 3. Mild free fluid in the pelvis. 4. Left renal cyst. 6/8 at 0545 - CT head w/o contrast: Impression: Noncontrast CT head is within normal limits.
CDC Split Type:

Write-up: Only reporting to VAERS as patient received covid-19 vaccination under EUA and was hospitalized and is now deceased from illness deemed UNRELATED to prior covid-19 vaccination. She was a 69 yr old female who was transferred to hospital on 6/8 at 0141 from outside hospital with severe shock, acute hypoxemic respiratory failure, who had a cardiac arrest on arrival here for 5 mins, during arrest CPR was done and 2 doses of epinephrine were administered prior to ROSC and targeted temperature management was initiated. She was found to have a massive PE, alteplase was given and a heparin continuous infusion was started on 6/8 at 0154 and 0345, respectively. She later underwent a thrombectomy on 6/8 at 1640. She showed signs of poor neurological status. Went into MSOF despite aggressive supportive care. Family requested to make her comfortable and the patient expired on 6/10 at 0449.


VAERS ID: 1388553 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-19
Onset:2021-05-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir, Citalopram, Dexamethasone, Eliquis, Lipitor, Metoprolol, Pantoprazole, Calcium, Chondroitin-Glucosamine, Vitamin B Complex
Current Illness: Multiple Myeloma
Preexisting Conditions: Atrial fibrillation, Carotid artery stenosis, Chronic diastolic heart failure, Mixed Hyperlipidemia, Hypertension, Migraine, Osteoarthritis, Osteonecrosis of jaw, Sleep apnea, TIA
Allergies: Venlafaxine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1388572 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-07
Onset:2021-06-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   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: vitamin C, zinc, santyl, pantoprazole, chlorhexidine, apixaban, levetiracetam, humalog, metroprolol, docusate, duoneb, dakins, tramadol, hydroxyzine
Current Illness: dysphagia, hypertension, CHF, COPD, Acute respiratory failure with hypoxia, sepsis, cerebral infarction, COPD, PUD, seizures
Preexisting Conditions: dysphagia, hypertension, CHF, COPD, Acute respiratory failure with hypoxia, sepsis, cerebral infarction, COPD, PUD, seizures
Allergies: codeine, ertapenem
Diagnostic Lab Data:
CDC Split Type:

Write-up: At around 5:30 a.m. on the day after 2nd Moderna dose, resident was found non-responsive with no vital signs. CPR was performed. Time of death 6:20 a.m. There were no acute illnesses or changes in condition noted prior to receiving vaccine.


VAERS ID: 1388903 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Brain injury, Death, Intensive care, Pain in extremity, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 14
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The vaccine was administered at 12:30 pm on Saturday, March 6, 2021. That night around 7:00 pm he called to tell me that his arm was hurting. That was the last time anyone heard from him. Two days later on the evening of Monday, March 8, 2021, he was found unresponsive in his home. When the ambulance arrived they found he had a temperature of 115 degrees. He was taken to the emergency room and placed in the critical care unit. It was determined that he suffered an anoxic brain injury and would never recover. He passed away on March 21, 2021.


VAERS ID: 1388920 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-02
Onset:2021-05-16
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chronic lymphocytic leukaemia, Death, SARS-CoV-2 test positive, Vaccination complication
SMQs:, Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 24
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: Amlodipine Dorzolamide-timolol Latanoprost Oxybutynin Travoprost
Current Illness: Chronic lymphocytic leukemia
Preexisting Conditions: Chronic lymphocytic leukemia Hypertension Primary hyperparathyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Contracted COVID-19 ~1 month later, tested positive on 5/16/21. Died 6/9/2021 at 94 years old. Had CLL diagnosed during final hospitalization, thought to have caused poor vaccine response and susceptibility to COVID.


VAERS ID: 1389069 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-06
Onset:2021-05-09
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Pt had heart attack 2 weeks after receiving the vaccine and passed away.


VAERS ID: 1389518 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Influenza like illness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pro Air Inhaler
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flu like symptoms with vomiting and nausea for 2 weeks following the second shot


VAERS ID: 1389545 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-02
Onset:2021-02-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   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: Death occurred 8 days after vaccination - pulmonary thromboemboli found on autopsy.


VAERS ID: 1389554 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-02
Onset:2021-02-22
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Disturbance in attention, Feeling abnormal, Hypersomnia, Hyporesponsive to stimuli
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 42
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: None noted per daughter of patient, daughter of patient
Current Illness: None noted per daughter of patient, just usual issues with hypertension and diabetes
Preexisting Conditions: Hypertension, Diabetes, Thyroid issues
Allergies: None noted per daughter of patient, daughter of patient
Diagnostic Lab Data: Only information received was that patient had stroke.
CDC Split Type:

Write-up: Message received from the daughter of the patient, daughter states that the 3-4 days after the administration of the vaccine that she reported to feel unfocused and "out of it", falling asleep more, and was seen by physician who advised to keep an eye on her, then was later found slightly unresponsive, transported to hospital and found to be suffering from stroke. Patient later discharged from hospital to nursing home and stayed there until 3/28/2021, where she was later transferred to the care of the family and passed away on 4/6/2021. Daughter of patient


VAERS ID: 1389821 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-03
Onset:2021-03-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: Aspirin, Statin, and Vitamins: B6, B12, C, D3, Biotin, Potassium
Current Illness:
Preexisting Conditions: Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1390027 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Histology, Muscle rigidity, Pain, Snoring, Toxicologic test normal
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Up until the vaccination has been on Augmentin Oral Tablet for an ear infection that was changed on the day of vaccination to Cefurozime Axetil 500MG
Current Illness: Ear infection
Preexisting Conditions: High function autism
Allergies: No known
Diagnostic Lab Data: Autopsy conducted by the local Medical Examiner, as of the date of this report cause of death is still undetermined pending results of tissue samples taken during the autopsy. Tox screens were negative.
CDC Split Type:

Write-up: The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died. Was found in his bed at approximately 6pm with rigor already set.


VAERS ID: 1390921 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-02-11
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram, Fallopian tube neoplasm, Headache, Meningitis, Nystagmus, Secondary cerebellar degeneration, Vertigo
SMQs:, Malignancy related conditions (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (narrow), Vestibular disorders (narrow), Ocular motility disorders (narrow), Uterine and fallopian tube tumours of unspecified malignancy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 71
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 74 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bladder cancer
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: CT scans; Result Unstructured Data: Test Result:never saw the tumor; Comments: She had multiple CT scans and never saw the tumor until they removed the fallopian tubes.
CDC Split Type: USPFIZER INC2021606920

Write-up: half cm tumor in her fallopian tube/1.5cm tumor in the fallopian tubes; Paraneoplastic cerebellar degeneration; meningitis; Severe headache; eyes would move back and forth involuntarily; severe vertigo; This is a spontaneous report from contactable consumer (sister) from Medical Information Team. An 81-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), via an unspecified route of administration at the age of 81-year-old in Jan2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. Medical history included bladder cancer. The patient''s concomitant medications were not reported. Caller states ''''My sister and I both received the Pfizer COVID-19 vaccine. My sister developed Paraneoplastic cerebellar degeneration two weeks after receiving the Pfizer vaccine. They did find a half cm tumor in her fallopian tube. Her doctors have reported the side effect but at that time she was not fully diagnosed. They thought at that time it was meningitis .'''' Caller wants to know if Meningitis or Paraneoplastic cerebellar degeneration has been associated with the Pfizer COVID-19 vaccine. Response: Spoke from the attached document. These two disorders have not been listed as side effects associated with the vaccine. However we may not have the list of all the possible side effects associated with the vaccine. Caller was reporting side effects for her sister related to the Covid 19 vaccine. Her sister had received the Pfizer Covid 19 vaccine and 2 weeks later developed a disorder called Paraneoplastic cerebellar degeneration. They had found a tumor in the fallopian tube that was a tiny half centimeter tumor. Said that the doctors had reported the side effects but at the time it was not yet diagnosed as paraneoplastic cerebellar degeneration. At the time, they thought she had meningitis. The event happened about 2 weeks after the vaccine, so about 11Feb2021, was about 2 weeks before or 2 and a half weeks before 11Feb2021 that she got the vaccine. She was in the hospital 10 and a half weeks (about for 74 days). She contacted Pfizer, she believes in Mar2021. Since Feb2021 she had been in 3 different hospitals. They did send her some paperwork but she has not completed it yet. At that point in Mar2021 her diagnosis was meningitis. As it later turns out, it turned to a new diagnosis of the Paraneoplastic cerebellar degeneration. Her sister lives in PRIVACY, she does not even know where she went for the vaccine. She hasn''t filed the written report yet. She was not diagnosed with the Paraneoplastic cerebellar degeneration until the very end, 10 days before she died. She died on 24Apr2021. Cause of death: They had removed her ovaries and fallopian tubes had the suspicion that this might have been the diagnosis without ever seeing the tumor. She had multiple CT scans (2021) and never saw the tumor until they removed the fallopian tubes. They found a 1.5cm tumor in the fallopian tubes which is what the cause of death was. She was calling to see if this has happened to anyone else. They say the tumor was the cause because it would have been so odd that it came on so suddenly, 2 weeks after the vaccine. The caller is terrified to get the vaccine, since she had bladder cancer. She had asked if anyone had reported this because that was the diagnosis at the time. They did not do an autopsy, probably because that was up to her brother in law and can understand why an autopsy was not done. They also say when her sister was having all of these bizarre symptoms, it was an auto immune reaction. She was perfectly fine and had come home from a bird watch. She had severe headache, eyes would move back and forth involuntarily in 2021. That never went away. She had severe vertigo in 2021, and it all happened in one day, it didn''t go away. They did an immunoglobulin infusion treatment, she had very good treatment. They put her on steroids. The immunoglobulin treatment was for five days and nothing touched those symptoms. They had moved her from one hospital to a rehab facility in PRIVACY. The rehab doctor reported all of these symptoms to Pfizer. At that time, they were still calling it meningitis. He said that the elephant in the room was the vaccine. Felt the vaccine is not totally what caused it but accelerated what ever was going on with her, these bizarre disorders. Maybe this would have happened without the vaccine. They will never know. She wishes that someone can tell her whether or not she should get the vaccine. She asked her doctor who said he was not going to tell her to not get the vaccine. She was calling to see if this has happened to anyone else. They say the tumor was the cause because it would have been so odd that it came on so suddenly, 2 weeks after the vaccine. She had asked if anyone had reported this because that was the diagnosis at the time. The patient was hospitalized for events for 74 days. Therapeutic measures were taken as a result of events. The patient died on 24Apr2021. An autopsy was not performed. The outcome of event half cm tumor in her fallopian tube/1.5cm tumor in the fallopian tubes was fatal. The outcome of events Paraneoplastic cerebellar degeneration and meningitis was unknown. The outcome of other events was not recovered. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: half cm tumor in her fallopian tube/1.5cm tumor in the fallopian tubes


VAERS ID: 1390953 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-17
Onset:2021-05-01
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Brain death, Cerebral haemorrhage, Computerised tomogram abdomen, Computerised tomogram head, Contusion, Fibrin D dimer, Fibrin D dimer increased, Immune thrombocytopenia, Lack of spontaneous speech, Mouth haemorrhage, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LIPITOR [ATORVASTATIN]; ASPIRIN (E.C.); METOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bypass surgery; Cholesterol
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Abdominal CT; Result Unstructured Data: Test Result:No active bleeding, no mass; Test Date: 20210504; Test Name: CT of head; Result Unstructured Data: Test Result:Hemorrhage; Test Name: ITP D Dimer; Result Unstructured Data: Test Result:Very high
CDC Split Type: USPFIZER INC2021612319

Write-up: ITP; Brain dead; Brain hemorrhage; Blood in the mouth; Patches on legs; Back pain; D Dimer Very high; Her husband couldn''t talk; bruise on arm; This is a spontaneous report from a contactable Nurse (patient''s wife). A 72-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm on 17Mar2021 16:00 (Batch/Lot Number: EL3247; Expiration Date: 31May2021) as 2ND DOSE, SINGLE (at the age of 72 years) for covid-19 immunisation . The patient received the first dose of BNT162B2 (Lot number: EL3246, Expiration date: Unknown) on 25Feb2021 16:30 in Arm (side not specified) as single dose (at the age of 72 years) for Covid-19 immunisation. Medical history included blood cholesterol from an unknown date and unknown if ongoing, vascular graft from 2013 to an unknown date. Had flu shot and pneumonia shot. No problems. The patient received no other vaccine other than BNT162B2 within 4 weeks. Concomitant medications included atorvastatin (LIPITOR [ATORVASTATIN]) taken for blood cholesterol, start and stop date were not reported; acetylsalicylic acid (ASPIRIN (E.C.)) taken for vascular graft from 2013 to an unspecified stop date; metoprolol (METOPROLOL) taken for vascular graft, start and stop date were not reported. 6 weeks after the second vaccine, he had patches on legs and back pain. He went to hospital. They found generalized bleeding and ITP, and he passed away immediately. The patient experienced brain dead (death, hospitalization) on 09May2021 , brain hemorrhage (death, hospitalization) on 04May2021 , ITP (immune thrombocytopenia) (death, hospitalization) on an unspecified date , blood in the mouth (death, hospitalization) on 03May2021 , back pain (death, hospitalization) on 2021 , patches on legs (death, hospitalization) on May2021 , D Dimer very high (death, medically significant) on an unspecified date , her husband couldn''t talk (Her husband couldn''t talk. She was calling his name. She asked him why he was not talking. She squeezed his hand and he squeezed back. He couldn''t talk.) (death) on an unspecified date, bruise on arm (death) on 2021. The patient was hospitalized from 03May2021 to 09May2021. The patient underwent lab tests and procedures which included computerised tomogram abdomen: no active bleeding, no mass on 03May2021, computerised tomogram head: hemorrhage on 04May2021, fibrin D Dimer: very high on unspecified date. Therapeutic measures were taken as a result of ITP, back pain. With ITP, they started to do plasmapheresis. Wife stated that the doctor gave him medication Aleve, for back pain. He took 5 tablets only. Then she saw the spots. She told her husband not to take anymore and he did not. The patient died on 09May2021. An autopsy was not performed. Wife said that the doctor was not sure if they were related. The wife stated that she did feel that they were related. The reporter stated events back pain, ITP, blood in the mouth, brain Hemorrhage, Patches on legs, were related to the suspect product. Wife stated that before this, her husband did 2 miles running every other day or twice a week. He was healthy. He ate healthy foods. Her husband''s cholesterol was always under 200. He had no issues. His bloodwork was done, and all was OK. He constantly went to the doctor. This case is not related to a study.; Sender''s Comments: Based on the information currently available, the reported events are attributed to intercurrent or underlying medical conditions that were unlikely related to BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE). 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: Brain dead; Brain hemorrhage; ITP; Blood in the mouth; Back pain; Patches on legs; bruise on arm; Her husband couldn''t talk; D Dimer Very high


VAERS ID: 1391006 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-14
Onset:2021-04-26
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8731 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm ruptured, Brain death
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 4
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021641444

Write-up: Ruptured aneurysm with in 12 days of vaccine with no previous symptoms and patient deceased due to brain dead after the surgery due to rupturing.; Ruptured aneurysm with in 12 days of vaccine with no previous symptoms and patient deceased due to brain dead after the surgery due to rupturing.; This is a spontaneous report from a contactable reporter consumer wife reporting on behalf of her 35-year-old husband (patient) received the second dose of BNT162B2 (lot number: ER 8731) at single dose for COVID-19 immunisation on 14Apr2021 at 05:15 PM. Relevant history included was unknown. Relevant concomitant drug was not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient previously received the first dose of BNT162B2 (lot number: ER 8727) at single dose for COVID-19 immunisation on 22Mar2021 at 04:45 PM. The patient experienced ruptured aneurysm on 26Apr2021 at 09:00 PM, within 12 days of vaccine with no previous symptoms and patient deceased due to braindead after the surgery due to rupturing. The event was assessed as serious due to Hospitalization (7 days), Life threatening illness (immediate risk of death from the event), Patient died on 30Apr2021 due to brian anuerysm. No autopsy was performed. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19.; Reported Cause(s) of Death: brain dead; Brian Anuerysm


VAERS ID: 1391020 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-21
Onset:2021-05-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Platelet count, Platelet count decreased, SARS-CoV-2 test
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ATENOLOL; ROSUVASTATIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210530; Test Name: Platelets; Result Unstructured Data: Test Result:9000; Test Date: 20210529; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC2021651379

Write-up: Brain bleed; His platelets were only 9000; This is a spontaneous report from a contactable consumer reporting for her husband. A 63-years-old male patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration, administered in Arm Left on 21May2021 14:00 (Batch/Lot Number: EW0172) as single dose for covid-19 immunisation (Age at vaccination 63 years) . The patient medical history was not reported. Concomitant medications included atenolol (ATENOLOL) taken for an unspecified indication, start and stop date were not reported; rosuvastatin (ROSUVASTATIN) taken for an unspecified indication, start and stop date were not reported. On 23Apr2021 the patient received the first dose of BNT162B2 vaccine Lot # EW0169. The patient experienced brain bleed on 30May2021 causing patient''s death on an unknown date, and his platelets were only 9000 on 30May2021 with outcome of unknown. The patient underwent lab tests and procedures which included platelet count: 9000 on 30May2021 , sars-cov-2 test: negative on 29May2021 . The patient died on an unspecified date. It was not reported if an autopsy was performed. Reporter''s comments: My husband was rushed to the ER one week after his 2nd vaccine. He had a brain bleed, they couldn''t operate because his platelets were only 9000. He died! I believe it was from the vaccine Information about lot/batch number has been obtained. Additional information is requested.; Reported Cause(s) of Death: Brain bleed


VAERS ID: 1391050 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-16
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Feeling cold, Headache, Peripheral coldness
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: ELIQUIS; METOPROLOL; SIMVASTATIN; ISOSORBIDE; ASPIRINE
Current Illness: Blood pressure high (Illness/AE:,High blood pressure Onset Date:Oct2009 Stop Date:Ongoing)
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac disorder (Illness/AE:Heart issue,High blood pressure Onset Date:Oct2009); Heart attack (Illness/AE:Mild heart attack Pertinent Details:Hospitalised received surgery to insert stent.); Stent placement (Pertinent Details:Hospitalised for high blood pressure;surgery to check heart stent.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021658413

Write-up: feeling cold; stomach pains; coldness was in hands and feet; headache; This is a spontaneous report from a contactable consumer (patient''s daughter). A 96-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection Lot Number: EW0164 and Expiration Date was not reported), via an unspecified route of administration in Arm on 16Apr2021, as 1st dose, single dose for COVID-19 immunization. Medical history included hypertension from Oct2009 and ongoing, cardiac disorder from Oct2009 to an unknown date, myocardial infarction from an unknown date and unknown if ongoing, stent placement from an unknown date and unknown if ongoing. Concomitant medication(s) included apixaban (ELIQUIS); metoprolol (METOPROLOL); simvastatin (SIMVASTATIN); isosorbide (ISOSORBIDE); acetylsalicylic acid (ASPIRINE) all taken for an unspecified indication from an unspecified start date and ongoing. It was reported that within the week prior (Prior to death), she complained of being cold, and had stomach pain, coldness was in hands and feet, she also mentioned headache. The outcome of the events was unknow. Follow up needed, further information has been requested.


VAERS ID: 1391226 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-26
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardioversion, Chest pain, Coma, Death, Dialysis, Hepatic failure, Laboratory test, Life support, Myocardial infarction, Peripheral swelling, Renal failure, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: 5/31-6/4 several tests were performed
CDC Split Type:

Write-up: My brother started with some swelling in the legs/feet, followed by chest pains that led him into a heart attack, followed by cardiac arrest. He was shocked back to life where he lay in a coma. His kidneys stopped functioning followed by his lungs and liver?he was kept alive on life support and dialysis, he died after having 4 more heart attacks back to back on June 4, 2021.


VAERS ID: 1391273 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-09
Onset:2021-06-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Diarrhoea, Pulse absent, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Metastatic breast cancer with bone mets, necrosis of the lung, sepsis, pneumonia, cholecystitis
Allergies: Penicillins, Sulfa, Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Went unresponsive at home after experiencing diarrhea. Pulses were lost at home and regained by EMS prior to transport to the emergency room. Pulses lost again in the emergency room. ACLS performed for approximately 40 minutes before pronouncement of death was made.


VAERS ID: 1391343 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-06-02
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / UNK - / -

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

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

Write-up: I63.9 - Stroke determined by clinical assessment (CMS/HCC)


VAERS ID: 1391469 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-22
Onset:2021-02-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Carditis, Confusional state, Dysarthria, Hepatic failure, Mobility decreased
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 83
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 120 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Kidney disease
Allergies:
Diagnostic Lab Data: 2/23/21-- 5/17/21
CDC Split Type:

Write-up: Slurred speech, loss of use of limbs, confusion, heart inflammation and liver failure


VAERS ID: 1391483 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Anticoagulant therapy, Atrial fibrillation, Blood creatinine increased, Blood potassium decreased, Brain natriuretic peptide normal, Cardiac arrest, Cardiac telemetry, Cardio-respiratory arrest, Cardiomegaly, Chest X-ray abnormal, Chest pain, Chronic left ventricular failure, Condition aggravated, Continuous positive airway pressure, Decreased appetite, Dehydration, Diastolic dysfunction, Dyspnoea, Echocardiogram abnormal, Ejection fraction normal, Electrocardiogram abnormal, Fall, Fatigue, Feeding disorder, Fluid intake reduced, Hypokalaemia, Hypotension, Hypovolaemia, Malaise, Myocardial necrosis marker normal, Palpitations, Renal impairment, Renal tubular necrosis, Sleep apnoea syndrome, Sudden cardiac death, Tachycardia, Urine output
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (narrow), Supraventricular tachyarrhythmias (narrow), 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 (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Renovascular disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Chlorthalidone 25MG Oral Tablet 12.5 MILLIGRAMS ORAL DAILY Losartan Potassium 50MG Oral Tablet 50 MILLIGRAMS ORAL TWICE DAILY Meloxicam 15MG Oral Tablet 15 MILLIGRAMS ORAL DAILY Metoprolol Succinate 50MG Oral Tablet, Extended Release 50 MIL
Current Illness: None
Preexisting Conditions: Past medical history includes coronary artery disease, congestive heart failure, and hypertension. chronic afib, pulm HTN PAST SURGICAL HISTORY: Cholecystectomy. Hernia Repair. Tonsillectomy.
Allergies: NKDA
Diagnostic Lab Data: I put the Death Summary on the Continuation Page. This won''t all fit on the continuation page, but I can provide his medical records from that hospitalization.
CDC Split Type:

Write-up: Outcome: Patient Death CHIEF COMPLAINT in ER: chest pain, SOB History of Present Illness: Patient is a 66 yo with PMH of chronic afib on chronic anticoagulation who presented to the ER with a chief complaint of shortness of breath and increased fatigue over the past several weeks that has progressively become worse. Patient denies orthopnea or PND but does have some palpitations and occasional chest pain associated with increased fatigue with exertion. On evaluation emergency room patient was noted to be tachycardic consistent with chronic atrial fib, also acute renal insufficiency likely secondary to dehydration. Patient is admitted to the medical service for further treatment and evaluation. DEATH SUMMARY Date of Admission: 04/07/2021 Time of Death: 04/10/2021 at 0737 Final Diagnoses: 1. Sudden Cardiac Death 2. Acute Renal Impairment Secondary to Hypovolemia, A TN 3. Chronic Atrial Fibrillation w/ RVR, Resolved 4. Atypical Chest Pain, Resolved 5. Hypokalemia, Resolved 6. Obstructive Sleep Apnea 7. Chronic Diastolic Heart Failure Hospital Course: Patient is a pleasant 66yo admitted for acute renal impairment secondary to significant o hypovolemia resulting in ATN as well as atrial fibrillation w/ RVR after presenting to ER with complaints of chest pain, dyspnea, malaise, and anorexia that began after receiving his second COVID vaccine on 4/01/2021. Please see H&P for full details. Patient reported that on the day after his COVID #2 vaccine, he lost his appetite and was not able to eat or drink. He continued to take his home medications as prescribed including losartan, chlorthalidone, and meloxicam. After experiencing progressive worsening of symptoms for 5 days, patient presented to ER for further evaluation. Upon arrival to ER, patient was noted to be hypotensive and tachycardic. EKG showed atrial fibrillation w/ RVR. Routine labs were obtained and were remarkable for elevated creatinine and mild hypokalemia w/ normal BNP and negative cardiac enzymes. CXR showed enlarged cardiac silhouette, but no evidence of pulmonary edema or other acute abnormalities. Patient was subsequently admitted for further evaluation and medical management. He was staited on aggressive IV hydration for his hypotension and hypovolemia w/ PRN IV metoprolol as needed for HR$g l lObpm. He was continued on anticoagulation. Serial cardiac enzymes were obtained and were negative. TIE report from Dr''s office that was performed recently was obtained and showed EF of 55-60% with Grade 1 diastolic dysfunction. Patient''s wife brought his CPAP from home and patient wore his CPAP while sleeping during his hospital stay. During the course of hospitalization, patient''s blood pressure & HR improved, though he remained in atrial fibrillation. His creatinine continued to trend up consistent with ATN, but patient continued to produce adequate urine and he had no signficant electrolyte derangements. IVF were adjusted based on urine output and volume status. Patient had no recurrence in his presenting complaint of chest pain and he overall reported feeling better throughout his course of hospitalization despite reporting that he continued to have little appetite. Patient was monitored closely on telemetry throughout his hospital stay. On the morning of 4/10/2021, lab tech and nurse walked into the patient''s room to obtain specimen for AM labs. Patient reportedly tried to get out of the bed independently, grabbed at his chest & pulled off his telemetry, and fell to his knees. Staff called Code 99 and patient was placed back in the bed. He was noted to be in asystole. ACLS was performed and despite maximal efforts, patient subsequently expired at 0737. I personally called the patient''s cardiologist & personal friend, to discuss the events leading up to the patient''s death. Upon review of the patient''s course of hospitalization, it was felt that patient most likely experienced sudden cardiac death. Of note, Dr reports that the patient frequently contacts him via text message with concerns or complaints. He states that the patient did not message him during the hospitalization to report any chest pain or other concerns. Disposition: Patient Expired


VAERS ID: 1391500 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Dyspnoea, Laboratory test, Mechanical ventilation, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Seizure, Thrombosis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity
Allergies:
Diagnostic Lab Data: Yes, extensive. You will need medical records. He had 3 covid tests and 1 antibody test all negative for Covid.
CDC Split Type:

Write-up: Patient had his 2nd Moderna vaccine at pharmacy at 2:00 and was struggling to breathe a few hours later. We were at the emergency room around 6:00pm and he was placed on a ventilator between midnight and 1:00am. He died 10 days later after experiencing clots that led to seizures and congestive heart failure. I have a death certificate if needed.


VAERS ID: 1391630 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-05-20
Onset:2021-05-23
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Chest X-ray abnormal, Death, Intensive care, Metabolic function test, Microbiology test, Pneumonia, Rhabdomyolysis, SARS-CoV-2 test, Sepsis, Sputum culture
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: meclizine zyrtec azithromycin
Current Illness: Time of hospitalization Severe sepsis, bilateral pneumonia, acute kidney injury, rhabdo
Preexisting Conditions: hyperlipidemia AFIB Tumor in lungs
Allergies: penicillin sulfa drugs
Diagnostic Lab Data: CMP, microbiology, chest xray, sputum culture, covid test-all done on 5/23/21 and 05/24/21
CDC Split Type:

Write-up: 3 days after vaccination, patient was found down in his home. Admitted to ICU from the ER with severe sepsis, bilateral pneumonia, acute kidney injury and rhabdomyolysis. Patient deceased day after hospitalization.


VAERS ID: 1391671 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-17
Onset:2021-05-19
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Surgery
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: 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: Diabetes High blood pressure High cholesterol
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Her surgery in the morning went very well according to her doctor. Later in the afternoon, pt. had a massive stroke. Next day pt. died at Hospital .


VAERS ID: 1391681 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-27
Onset:2021-06-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: brain bleed/aneurysm


VAERS ID: 1391711 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Hypertensive heart disease
SMQs:, Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Certificate 4/22/2021 Cause of Death - Hypertensive Cardiovascular Disease


VAERS ID: 1391864 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-23
Onset:2021-05-13
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic dissection, Autopsy, Chest pain, Computerised tomogram thorax normal, Death, Electrocardiogram normal, Hiatus hernia, Laboratory test normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Final autopsy report is pending but preliminary report showed a thoracic aortic dissection. The heart and coronaries are reported as normal
CDC Split Type:

Write-up: About 14 days after the first vaccine dose ( Pfizer) patient presented to the ER with severe chest pain. He was sent home after labs, EKG and CT chest were reported as normal. He was told that he had a hiatal hernia. One week later he was found by his wife expired in his bedroom late morning. Patient had no medical problems such as hypertension and never smoked. He was very active and played sports such as pickle ball.


VAERS ID: 1391995 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-26
Onset:2021-05-11
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA A-HRSA-043B2 / UNK LA / SYR

Administered by: Private       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: Lisinopril, Colcrys
Current Illness: Hypertension, Hyperlipidemia, tobacco use, gout, sleep apnea
Preexisting Conditions: Hypertension, Hyperlipidemia, tobacco use, gout, sleep apnea
Allergies: Sertraline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of unknown cause 2 weeks after receiving vaccine.


VAERS ID: 1392054 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-06
Onset:2021-02-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 UN / -

Administered by: Private       Purchased by: ?
Symptoms: B-cell lymphoma, Computerised tomogram, Death, Fatigue, Full blood count, Lymphoma, Magnetic resonance imaging, Pain
SMQs:, Malignant lymphomas (narrow), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 104
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tikosyn Warfarin
Current Illness: Knee replacement surgery
Preexisting Conditions: A-fib
Allergies: None known
Diagnostic Lab Data: CBC, mri, CT, hematologists, oncologist etc etc
CDC Split Type:

Write-up: He died after being diagnosed with Lymphoma. Double hit , B cell. He was fatigued a couple weeks after vaccine, fatigue worsened, then developed severe pain. Diagnosis to death was 11 days.


VAERS ID: 1392406 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-07
Onset:2021-04-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Blood electrolytes decreased, Blood sodium decreased, Computerised tomogram, Death, Decreased appetite, Dysphagia, Electrocardiogram, Heart rate increased, Laboratory test, Malaise, Pain, Swelling, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Divalproex Sod ER 1000 mg at bedtime Levothyroxine Sodium 50 mcg Metoprolol Tartrate 25 mg (1/2 in a.m., 1/2 in p.m.) Pravastatin Sod 40 mg Furosemide 20 mg Potassium CL ER 20 meq Aspirin 81 mg Melatonin 5 mg @ bedtime
Current Illness: None
Preexisting Conditions: Inclusion Body Myositis Parkinson''s Bipolar
Allergies: None
Diagnostic Lab Data: See notes above. I don''t have record of every test performed.
CDC Split Type:

Write-up: On April 7, my husband received the J&J COVID vaccination. On April 17, he started to feel ill and developed severe abdomen and back pain, which were not normal symptoms of his other health conditions. He ate very little on that date (and that was the last food he had). At 3:30 a.m. on Monday, April 19, I took him to the ER because of severe pain. They gave him multiple tests, including CT scan, labs, EKG, ultrasound, and others. He was admitted to the hospital, and multiple other tests were performed during his stay. During his stay, his sodium and other electrolyte levels dropped to dangerously low levels, he experienced major swelling, his pain persisted, his swallowing ability diminished, he didn''t eat, and his heart consistently ran at a high rate. He was transferred home (with comfort care/hospice) on Tuesday, April 27, and died on Wednesday, April 28, at about 9:30 p.m.


VAERS ID: 1394058 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a patient family member or friend (subsequently medically confirmed) and describes the occurrence of DEATH (She passed away) and THROMBOSIS (Clots in her leg) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037A21B) for COVID-19 vaccination. No Medical History information was reported. On 17-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (She passed away) (seriousness criteria death, hospitalization and medically significant) and THROMBOSIS (Clots in her leg) (seriousness criteria hospitalization and medically significant). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, THROMBOSIS (Clots in her leg) outcome was unknown. No concomitant medications reported. Description: The patient had clots in her leg and was hospitalized. There was talk of amputation, but she passed away before that occurred. No treatment information provided. Company Comment: Very limited information regarding these events have been provided at this time. Further information cannot be requested.; Sender''s Comments: Very limited information regarding these events have been provided at this time. Further information cannot be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1394084 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Virginia  
Vaccinated:2021-03-17
Onset:2021-04-07
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

Administered by: Work       Purchased by: ?
Symptoms: Foetal death, Foetal exposure during pregnancy, Foetal growth restriction
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021607425

Write-up: I ended up with a miscarriage; fetus I was pregnant with stopped growing at 5.5 weeks; I was pregnant with stopped growing at 5.5 weeks which happens to be the same time I had the vaccine.; This is a spontaneous report from a contactable consumer. This consumer (mother) reported similar events for self and the foetus. This report for foetus included that: A fetus received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, via transplacental route, on 17Mar2021 13:30 as 1 st dose, single dose for covid-19 immunization. Also received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection, via transplacental route, on 07Apr2021 13:30 as 2 nd dose, single dose for covid-19 immunization. The patient medical history was not reported. The concomitant drugs included Prenatal Vitamin, Iron Supplement, Zoloft which patient had received within 2 weeks of vaccination. Facility where the most recent COVID-19 vaccine was administered was the workplace clinic. The patient had not received any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19 and had no allergies. The patient reported that on 07Apr2021 the foetus she was pregnant with stopped growing at 5.5 weeks which happened to be the same time she had the vaccine. She ended up with a miscarriage which resulted in doctor or other healthcare professional office/clinic visit. The patient had received the treatment. The outcome of the event was fatal. Follow-up attempts are needed. Further information is expected Follow-up (07Jun2021): This follow-up is being submitted to notify that the lot/batch number is not available despite the follow-up attempts made. Follow-up attempts completed. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-2021536223 fetal case and maternal case; Reported Cause(s) of Death: Fetal death


VAERS ID: 1394136 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   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: PFIZER INC2021655748

Write-up: This is a spontaneous report from a non-contactable nurse. An adult male patient of unspecified age received the second single dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date in Jun2021, for COVID-19 immunization. The first dose of BNT162B2 vaccine was administered on an unknown date. Medical history and concomitant medications were not reported. The patient took the second dose of Covid 19 vaccine and died sometime in the same week, on an unspecified date in Jun2021. Cause of death was unknown. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Event unknown cause of death is assessed as related until sufficient information is available to confirm an unrelated cause of death. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: The patient took the second dose of Covid 19 vaccine and died sometime in the same week


VAERS ID: 1394137 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-22
Onset:2021-03-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Adenovirus test, Blood calcium, Blood chloride, Blood creatinine, Blood glucose, Blood sodium, Blood urea, COVID-19, Carbon dioxide, Chest X-ray, Chills, Coccidioidomycosis, Computed tomographic abscessogram, Death, Diarrhoea, Diffuse alveolar damage, Dyspnoea, Fatigue, Glomerular filtration rate, Haematocrit, Haemoglobin, Headache, Influenza A virus test, Influenza B virus test, Malaise, Metapneumovirus infection, Monocyte count, Myalgia, Oropharyngeal pain, Oxygen saturation, Parainfluenzae virus infection, Platelet count decreased, Pneumonia legionella, Pyrexia, Rash, Red blood cell count, Red cell distribution width increased, Respiratory syncytial virus infection, Sensitive skin, Sepsis, Streptobacillus infection, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arteriosclerotic cardiovascular disease; High cholesterol; Seasonal allergy
Allergies:
Diagnostic Lab Data: Test Name: Adenovirus; Result Unstructured Data: Test Result:Not detected; Comments: Not detected; Test Name: Calcium; Result Unstructured Data: Test Result:8.3; Comments: Calcium was low; Test Date: 20210301; Test Name: Calcium; Result Unstructured Data: Test Result:8.3; Comments: Low; Test Date: 20210302; Test Name: Calcium; Result Unstructured Data: Test Result:7.8; Comments: Low; Test Date: 20210301; Test Name: Chloride; Result Unstructured Data: Test Result:95; Comments: Low; Test Date: 20210302; Test Name: Chloride; Result Unstructured Data: Test Result:92; Comments: Low; Test Date: 20210302; Test Name: Creatinine; Result Unstructured Data: Test Result:1.4; Comments: High; Test Name: Glucose; Result Unstructured Data: Test Result:105; Comments: Glucose was high; Test Date: 20210301; Test Name: Glucose; Result Unstructured Data: Test Result:150; Comments: High; Test Date: 20210302; Test Name: Glucose; Result Unstructured Data: Test Result:222; Comments: High; Test Name: Sodium; Result Unstructured Data: Test Result:134; Comments: Sodium was low; Test Date: 20210301; Test Name: Sodium; Result Unstructured Data: Test Result:129; Comments: Low; Test Date: 20210302; Test Name: Sodium; Result Unstructured Data: Test Result:126; Test Date: 20210302; Test Name: BUN; Result Unstructured Data: Test Result:21; Comments: High; Test Date: 20210302; Test Name: Co2; Result Unstructured Data: Test Result:18; Comments: Low; Test Date: 20210226; Test Name: Chest X-ray; Result Unstructured Data: Test Result:Normal; Test Name: Valley fever; Result Unstructured Data: Test Result:Negative; Comments: Cocci IGG and IGM and those were negative; Test Name: CTA; Result Unstructured Data: Test Result:No results; Test Name: Covid; Result Unstructured Data: Test Result:Negative; Test Date: 20210302; Test Name: EGFR; Result Unstructured Data: Test Result:52; Comments: Low; Test Date: 20210301; Test Name: Hematocrit; Result Unstructured Data: Test Result:54.9; Comments: High; Test Date: 20210302; Test Name: Hematocrit; Result Unstructured Data: Test Result:66.4; Test Date: 20210301; Test Name: HGB; Result Unstructured Data: Test Result:18.5; Comments: High; Test Date: 20210302; Test Name: HGB; Result Unstructured Data: Test Result:22.6; Test Name: Influenza AB; Result Unstructured Data: Test Result:Negative; Test Name: Influenza AB; Result Unstructured Data: Test Result:Negative; Test Name: Metapneumonia; Result Unstructured Data: Test Result:not detected; Test Date: 20210301; Test Name: Monocytes; Result Unstructured Data: Test Result:0.96; Comments: High; Test Name: Oxygen; Result Unstructured Data: Test Result:86; Comments: Oxygen was low; Test Name: parainfluenza; Result Unstructured Data: Test Result:Not detected; Test Name: Platelets; Result Unstructured Data: Test Result:122; Comments: Platelets were low; Test Date: 20210301; Test Name: Platelets; Result Unstructured Data: Test Result:73; Comments: Low; Test Date: 20210302; Test Name: Platelets; Result Unstructured Data: Test Result:61; Comments: Low; Test Name: Legionnaire''s disease; Result Unstructured Data: Test Result:Negative; Test Date: 20210301; Test Name: RBC; Result Unstructured Data: Test Result:6.16; Comments: High; Test Date: 20210302; Test Name: RBC; Result Unstructured Data: Test Result:7.39; Comments: High; Test Date: 20210302; Test Name: RDW; Result Unstructured Data: Test Result:15; Comments: RDWFD was 45.5; Test Name: Respiratory syncytial virus; Result Unstructured Data: Test Result:Not detected; Test Name: Strep; Result Unstructured Data: Test Result:Negative; Test Date: 20210301; Test Name: WBC; Result Unstructured Data: Test Result:Normal; Test Date: 20210302; Test Name: WBC; Result Unstructured Data: Test Result:18.6; Comments: High
CDC Split Type: USPFIZER INC2021658764

Write-up: Her husband passed away; Sepsis; Shock due to bilateral pulmonary acute disease syndrome; Shock due to bilateral pulmonary acute disease syndrome due to diffuse alveolar damage; misery and feeling horrible; Severe chills; Headache; Shortness of breath; Fever; Fatigue; Diarrhea; Muscle aches; Skin sensitivity and rash; Skin sensitivity and rash; Sore throat; This is a spontaneous report from a contactable consumer. A 57-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, administered in arm on 22Feb2021 at 10:00 (Lot Number: EN6202) (at the age of 57-year-old) as single dose for COVID-19 immunisation. Medical history included high cholesterol from 2017 to an unknown date, seasonal allergy from an unknown date and unknown if ongoing and arteriosclerosis from 2017 to an unknown date. The patient''s concomitant medications were not reported. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 01Feb2021 (Lot Number: EL9264) (at the age of 57-year-old) as single dose for COVID-19 immunisation; the patient previously received ZYRTEC (10mg almost daily) for seasonal allergy, ibuprofen (ADVIL, 200 mg) and TYLENOL both for pain. Caller stated that the patient passed away on 02Mar2021 which was 8 days after the 2nd dose of the Pfizer COVID Vaccine. On 26Feb2021 the patient went to urgent care and then on 01Mar2021 he went to the hospital emergency room (ER). It was reported that an autopsy was performed on 06Mar2021 and the cause of death listed sepsis and complications from sepsis and shock due to bilateral pulmonary acute disease syndrome due to diffuse alveolar damage. The manner of death was natural and the lung presentation is highly suggestive of diffuse alveolar damage due to COVID-19 although the patient had several negative tests for COVID. The patient tested negative for influenza AB, negative for valley fever, negative for Legionnaire''s disease and was in the hospital for less than 24 hours. The patient went back to urgent care on 28Feb2021 and was feeling miserable and asking for blood tests and urine tests, stated at that time his platelets were low at 122, glucose was high at 105, sodium was low at 134, calcium was low at 8.3, urine was negative and the patient did not get these labs til Monday when he was on the way to the emergency room and it was all different when he got to the hospital. The test for strep was negative, the oxygen was low at 86 percent when he got to the hospital on Monday and they just had to keep increasing his oxygen, stated a culture, no further details provided about the culture. A CTA done on the chest on Monday which was bad and stated the patient was symptomatic and they did not treat him for COVID but had a clinical suspicion for COVID. Adenovirus was not detected, metapneumonia virus was not detected, respiratory syncytial virus was not detected, parainfluenza was not detected, his platelets kept dropping and he had two tests for valley fever which is Cocci IGG and IGM and those were negative, the sodium level on 02Mar2021 was 126, all of these things were low: chloride 92, CO2 18, calcium 7.8, glucose was high at 222, bun was high at 21, creatinine was high at 1.4, EGFR was low at 52, WBC was high at 18.6, RBC was high at 7.39, HGB was 22.6, HCT was 66.4, RDW was high at 15, RDWFD was 45.5, and platelets were low at 61. The patient came into the emergency room those labs were when he was failing completely and on 01Mar2021 was when he arrived in the ER; at that time his WBC were normal, RBC was high at 6.16, HGB was high at 18.5, HCT was high at 54.9, platelets were low at 73, monocytes absolute were high at 0.96, sodium was low at 129, chloride was low at 95, calcium was low at 8.3, glucose was high at 150 and this was 7 days past the Pfizer COVID Vaccine. The patient was negative for strep pneumonia antigen and negative for Legionnaires Urinary antigen. The chest X-ray was done on 26Feb2021 and the patient was in misery and feeling horrible and they sent him home with albuterol and possible antibiotic to start that Monday and he had severe chills, headache, shortness of breath, fever, fatigue, diarrhea, muscle aches, skin sensitivity and rash, sore throat. Chest X-ray says normal; states the albuterol was PROAIR HFA 90mcg and he tested negative for influenza AB and he never got to the antibiotic because they said to wait til Monday and by that time this was an emergency. The patient outcome of sepsis and shock due to bilateral pulmonary acute disease syndrome due to diffuse alveolar damage was fatal and unknown for the other events. The patient died on 02Mar2021. An autopsy was performed that revealed the cause of death was sepsis and complications from sepsis and shock due to bilateral pulmonary acute disease syndrome due to diffuse alveolar damage.; Reported Cause(s) of Death: Sepsis; Autopsy-determined Cause(s) of Death: Shock due to bilateral pulmonary acute disease syndrome; Diffuse alveolar damage


VAERS ID: 1394140 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX8679 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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: 2021-05-14
   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: PFIZER INC2021664604

Write-up: the cause of death is myocarditis; This is a spontaneous report from a contactable consumer reporting for her father. A 78-years-old male patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration on 13May2021 (Batch/Lot Number: EX8679) as single dose for covid-19 immunisation . The patient medical history and concomitant medications were not reported. The patient died from myocarditis on 14May2021. The patient died on 14May2021. It was not reported if an autopsy was performed. Course of the event. The woman reported that her father, who was vaccinated in out of country, died after the second dose. He got his second dose on 13May2021 and died the next day (14May2021). The cause of death is myocarditis. Follow up information has been requested.; Reported Cause(s) of Death: the cause of death is myocarditis


VAERS ID: 1394314 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-28
Onset:2021-05-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Anaemia, Blood lactic acid increased, Catheterisation cardiac abnormal, Chest pain, Confusional state, Coronary artery disease, Death, Dyspnoea, Echocardiogram, Epigastric discomfort, Feeling cold, Fibrin D dimer increased, Haemoglobin decreased, Hypoglycaemia, Hypokinesia, Hypotension, Hypoxia, Livedo reticularis, Malaise, Nausea, Pneumonia aspiration, Tachycardia, Vomiting, Wall motion score index abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: family reports had "severe" reaction to first moderna vaccine
Other Medications: glycopyrrolate (Robinul) 2 mg tablet Take 4 mg by mouth daily. hydrOXYzine (Vistaril) 25 mg capsule Take 25 mg by mouth 3 (three) times a day as needed for itching. lisinopriL (Zestril) 10 mg tablet Take 10 mg by mouth daily. metFORMIN (
Current Illness:
Preexisting Conditions: DM2 HTN GERD Chronic pain
Allergies: Latex Codeine
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: 73 y.o. female with a past medical history of non-insulin-requiring diabetes type 2 and recent admission at Hospital (5/31-6/6/2021) who was transferred on 6/9 for chest pain with worsening EF with concerns for ischemic cardiomyopathy. Hospital course by dates 5/31?6/6/2021: Admitted for abdominal pain, nausea and vomiting thought to be secondary to ischemic colitis and severe constipation. Patient was found to be anemic during that hospitalization, but did not require blood transfusion. Patient''s hospital course was complicated by aspiration pneumonia requiring PICC placement and norepinephrine. She is no longer requiring supplemental oxygen was discharged home. 6/9: Return to hospital with increasing shortness of breath, confusion and generalized malaise. Repeat TTE with anterior wall motion abnormalities and decreased EF. Patient was transferred to bed for cardiology evaluation 6/10: Cardiac catheterization with moderate three-vessel coronary disease, wall motion abnormality does not correspond to coronary disease. Cardiology thinks findings are related to stress-induced cardiomyopathy. 6/11: Patient continues have downtrending hemoglobin, started to prep for colonoscopy on 6/12. 6/12: Rapid response was called at at approximately 4:40 AM, patient ultimately expired at 7:35 AM Patient was transferred from Hospital given new wall motion abnormalities and severe hypokinesis seen on repeat TTE. Fortunately, cardiac catheterization on 6/10 without coronary artery disease that corresponded to these wall motion abnormalities. Ultimately, it was thought to be stress induced cardiomyopathy. Patient was improving, but still complained of epigastric discomfort. Given her recent diagnosis of ischemic colitis and ongoing abdominal pain, GI was consulted for EGD/colonoscopy on 6/12 Rapid response was called at at approximately 4:40 AM. They were mottled appearing, hypotensive and cool to touch. Patient was found to be severely hypoglycemic and had wide-complex tachycardia. Multiple amps of D50 were given but remained hypoglycemic. Patient was also found to be hypoxemic and did not tolerate BiPAP. Eventually patient was transition to comfort measures only. After discussion with patient''s daughter, patient''s last 10 minutes of life consisted of "fluid pouring out of her mouth". Work-up also was positive for elevated lactic acid and elevated D-dimer. Given the abrupt change in patient''s clinical status, concern for embolic thrombosis is the most likely cause. Unclear if had pulmonary embolism or ischemia to gut. Interestingly, patient was visiting her from Indiana for her brother''s funeral. After discussion with family, patient''s brother had a similar unexplained death just a few weeks prior. The Family going back to the fact that she had her second Maderna vaccine 3 days prior to presenting to select hospital. Patient''s brother also had a Maderna vaccine before his recent demise. Given the unknown cause of death, an autopsy was discussed with family. They were agreeable to this. Highly concern for thrombotic event, but unable to confirm at this time without autopsy. Unknown if recent vaccine was related to her death, but could explain thrombosis leading to ischemic colitis prompting her last admission. Patient was noted to have a "severe" reaction to her first vaccine.


VAERS ID: 1394685 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-16
Onset:2021-05-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Myocardial infarction, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), 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), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Felt very Lethargic the month prior after recieving the first dose on 3/16/21
Preexisting Conditions: No, very healthy, in shape, 5?11? 170 lbs, no health conditions. Recently seen by doctor and cleared. Had had routine physical
Allergies: NO Known Allergies
Diagnostic Lab Data: No a topsy was done
CDC Split Type:

Write-up: He died suddenly on May 13th. Had just had thorough physical prior to vaccines. Perfect health, weight perfect. No prior health concerns. Heart attack or stroke in his yard. After his first dose on March 16, 2021 he ceased his several mile walk each day stating he was tired and lethargic. He was a military man that rose each day of his life to that walk. His second dose was 04/16/21 he still did not continue the walks and on May 13, 2021 died suddenly of heart attack or stroke.


VAERS ID: 1394730 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-04-14
Onset:2021-06-12
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram, Death, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Warfarin
Current Illness:
Preexisting Conditions: TIA, HTN. HLD, Afib
Allergies:
Diagnostic Lab Data: CT scan for diagnostics.
CDC Split Type:

Write-up: Pt had a spontaneous brain hemorrhage, leading to his death. Pt was found by his wife at approximately 0800, slumped over in the corner of the room, pt was brought into the ER unresponsive. Pt died 4 hours later.


VAERS ID: 1394806 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-17
Onset:2021-03-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father passed 2 days after vaccine


VAERS ID: 1394845 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-11
Onset:2021-06-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none listed
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received 2nd Moderna shot on 6/11/21 at 10:32am. Went home after the shot and didn''t feel well, so he laid down to rest. His wife checked on him and he was unconscious, so she called 911. Patient was taken to local hospital and died of Cardiac Arrest sometime between his vaccine and 7pm on 6/11/21.


VAERS ID: 1394899 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-30
Onset:2021-05-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Brain oedema, Brain operation, Cerebral haemorrhage, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Electrocardiogram, Thrombolysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 3
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: Metoprolol, aspirin (daily), fish oil, multivitamin, vitamin C, Zinc, vitamin B-12.
Current Illness: None.
Preexisting Conditions: Pollen/grass allergies.
Allergies: None.
Diagnostic Lab Data: CT scans 5/4/21 thru 5/8/21 showing brain hemorrhage. EKG test
CDC Split Type:

Write-up: Stroke at approx 1:10 p.m. on 5/4/21. Taken to emergency room. CT scan and given clot-buster mediation shortly after arrival at emergency room. Transport to hospital on 5/4/21 at 5:45 p.m. and subsequent CT scan revealed intracerebral hemorrhage. Administer medication to reverse clot buster medication and airlifted at approx 7:30 p.m. on 5/4/21. At medial center CT scans and EKG testing. Continued brain bleeding. Brain surgery to relieve swelling. Death on 05/08/2021.


VAERS ID: 1395042 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-27
Onset:2021-03-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

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

Write-up: Cardiac arrest leading to death


VAERS ID: 1395203 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-27
Onset:2021-06-06
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Death, Gait disturbance, Malaise, Mobility decreased, Respiratory arrest, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was feeling sick and in bed all day on 6/6, could barely walk or talk on 6/7. Collapsed and stopped breathing/ passed away in the middle of the night late 6/7 or early 6/8.


VAERS ID: 1395416 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-06-12
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / UNK - / -

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: 2021-06-12
   Days after onset: 0
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 due to infectious organism, unspecified laterality, unspecified part of lung


VAERS ID: 1395420 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-10
Onset:2021-03-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 63
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acidophillus/lactobacillus (FLORANEX) chew tablet alendronate (FOSAMAX) 70 MG tablet amLODIPine (NORVASC) 5 MG tablet ascorbic acid 250 MG tablet atorvastatin (LIPITOR) 10 MG tablet calcium-vitamin D (OSCAL-500+D) 500-200 MG-UNIT tablet cya
Current Illness: Patient was treated for a UTI on 2/8/2021. She was also being treated for lymphoma.
Preexisting Conditions: Bradycardia, dyspepsia, essential hypertension, hypercholesteremia, insomnia, lymphoma, seizure disorder
Allergies: No known drug allergies
Diagnostic Lab Data: COVID test positive on 3/3/2021, 4/8/2021, and 4/23/2021.
CDC Split Type:

Write-up: Patient presented to emergency department for increasing trouble breathing on 4/23/2021. She was previously diagnosed with COVID-19 infection on 3/3/2021. She was admitted to a different facility from 4/8/2021 to 4/20/2021 for management of COVID-19 infection where she also tested positive for COVID-19. She was admitted for further management of COVID-19 infection. Her symptoms did not improve and she was placed on comfort measures on 5/4/2021. Patient expired on 5/5/2021 due to complications from COVID-19 infection.


VAERS ID: 1395442 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-13
Onset:2021-02-01
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Brain stem infarction, Cardiac arrest, Cerebrovascular accident, Death, Magnetic resonance imaging abnormal, Magnetic resonance imaging head, Myocardial infarction, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: aspirin 81 mg, atorvastatin 40 mg, metformin 1000 mg BID, Onglyza 5 mg, amaryl 4 mg BID, ranitidine 150 mg BID, Claritin 10 mg, lyrica 75 mg BID, multivitamin
Current Illness:
Preexisting Conditions: CABG in 2004, HTN, DM, HLD
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: stroke and MI came in with symptoms of stroke but symptoms for 24 hours so did not receive tPa. MRI showed brainstem infarct. Statin was increased and started on plavix 75 mg daily for 3 weeks due to small stroke with low NIH. Patient came back in 3 days later due to STEMI and went into cardiac arrest. patient died after 1 hour of resuscitation


VAERS ID: 1395443 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-01
Onset:2021-03-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 AR / UN

Administered by: Public       Purchased by: ?
Symptoms: Aspiration, Death, Hiatus hernia, Intensive care, Mechanical ventilation, Oxygen saturation abnormal
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate, atenolol, calcium, B12, eliquis, klor-con, levothyroxine, metoclopramide, omeprazole, pravastatin, propafenone, tums, verapamil
Current Illness: none
Preexisting Conditions: A-fib; osteoporosis, recovering from an earlier bout of covid-19
Allergies: none
Diagnostic Lab Data: Various daily tests while in the emergency room, ICU, and room at hospital
CDC Split Type:

Write-up: Four days post-vaccination, she had a serious spell with a hiatal hernia which resulted in a possible gastric volvulus. Over the course of the episode, she ended up aspirating while vomiting. Within 24 hours she couldn''t hold her O2 sats at an acceptable level and was put on a ventilator in ICU. She recovered enough to extubate and go to a regular room but then ended up back on the vent and in ICU a second time. She was extubated again, but still could not maintain her O2 levels without medical intervention. She passed away on April 3, 2021. She did have covid-19 in late November 2020, with a mild case of pneumonia. She had been under the care of her primary doctor, as well as home health care and physical therapy, as part of her recovery. Her death may have been unrelated to the vaccine, but I have been told I should report anyway, as a precaution.


VAERS ID: 1395556 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-14
Onset:2021-03-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Hypertensive heart disease, Myocardial ischaemia, Resuscitation
SMQs:, Hypertension (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Irbesartan 150mg Fenofibrate 160mg
Current Illness: Hypertension
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: No info available.
CDC Split Type:

Write-up: Death. Ischemic and Hypertensive Heart Disease. No signs. Active and athletic middle age man. Was riding bicycle on a trail, stopped pedaling and dropped dead. Died instantly. CPR was performed. No vitals upon arrival.


VAERS ID: 1395663 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-05-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive heart attack and death


VAERS ID: 1395843 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-28
Onset:2021-01-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Death, Discomfort, Feeling abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   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: Atorvastatin Calcium, Bicalutamide, Finasteride, Furosemide, Metropolol, B-6, B-12, Potassium,
Current Illness: Prostate Cancer
Preexisting Conditions: Hip replacement, 5 way bypass in 2001, Esophageal replacement in 2014
Allergies: Penicillin,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dad woke up on January 29, 2021 with severe stomach pains and vomiting. He was very uncomfortable and ended up going back to bed. He was miserable all day. I called his physician and we decided to keep him comfortable at home and give him the BRAT diet which seemed to be helping with the pain and vomiting. Dad never got out of bed again. On February 4th, Dad was placed on Hospice and died on February 7, 2021.


VAERS ID: 1395844 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-13
Onset:2021-05-10
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, Malaise, Mechanical ventilation, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: Lymphocytic Leukemia, Colon Cancer, GERD, High Cholesterol, HTN, Hyperuricemia, Hypothyroid, Iron deficiency Anemai, Leukocytosis, Chronic Macrocytic anemia, Macular degeneration of rt eye, Neuropathy, Neutropenia, thrombocytopenia, Ulcerative Colitis, Vitamin B12 deficiency,
Allergies: unknown
Diagnostic Lab Data: covid-19 positive 5/17/2021
CDC Split Type:

Write-up: pt had 2nd Moderna vaccine on 2/10/2021 lot # 013M20A. Pt became Ill on 5/10/2021, test covid-19 positive on 5/17/2021 and treated with BAM, Intubated on vent 6/1/2021 deceased 6/13/2021


VAERS ID: 1395873 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-01
Onset:2021-05-24
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Traceva 18u, Amloditin 10mg, glutizide 10 mg, formin 1000, dicyclamine, metaporlal, pregnazone, aspirin, styolato, multi-vitamin, stool-softener, xanax
Current Illness:
Preexisting Conditions: Non-Hodgkin''s Lymphoma
Allergies: Uncertain
Diagnostic Lab Data: Tested positive for covid 05/24.
CDC Split Type:

Write-up: Pt went to the hospital with covid 05/30. She was on bipap at 100%. Pt ended up passing away 06/11 at 5:32 pm.


VAERS ID: 1395978 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-26
Onset:2021-06-11
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Oxygen saturation decreased
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 16 days following vaccine patient''s Sp02 saturation dropped to 70-80% despite being on 6liters O2


VAERS ID: 1396032 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-06-11
Onset:2021-06-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   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: Enalapril-HCTZ, prednisone, Albuterol nebulizer
Current Illness: states that asthma has been doing well lately
Preexisting Conditions: Asthma, Hypertension, MR
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had no reaction at time of vaccination; was monitored for 15 minutes prior to leaving clinic. This nurse was notified today by ER Physician that the patient came into the ER around 8pm (on the night of the same day that he received his vaccine in the early morning hours) with c/o shortness of breath. It was reported that the patient had taken nebulizer treatments at home with no relief. Symptoms began around 5:30pm. Patient ambulated into ER at time of visit but during the visit became unresponsive. Patient was intubated and coded with time of death called at 9:52pm. Patient has history of asthma.


VAERS ID: 1396353 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-03-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Arteriosclerosis, Autopsy, Bronchial irritation, Coronary artery disease, Death, Dyspnoea, Emphysema, Enteritis, Eosinophilia, Hypertension, Myocardial fibrosis, Myocarditis, Oedema, Respiratory viral panel, Resuscitation, SARS-CoV-2 test negative, Toxicologic test normal, Tryptase, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   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: Current medications included apple cider vinegar, atenolol, cinnamon bark, Lofibra, Glucotrol, Lisinopril, metformin, multivitamin, pioglitazone, potassium, nystatin cream.
Current Illness: Unknown
Preexisting Conditions: PMH includes cardiovascular disease, diabetes, severe obesity (BMI 45.3), prostate cancer.
Allergies: He had a history of allergies to Januvia and cephalexin.
Diagnostic Lab Data: Full autopsy performed on 3/12/2021. Findings included: lungs - emphysema with mild to focally moderate lymphoplasmacytic inflammation of bronchi, with rare to moderate eosinophils, with bronchial mast cells with associated tissue edema; heart - interstitial fibrosis, CAD with multiple areas of lymphoplasmacytic inflammation within the epicardium with rare eosinophils and scattered mast cells in myocardium and within epicardial fat near AV node; small intestine- intense eosinophilic enteritis and some areas of scattered eosinophilic inflammation; bone marrow - eosinophils identified, all cell lines present; cause of death hypertensive and atherosclerotic cardiovascular disease, contributing causes pending. Postmortem SARS-CoV-2 and respiratory pathogen panel negative; tryptase 11.11 ng/ml; toxicology negative.
CDC Split Type:

Write-up: Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful.


VAERS ID: 1396378 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-30
Onset:2021-05-10
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, General physical health deterioration, Hypersomnia, Hypophagia, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad)

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: Patient received the COVID 19 vaccine on 3/30/21. He died at home on 5/10/2021. Per his daughter, he began to decline approximately 2 weeks prior to his death (poor po intake, weight loss, increased sleep) and had not been dx or treated for an acute illness prior to his death.


VAERS ID: 1396391 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-26
Onset:2021-05-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bone Cancer
Preexisting Conditions: Malignant neoplasm of prostate, COPD
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse event reported during home visit provided by RN on 5/26/2021 from 11:15am to 11:45am. VIS information given to patient prior to vaccination. Patient went to ER on 5/27/2021-5/28/2021 and reported that not feeling well. Patient discharged home from ER. Family found him dead in his apartment on 6/3/2021.


VAERS ID: 1396396 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-27
Onset:2021-05-12
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: In assisted living facility
Preexisting Conditions: Unknown using nasal canula for oxygen
Allergies: None known
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient passed away on 5/12/2021 at assisted living facility


VAERS ID: 1396420 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-22
Onset:2021-05-12
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown, She had been in the hospital recently before the vaccine dose was given.
Preexisting Conditions: Unknown
Allergies: Codeine, and Erythromycin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Client passed away on 5/12/2021, she had been residing at assisted living facility.


VAERS ID: 1396485 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-30
Onset:2021-05-13
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per obituary, patient died at the Hospital on 5/13/2021. SARS CoV2 PCR on 5/12/2021 was negative.


VAERS ID: 1396581 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-03-14
Onset:2021-04-02
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Mechanical ventilation, Vaccine breakthrough infection
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HIV+, hypertension, and BMI=43
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a COVID-19 vaccine breakthrough case who is deceased. Patient was admitted to the hospital on 4/5/2021. He was then admitted to the ICU and placed on a ventilator before passing.


VAERS ID: 1396672 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-19
Onset:2021-04-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Chest pain, Diarrhoea, Nausea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide, Lisinopril, Fenobrite, Metformin HCL, Januvia
Current Illness: Chronic rhinitis Deviated nasal septum Hypertrophy of nasal turbinates
Preexisting Conditions: Diabetes Mellitus type 2 Hypertension benign Mixed hyperlipidemia Hypertriglyceriemia Morbid obesity Deviated septum Rash
Allergies: NKDA
Diagnostic Lab Data: 05/01/2021 available at Hospital and possibly staff primary physician
CDC Split Type:

Write-up: 4/27/2021 nausea, on 4/28/2021 nausea, vomiting, diarrhea, 4/30/2021 chest pain, 5/1/2021 cardiac arrest


VAERS ID: 1396725 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions:
Allergies: Not aware of any
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per daughter, patient died the next day after receiving the shot. Patient didn''t have any issues with 1st shot and she went to check on her and she was dead.


VAERS ID: 1397041 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-05
Onset:2021-05-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Decreased appetite, Fatigue, Loss of consciousness, Malaise, Myocardial infarction, Respiratory arrest, Resuscitation, Somnolence, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Potassium 50 MG twice a day
Current Illness:
Preexisting Conditions:
Allergies: chickhen, tomatoes, garlic, onions, anything with codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after shot patient was tired, he was not feeling well, & he never fully recovered. He went to work on Monday, May 10th & worked until 6:00pm. Returned home eat a little & went to bed. Tuesday, May 11th he worked at home, Wednesday, May 12th we had coffee, laughed & joked around & he went back to work at home. I went to check on him about five minutes later & he was sitting up sleeping. He would usually wake up & say I took a power nap but he was not breathing. I started mouth 2 mouth but he did not respond. My sister told my nephew to call 911 & they told us to lay him on the floor & start CPR until the paramedics arrived. Once they arrived & took over they tried to get him to breathe & restart his heart. The paramedics worked on him for a long time giving us updates on what they were trying to do. Patient never regained consciousness. They indicated probably a heart attack.


VAERS ID: 1397246 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-06-03
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio, Aspartate aminotransferase increased, Asthenia, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase normal, Blood creatinine normal, Blood glucose normal, Blood lactic acid, Blood potassium normal, Blood sodium normal, Blood test, Blood urea decreased, Carbon dioxide normal, Dizziness, Echocardiogram normal, Electrocardiogram abnormal, Fatigue, Gait inability, Haematocrit decreased, Haemoglobin normal, Headache, Hypophagia, Nausea, Platelet count normal, Protein total normal, Pyrexia, SARS-CoV-2 test negative, Sinus rhythm, Supraventricular extrasystoles, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 2
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABORATORY DATA: Reviewed by me in ED. WBC 9.9, hemoglobin 14.4, hematocrit 41.8, platelets 177. CPK 114. Chemistry, sodium 139, potassium 4.3, chloride 108, carbon dioxide 25, blood glucose 114,BUN 7, creatinine 0.72, calcium 8.9, protein 7.9, albumin 3.8, A/G ratio 0.9, AST 72, ALT 74, alkaline phosphatase 42, bilirubin 0.5. Lactic acid 2. COVID-19 negative. EKG reviewed by me, sinus rhythm with premature atrial complexes.
CDC Split Type:

Write-up: HISTORY OF PRESENT ILLNESS: This is a 20-year-old male with past medical history of asthma, who was brought to ED by ambulance for nausea, vomiting, generalized weakness, and fever. The patient received his second dose of Moderna vaccine 10 days ago. The patient is experiencing symptoms of nausea, vomiting, fatigue, poor p.o. intake for the last few days. He was at ED 4 days ago and had a negative workup. The patient had a fever with T-max of 103 at home. He also had 2 episodes of emesis in the last few days. He denies any diarrhea, chest pain, abdominal pain. He complains of headache. He denies any blurred vision or neck stiffness. At hospital, the patient was given 4 L of fluid and had multiple blood tests. Even echocardiograms were unremarkable. The patient is unable to ambulate because of generalized weakness and dizziness.


VAERS ID: 1397724 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-11
Onset:2021-06-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery thrombosis, Death
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Thrombosis of LAD, death


VAERS ID: 1398443 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse drug reaction
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: USJNJFOC20210619563

Write-up: SEVERE SIDE EFFECTS; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced severe side effects. On an unspecified date, the patient died from severe side effects. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20210619563 - Covid-19 Vaccine Ad26.Cov2.S - Severe Side Effects. This event is considered Unassessable. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: SEVERE SIDE EFFECTS


VAERS ID: 1398476 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-17
Onset:2021-02-15
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Feeling abnormal, Movement disorder, Pain, Vital signs measurement
SMQs:, Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASPIRIN 81; CALCITRIOL; CLOPIDOGREL; FERROUS SULFATE [FERROUS SULFATE HEPTAHYDRATE]; FUROSEMIDE; ISOSORBIDE; LAMOTRIGINE; METFORMIN HYDROCHLORIDE; METOPROLOL; PANTOPRAZOLE; VITAMIN B12 NOS; VITAMIN D3 1000; LANTUS; ACITRETIN; DULOXETINE; AT
Current Illness: Atherosclerosis; Blood pressure high (stable); Diabetes; Heart attack (recovered)
Preexisting Conditions: Medical History/Concurrent Conditions: Stroke (recovered)
Allergies:
Diagnostic Lab Data: Test Name: Vitals; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Death; Felt like he was dying; Can''t move; Hurting pain over the whole body; Weak; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death), FEELING ABNORMAL (Felt like he was dying), MOVEMENT DISORDER (Can''t move), PAIN (Hurting pain over the whole body) and ASTHENIA (Weak) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 016M20A and 028L20A) for COVID-19 vaccination. The patient''s past medical history included Coronary artery disease in 2000 and Stroke (recovered) in 1992. Concurrent medical conditions included Diabetes since 2000, Blood pressure high (stable) since 1964, Atherosclerosis since 2016 and Heart attack (recovered) since 2019. Concomitant products included PANTOPRAZOLE for Acid reflux (oesophageal), METOPROLOL for Blood pressure, DULOXETINE for Depression, METFORMIN HYDROCHLORIDE for Diabetes, FERROUS SULFATE HEPTAHYDRATE (FERROUS SULFATE [FERROUS SULFATE HEPTAHYDRATE]) for Iron deficiency, LAMOTRIGINE for Seizure, ACETYLSALICYLIC ACID (ASPIRIN 81) from 18-Jul-2017 to an unknown date, CALCITRIOL, CLOPIDOGREL, FUROSEMIDE, ISOSORBIDE, VITAMIN B12 NOS, COLECALCIFEROL (VITAMIN D3 1000), INSULIN GLARGINE (LANTUS), ACITRETIN, ATORVASTATIN, LOSARTAN POTASSIUM (COZAAR), DULAGLUTIDE (TRULICITY), METFORMIN HYDROCHLORIDE (METFORMINE HCL) and LAMOTRIGINE for an unknown indication. On 17-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-Feb-2021, the patient experienced FEELING ABNORMAL (Felt like he was dying) (seriousness criteria death and hospitalization), MOVEMENT DISORDER (Can''t move) (seriousness criteria death and hospitalization), PAIN (Hurting pain over the whole body) (seriousness criteria death and hospitalization) and ASTHENIA (Weak) (seriousness criteria death and hospitalization). The patient was treated with TRAMADOL for Pain, at a dose of 50 mg; LORAZEPAM for Anxiety, at a dose of 0.5 mg and MECLIZINE [MECLOZINE] for Dizziness, at a dose of 25 mg. The patient died on 05-Mar-2021. The reported cause of death was heart and kidney failure and Kidney failure. An autopsy was not performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Vital signs measurement: unknown (Inconclusive) Inconclusive. This is a case of sudden death in a 74-year-old male patient with a history of Coronary artery disease and Stroke, who died of heart and kidney failure 19 days after receiving last dose of vaccine. Very limited information has been provided at this time. Most recent FOLLOW-UP information incorporated above includes: On 04-Jun-2021: Follow up received, includes patient''s gender. On 07-Jun-2021: Follow up received, includes Patient information, historical conditions, batch number, cause of death, concomitant drugs.; Sender''s Comments: This is a case of sudden death in a 74-year-old male patient with a history of Coronary artery disease and Stroke, who died of heart and kidney failure 19 days after receiving last dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Heart and kidney failure; kidney failure


VAERS ID: 1398495 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
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: No medical history information was provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Myalgia; Chills; Taste loss; Smell loss; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Myalgia), CHILLS (Chills), AGEUSIA (Taste loss) and ANOSMIA (Smell loss) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 030M20A and 007M20A) for COVID-19 vaccination. No medical history information was provided. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced MYALGIA (Myalgia) (seriousness criterion death), CHILLS (Chills) (seriousness criterion death), AGEUSIA (Taste loss) (seriousness criterion death) and ANOSMIA (Smell loss) (seriousness criterion death). The patient died on 06-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No Concomitant medication information was provided. No treatment medication information was provided. Company Comment: This is a case of sudden death in a 74-year-old male patient with unknown medical history died after receiving vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of sudden death in a 74-year-old male patient with unknown medical history died after receiving vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1398528 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: heart attack; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (heart attack) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) unknown. On an unknown date, the patient experienced MYOCARDIAL INFARCTION (heart attack) (seriousness criteria death and medically significant). The reported cause of death was Myocardial infarction. It is unknown if an autopsy was performed. Concomitant medications were not reported. No treatment information was provided. Patient reported a family member died from a heart attack shortly after getting your vaccine. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Myocardial infarction


VAERS ID: 1398802 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-16
Onset:2021-04-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN0151 / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   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: Blood pressure med don?t know name
Current Illness: Psriosis
Preexisting Conditions: Psriosis had short history of blood pressure
Allergies: None
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Patient went into cardiac arrest about 14 hours after receiving vaccine and passed


VAERS ID: 1399352 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Montana  
Vaccinated:2020-12-30
Onset:2021-05-18
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cataract operation, Death, Dyspnoea, Small cell lung cancer
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Lens disorders (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had cataract surgery in mid May, developed shortness of breath after, was seen in ER and admitted. Found to have stage 4 small cell lung cancer (not a smoker to my knowledge). Stayed in hospital until June 3rd when he was transferred home to medical center for end of life care. Died June 7th.


VAERS ID: 1399358 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-21
Onset:2021-06-09
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: RA, HTN, CKD, CAD
Allergies: methotrexate, Augmentin, azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient deceased 6/9/2021 from COVID pneumonia


VAERS ID: 1399375 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-18
Onset:2021-06-03
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Syncope
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   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: NONE
Current Illness: NONE
Preexisting Conditions: Heart Murmur
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Coroner stated that 3 weeks after patient received 2nd dose of COVID-19 Moderna vaccine, patient collapsed from cardiac arrest, which lead to death.


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