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From the 5/7/2021 release of VAERS data:

Found 4,057 cases where Vaccine is COVID19 and Patient Died



Case Details (Reverse Sorted by Onset Date)

This is page 5 out of 41

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VAERS ID: 1243300 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-06
Onset:2021-04-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Fatigue, Feeling abnormal, Impaired work ability, Unresponsive to stimuli, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (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: 2021-04-21
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: Smoker
Allergies: None Known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started feeling bad two=three days after shot, became fatigued, lost 15 pounds and could not go to work. On morning of 4/21 was found unresponsive and rushed to hospital where he died 2 hours later


VAERS ID: 1246534 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Cardiomegaly, Death, Nausea, Pain in extremity, Renal disorder, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Acetaminophen at approximately 5:00pm.
Current Illness: No.
Preexisting Conditions: Asthma, stomach ulcers.
Allergies: No.
Diagnostic Lab Data: Dr. from the Office of Chief Medical Examiners is currently conducting an autopsy report but shared some initial findings such as: an enlarged heart and patches on her kidney (4/10/21)
CDC Split Type:

Write-up: Patient felt initially well, but later in that afternoon her arm started hurting and she felt increasingly nauseous and started vomiting at 10:49pm, two hours later she was pronounced dead at approximately 12:30am.


VAERS ID: 1263591 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Respiratory arrest, Resuscitation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Fluoxetine, Gabapentin, Lorazepam, Losartan, Pantoprazole, Crestor
Current Illness: Hypertension, Hyperlipidemia, Chronic back pain
Preexisting Conditions: HTN, CHronic back pain
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 12 hours of vaccine patient complained of being short of breath and asked his wife to call 911, he then stopped breathing and she did CPR until rescue squad arrived. Pt was unable to be revived and died.


VAERS ID: 1268636 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-06
Onset:2021-04-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received the vaccine, no adverse reactions while at the facility/post observation time period. Patient''s niece came into the facility on 4/28/2021 and stated that patient was sick and couldn''t move out of the bed after getting the shot. After three days, patient went into Hospital and later expired on 4/27/2021.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GLUCONORM G1 (METFORMIN HYDROCLORIDE 500 MG) TENOLOL - 12.5 MG
Current Illness: DIABETES, BP
Preexisting Conditions: DIABETES, BP
Allergies: NO
Diagnostic Lab Data: CONTACT 911 FOR THE REPORTS ON TESTS THEY DID
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away


VAERS ID: 1292940 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-08
Onset:2021-04-09
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, HTN, obesity
Allergies: iodine, simivastin
Diagnostic Lab Data: covid test
CDC Split Type:

Write-up: tested positive for covid


VAERS ID: 1249184 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-04-09
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210422620

Write-up: ACUTE DECOMPENSATION; This spontaneous report received from a consumer via a company representative concerned a 7 decade old female. The patient''s height, and weight were not reported. The patient''s past medical history included oncologic process. The patient received covid-19 vaccine ad26.cov2.s (form of admin and route of admin were not reported, batch number: Unk) dose was not reported, administered on 08-APR-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 09-APR-2021, the subject experienced acute decompensation. On 09-APR-2021, the subject died from unknown cause of death. The patient had an oncologic process for which she considered traveling to the US to be vaccinated against COVID given that in Argentina and patient would to wait very long. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210422620-Covid-19 Vaccine Ad26.Cov2.S-Acute Decompensation. This event is considered Unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1181914 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Accident, Death
SMQs:, Accidents and injuries (narrow)

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

Write-up: Patient entered Drug store to get his second Moderna COVID shot on 4/8/2021 at approx. 12:30pm. (First dose was 3/11/2021) He filled out his Pre-Vaccination Checklist for COVID-19 Vaccines and signed the consent. His form was reviewed and he was given his vaccine in his left deltoid. He then was given his CDC card and waited at least 15 minutes and then exited the building. At 1p.m he was in an accident on the main highway. He was conscious after the accident, but later did pass away. This information came from a Police Officer as no one at the pharmacy witnessed the accident.


VAERS ID: 1182018 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-31
Onset:2021-04-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   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: Xarelto 20 mg daily Chlorthalidone 25 mg daily Amlodipine 5 mg daily Potassium Chloride BID Furosemide 40 mg BID Amlactin 12% gtts BID Calcium with Vitamin D daily Arimidex 1 mg daily Metformin 500 mg BID Pravastatin 40 mg HS Labetalol 200
Current Illness: None
Preexisting Conditions: Atrial fibrillation Obesity Hyperlipidemia Diabetes mellitus Hypertension Breast cancer Chronic lower extremity edema with venous stasis dermatitis
Allergies: Catapres Prinivil Corgard Procardia Cardiazem
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death from cardiac arrest


VAERS ID: 1185061 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Lipase increased, Pancreatitis acute, Sudden cardiac death, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol; Norco; Methylphenidate, Budesonide, Pantoprazole; Hydrocortisone, Venlafaxine, Atenolol; Omeprazole; Levothyroxine; Verapamil ER; Cyanocobalamin; Ondansetron; Triamcinolone Acetonide; Ventolin HFA; Spiriva HandiHaler; Ipratropium
Current Illness: Denied - pt. has 2nd Covid vaccine on 04/07/2021
Preexisting Conditions: COPD, Hypothyroidism, Graves Disease, PAD, restless legs, recent amputation of right 3 and 4th toe, EF on 10/05/20 of 55-60%; HTN, Hx. of TB; arthritis, Hx. of MRSA; Carpel tunnel syndrome, pancreatitis, CHF, chronic kidney disease, Depression. Dx. with Covid-19 on 11/08/20.
Allergies: ASA, Cefuroxime, Fentanyl, Iopamidol, Levofloxacin, Midazolam, NSAIDS, Tramadol
Diagnostic Lab Data: None applicable to this event on 04/08/2021 since pt. was found passed away in her bath tub.
CDC Split Type:

Write-up: On 04/08/2021 pt. was found passed away in her bath tub. Pt. received her 2nd dose of the Covid vaccine on 04/07/2021 at 2:00 p.m. Family choice not to have an autopsy performed and death certificate was completed with cause of death "sudden cardiac arrest". Note on 2/20/21 Pt. was transferred to Hospital with dx. of acute pancreatitis with elevated lipase and wbc.


VAERS ID: 1185219 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-30
Onset:2021-04-08
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown but patient was administered the vaccine at home due to report of homebound status.
Allergies: None per Pre-Vaccination Checklist
Diagnostic Lab Data: Unknown of Medical Examiner will be doing any testing.
CDC Split Type:

Write-up: Patient was vaccinated on 3/30/2021. Found DOA on 4/8/2021. Last time anyone spoke with the patient was on 4/3/2021.


VAERS ID: 1194600 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Acute cardiac event, Death, Malaise, Somnolence
SMQs:, Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Other ischaemic heart disease (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril We think High Blood pressure medicine as well She had been prescribed Sertraline but do not believe she was taking it
Current Illness:
Preexisting Conditions: Asthma High Blood Pressure High Cholesterol
Allergies: Penicillin and Shellfish
Diagnostic Lab Data: Medical Examiner suspects cardiac event, however, she left work early not feeling well Thursday evening (falling asleep at work) and no one heard from her after that. No time of death has been given but we are assuming Thursday evening since no one heard from her. They are going to cremate her tomorrow and we want to make sure if any tests need to be done, we can have them hold off. We feel it necessary for you to do an autopsy to confirm cause of death.
CDC Split Type:

Write-up: Death She was found Saturday Apr 10th deceased at her home.


VAERS ID: 1197086 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Death
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: The individual complained of severe stomach pain - called 9-1-1 was unable to be revived.


VAERS ID: 1197095 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-04-08
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1199594 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: obesity, hypertension
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: There were no noted adverse signs or symptoms at the time of vaccination. Fiance of patient called Public Health on 4/12/21 to report the patient died in her sleep overnight on 4/7 or 4/8. Autopsy not performed, body embalmed prior to Public Health''s knowledge of client death. Pfizer BioNTech COVID-19 Vaccine EUA


VAERS ID: 1201182 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-19
Onset:2021-04-08
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 10mg
Current Illness: hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Normal wellness exam 3/25/2021
CDC Split Type:

Write-up: Sudden death - found by paramedics


VAERS ID: 1202967 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-03-20
Onset:2021-04-08
   Days after vaccination:384
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Exposure to SARS-CoV-2, Pulse absent, Respiratory arrest, SARS-CoV-2 test positive, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested positive for COVD on 4/1
CDC Split Type:

Write-up: Death Narrative: Patient had Pfizer COVID vaccine dose #1 on 3/20/21. He called his provider on 3/30 to report known exposure to COVID that occurred on 3/27 and 3/28. On 4/1 he tested positive for COVID swabbed at the facility and sent to the main facility for processing. He was notified of positive result on 4/1 at 4pm. He was advised to quarantine and to call facility call center/triage should he develop any fever, shortness of breath, and other Covid-related symptoms. Provider received a phone call from PD on 4/8 notifying of patient unattended death. According to EMS report neighbors were aware of patients COVID positive status. No one had seen or heard from the patient in 3 days so they contacted PD for wellness check. Entry was forced into apartment and patient was found deceased, sitting on the couch. Not breathing ashen color. Pt has ringer and no Pulse. PMH: Quit tobacco 5-15 yrs ago Hyperlipidemia Hyperglycemia Obesity Allergic rhinitis, stable Hx AAA and Right ICA aneurysm, S/P Open repair in 2013 Patient had no prior history of COVID before 4/1 diagnosis. He was not having any symptoms between 4/1 when he tested positive and he did not call to report any symptoms between 4/1 diagnosis and death. There was no communication after 4/1 positive covid test. Patient was scheduled for a phone call with RN on 4/8 the date he was found deceased. Cause of death is not mentioned, but suspected to be due to COVID infection. There were no reported side effects to COVID Vaccine administration.


VAERS ID: 1204112 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-04-06
Onset:2021-04-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Unknown       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: 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:

Write-up: Patient suffered a left sided nontraumatic intracerebral hemorrhage


VAERS ID: 1207198 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-04-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN6199 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Blood lactic acid increased, Chronic kidney disease, Death, Gastrointestinal haemorrhage, Spinal compression fracture
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Gastrointestinal haemorrhage (narrow), Accidents and injuries (narrow), Ischaemic colitis (broad), Osteoporosis/osteopenia (broad), Chronic kidney disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Anemia GI bleed Lactate blood increased CKD (chronic kidney disease) Jefferson fracture


VAERS ID: 1207254 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-20
Onset:2021-04-08
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Death, Headache
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased complained of abdominal pain and was taking aspirin for a headache. He died within less than a day of initial complaints.


VAERS ID: 1207999 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-04-08
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized x 3 and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1208762 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-04-08
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

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

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

Write-up: Death


VAERS ID: 1212771 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Agonal respiration, Bacteraemia, Cardiac arrest, Computerised tomogram abdomen normal, Computerised tomogram pelvis, Computerised tomogram thorax normal, Condition aggravated, Dyspnoea, Endotracheal intubation, Gastrointestinal disorder, Gastrointestinal haemorrhage, Hepatobiliary disease, Intensive care, Pulseless electrical activity, Resuscitation, Scan with contrast, Sepsis, Systemic candida
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Angioedema (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 (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone (PACERONE) 100 mg Oral Tablet Sig: TAKE 1/2 TABLET BY MOUTH DAILY budesonide/formoterol (SYMBICORT) 160-4.5 mcg/actuation Inhalation HFA Aerosol Inhaler Sig: Inhale by mouth. clopidogrel 75 mg Oral Tablet Sig: Take 7
Current Illness: ESRD on PD, pAfib, CAD, HTN, HLD, hypothyroidism, who was brought in after a witness cardiac arrest.
Preexisting Conditions: above
Allergies: ASA
Diagnostic Lab Data: ICU admission post PEA arrest. Pt was septic: per ID notes: It remains uncertain what happened. The polymicrobial bacteremia and candidemia favors GI/hepatobiliary sepsis. However contrast-enhanced CT of the abdomen and pelvis yesterday does not show any obvious indication of anatomic abnormality. CT of the chest does not reveal any evidence of pneumonia. He has not improved despite aggressive polymicrobial therapy. He is not making urine and is building up acid. His chance of survival is minimal. In retrospect it does not appear that this is a side effect of COVID-19 vaccination as he is found to have multiple organisms in the blood. Vancomycin is no longer indicated and can be stopped. He also does not need any further tobramycin. Zosyn and anidulafungin are all that is required here based on the culture results.
CDC Split Type:

Write-up: an 87 year old male with ESRD on PD, pAfib, CAD, HTN, HLD, hypothyroidism, who was brought in after a witness cardiac arrest. Patient apparently received the first dose of the Covid vaccine (pfizer) at around 11 am. He was doing fine the rest of the day until later in the evening when he had shortness of breath without chest pain, abdominal pain, nausea, vomiting. Upon EMS arrival, the patient appeared to have some agonal breathing and then went down, was in PEA arrest, received CPR with 1 dose of calcium, 1 dose of bicarbonate, and 3 doses of epinephrine with return of spontaneous circulation. Upon arrival in the ED, patient had an intraosseous line, on dopamine for soft blood pressure. Patient has been successfully intubated.


VAERS ID: 1213285 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-04-08
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / IM

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

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

Write-up: Death Narrative: Patient received his first COVID-19 vaccination 2/27/2021 and received his second COVID-19 vaccination 03/27/2021. Patient had not been tested for COVID per chart review and had no contraindications to receiving the vaccine. Patient did not experience any adverse events to the COVID-19 vaccine between time of vaccination and the time of death 12 days later. Of note, patient was receiving home hospice at the time of his death (04/08/2021) for his advanced acute myeloid leukemia.


VAERS ID: 1214056 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Face injury, Fall, Skin laceration
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: denied blood thinners during screening/unknown if taking other meds
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: denied any allergies
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: got up out of his chair to leave from his 15 minute wait and fell face down on the floor. He did not put his hands out and received a cut on his left cheek below eye from glasses. He was assisted onto his feet and back onto his chair. Vital signs were BP-117/64, Pulse 85, RR 18, O2 sat 98% (WNL). Water provided to patient. Had him take several deep breaths. Band Aid applied to cut on cheek. Patient did not complain of any symptoms. Denies dizziness. Refused to seek further medical attention or go to ER. He was then assisted back to his car by staff after the incident.


VAERS ID: 1214135 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Chronic Kidney disease, coranary disease, mulitple medical , full list can be gotten from primary
Preexisting Conditions: stage 4 renal failure,
Allergies: none listed
Diagnostic Lab Data: none
CDC Split Type:

Write-up: unknown, death at home, with no one in attendance. Pt with mulitple medical conditions, when RN adminstered 2nd dose on 4/07/2021. They dicussed how the first one went. Pt states, besides sore arm nothing. She did have acid reflux, (common for her) which she took regular medication which took care of it. But denied any other problems with first dose. Seccond dose given with no reaction during 15 min observation time. EMS was called to scene on 4/08/2021 at approx 1630 hrs, to find pt deceased, spine in bed. approx down time 2-3 hrs. Pt''s primary Dr. contact as well as corner. With pt''s medical history no further investigation was done.


VAERS ID: 1216240 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-16
Onset:2021-04-08
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Iron Multi vitamin
Current Illness: Na/unknown
Preexisting Conditions: NA- cancer 30 years ago
Allergies: Na/unknown
Diagnostic Lab Data: See hospital
CDC Split Type:

Write-up: Massive stroke Death 4 Days later


VAERS ID: 1222868 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-03-31
Onset:2021-04-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Cough, Death, Heart rate increased, Hypotension, Lung disorder
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   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: Phenacyl, Zoloft, Aspirin, Lorazepam, Losartan, Metformin, Eloupramide, Lasix
Current Illness: None reported
Preexisting Conditions: Diabetes, amputation in one limb, hypertension, cardiovascular, lung problems and dementia.
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR-108-21

Write-up: According to POC the resident was transferred to the hospital on 4/8/2021, due to low pressures, high pulse and cough. They certify death by COVID 19, because it affected the lungs.


VAERS ID: 1224121 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM6205 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, Fall, Intensive care, Pain, Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 5
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide, Metoprolol Succinate ER, Entresto, Warfarin Sodium, Levothyroxine Sodium, Tamsulosin HCl, Finasteride, Fexofenadine-Pseudoephed ER, Florastor, Lovenox, Tramadol.
Current Illness: None
Preexisting Conditions: Heart surgery in 2000, Colon surgery 2018.
Allergies: None
Diagnostic Lab Data: I do not have the Emergency Room nor Intensive Room records
CDC Split Type:

Write-up: My Husband and I received the same day a strong pain in our left arms. The next day my husband complained about pain in his entire body and weakness, and I had the same. In the evening he collapsed falling out of his wheelchair. He tried for an hour to sit down back in his wheelchair with my help, but he couldn''t. He agreed that I call 911. Two nurses took him to Emergency Room at Hospital and didn''t allow me to go with him. In the morning on Saturday, he was transferred to Room at Hospital and the next day to the Intensive Care Room, where he sadly passed away on Tuesday April 13 at 4:22 am.


VAERS ID: 1224919 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-08
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021392222

Write-up: the client died yesterday; This is a spontaneous report from a non-contactable other healthcare professional (hcp) from a Pfizer-sponsored program. A patient of unspecified age and gender received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE, Solution for injection, lot number and expiry date were not reported) via an unspecified route of administration on an unspecified date at a single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died on 08Apr2021. The 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 been obtained.; Sender''s Comments: Death of unknown cause is assessed related as a cautionary measure and for reporting purposes. 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 client died yesterday


VAERS ID: 1240574 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-08
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210424597

Write-up: DEATH; This spontaneous report received from a consumer concerned a female of unspecified age and unknown race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN) dose was not reported, administered on 05-APR-2021 for prophylactic vaccination. The batch number was not reported, the company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 08-APR-2021, after 3 days of vaccination the patient died due to unknown cause. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: This is a spontaneous report of a female of unspecified age who died 3 days following the administration of the Janssen COVID-19 vaccine. Cause of death, details surrounding the death, the patient''s medical history and concomitant medications were not reported. There are insufficient details to make a meaningful medical assessment at this time.; Reported Cause(s) of Death: UNKNOWN CASE OF DEATH


VAERS ID: 1243648 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aripiprazole, apixaban, basaglar, gabapentin, fluoxetine, metoprolol, furosemide, famotidine, farxiga, albuterol, mametasone, admelog, atorvastatin
Current Illness: none
Preexisting Conditions: HF, Bipolar, OSA, DMs, HLD, HTN, PE, morbid obesity, COPD/Asthma
Allergies: no known allergies
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: headache on 4/8/21, sudden death 4/11/2021


VAERS ID: 1247898 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-02
Onset:2021-04-08
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Dementia, Cardiovascular Disease, Coronary Artery Disease, Peripheral Vascular Disease
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had second covid 19 vaccine on 2/2/21 at pharmacy. Was admitted on 4/6/21 to hospital with Shortness and Breath, Vomiting, and COVID-19 (tested positive on 4/6/21). Patient expired on 4/8/21 @ 1954.


VAERS ID: 1249559 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-04-08
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Pulmonary embolism, Respiratory distress
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lipid metabolism disorder NOS
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: respiratory distress; cardiac arrest; pulmonary emboliasm; This spontaneous case was reported by a consumer and describes the occurrence of RESPIRATORY DISTRESS (respiratory distress), CARDIAC ARREST (cardiac arrest) and PULMONARY EMBOLISM (pulmonary emboliasm) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Lipid metabolism disorder NOS. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Apr-2021, the patient experienced RESPIRATORY DISTRESS (respiratory distress) (seriousness criterion death), CARDIAC ARREST (cardiac arrest) (seriousness criterion death) and PULMONARY EMBOLISM (pulmonary emboliasm) (seriousness criterion death). The patient died on 11-Apr-2021. It is unknown if an autopsy was performed. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. NO treatment or Concomitant medication were provided. Company Comment This is a case of sudden death in a 76-year-old female patient with a history of Lipid metabolism disorder, who died (date unknown) of respiratory distress, cardiac arrest and PULMONARY EMBOLISM after receiving first dose of vaccine. Very limited information has been provided at this time.


VAERS ID: 1255748 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-16
Onset:2021-04-08
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210408; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC2021439024

Write-up: Patient tested positive for Covid; Patient tested positive for Covid; The patient died; This is a spontaneous report from a contactable consumer. An 86-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 via an unspecified route of administration, administered in right arm on Feb2021 (Batch/Lot Number: En6303) as single dose, and dose 2 via an unspecified route of administration on 16Mar2021 (Batch/Lot Number: Ep7534) as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The patient tested positive for COVID on 08Apr2021 which resulted in Emergency room/department or urgent care, and hospitalization for 3 days. Treatment included high flow oxygen, doxycycline, inhalers, and Rocephin. The patient underwent lab tests and procedures which included Nasal Swab: positive on 08Apr2021. The patient died on an unspecified date. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: The patient died


VAERS ID: 1262410 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-04-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Death, Myocardial infarction, Stent placement
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 2
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: Gout
Allergies: None
Diagnostic Lab Data: Blood work, stents, pump device, meds
CDC Split Type:

Write-up: Heart Attack 2 days after 2nd dose of moderna vaccine - followed by death


VAERS ID: 1263795 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-02-06
Onset:2021-04-08
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Death, Dyspnoea, Fluid retention
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   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: Cardizm, Diltiazm, Ativan, LASIK, tums.
Current Illness: Heart Failure Atrial Fibrillation. Had a bad heart & did not need to be injected with an Experimental Gene Therapy. Which Doese NOT prevent the contracting of Covid-19. The shot did not benefit her at all.
Preexisting Conditions:
Allergies: Not known
Diagnostic Lab Data:
CDC Split Type:

Write-up: 11;45 Mom put her light on had shortness of breathe, needed a Nirtro pill. Didn?t give much relief. Was given Ativan for anxiety & Diltiazm for blood pressure.. not much relief, was given oxygen. Then LASIK for fluid build up. Passed about 6;20 A.M. on the 9th.


VAERS ID: 1266971 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-16
Onset:2021-04-08
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: COVID-19, Chills, Death, Diarrhoea, Dyspnoea, Dyspnoea exertional, Endotracheal intubation, General physical health deterioration, Mechanical ventilation, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: vitamins
Current Illness: None reported
Preexisting Conditions: Morbid Obesity
Allergies: None
Diagnostic Lab Data: Not provided by Health system upon request
CDC Split Type: N/A

Write-up: o 2-Apr-21, developed fever, chills, nausea, and diarrhea which he was managing at home. o 5-Apr-21 performed a PCR swab at Hospital and received positive results on 6-Apr-21. o 8-Apr-21 developed difficulty breathing and notified his Mgmt. who called for an ambulance. He was transported to Hospital and later to Hospital. o SOB on exertion. Receiving vitamins, P and antibiotics. O2 via face mask. Stable condition was the report provided to his wife from Hospital. o 14-Apr-21 condition deteriorated and he was intubated and placed on the ventilator o 15-Apr-21 was transferred to Hospital


VAERS ID: 1267665 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Feeling abnormal, Unresponsive to stimuli
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 1998 flu vax- pt had a reaction about 2 weeks after getting the vax. he was diagnosed transverse .myelitis.
Other Medications: enalapril maleate 20mg bds, hydrochlorothiazide 25mg qd, clonidine hcl 0.2 mg qhs, atenolol 50mg qd,
Current Illness:
Preexisting Conditions: Hypertension, Scoliosis,
Allergies: nka
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: 4/8/21 pt had brain fog like he was in a haze and felt strange being very relaxed like he had taken a tranquillizer he felt better next day. pt seemed to be fine at this point. 4/22/21 pt seemed to be fine and went to the store where he went shopping. He put shopping bags in car. He was found in his car after and hour and 20 minutes by a couple of bystanders unresponsive. 911 was called and he transported to ER. He was intubated but patient died. Unknown is any test were performed.


VAERS ID: 1269415 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-06
Onset:2021-04-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Abnormal behaviour, Acidosis, Blood glucose increased, Blood potassium decreased, Blood pressure abnormal, Cardio-respiratory arrest, Computerised tomogram abdomen normal, Computerised tomogram normal, Confusional state, Cytokine storm, Death, Dehydration, Delirium, Diabetic ketoacidosis, Dialysis, Diarrhoea, Electroencephalogram normal, Hypersomnia, Intensive care, Lumbar puncture normal, Magnetic resonance imaging normal, Malaise, Memory impairment, Pain, Panic reaction, Patient restraint, Peripheral artery occlusion, Peripheral swelling, Poor peripheral circulation, Pyrexia, Restlessness, SARS-CoV-2 test negative, Sedative therapy, Stomach scan normal, Unresponsive to stimuli, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Akathisia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, 1,500 mg 2x daily Pravastatin, 40 mg daily Glimepiride, 4 mg, 1/2 tab in am, 1 tab in pm Januvia, 50 mg twice daily *Prednisone, 5 mg, 1 in am, 1/2 in pm Levothyroxine, 0.100 mg daily * Azathioprine, 50 mg 2x daily Lisinopri
Current Illness: None
Preexisting Conditions: Sarcoidosis (all lymph nodes involved) Causes the sleepiness/?ams? Cannot stop prednisone Diabetes Hypothyroidism High blood pressure High cholesterol Lots of pain in legs Toes curled up Osteoarthritis Polyp - found when doctor tried to do Pap smear/removed 04-01-2013 - taken out later in same year Chronic kidney disease
Allergies: Pseudoephedrines Demerol Oxycodone Vancomycin
Diagnostic Lab Data: see item 18 for the known tests and laboratory results.
CDC Split Type:

Write-up: ? Tuesday, April 6th ? Patient receives the 2nd Pfizer vaccine shot ? Thursday, April 8th ? Patient is sick with vomiting and diarrhea ? Friday, April 9th ? Patient is delirious and still sick with vomiting and diarrhea. She is also has pain in her stomach. An ambulance is called to take her to the hospital. The hospital determines her white blood count is elevated, indicating an infection. Blood sugar is very high ? approximately 400. Covid test is negative. She is restless upon arrival. She tries to climb out of bed continuously. She is restrained. o Saturday, April 10th ? Patient is running a fever and is in pain. She is also confused and doesn?t recognize her oldest sister. Meds are administered to handle both items. (Toradol?). Blood sugar around 200. She continuously counts and calls for Mother and Father. Patient continues to be restless o Sunday, April 11th - at request of family, a CT scan is done of her stomach and abdomen. Nothing is found. Potassium was at 3.2 (normal is 3.5) so she received an IV drip to help with potassium levels. Sugar ? 206. Later drops to 176. Patient calms down some. She is still confused and doesn?t recognize her oldest sister. ? Monday April 12th ? the hospital attempts to do an MRI, but patient panics. This is a closed MRI and her 1st husband died in one. The MRI isn?t done. ? Tuesday, April 13th ? she is asked by the doctor to state her name and wiggle her toes. She complies. Doctor orders speech therapy. She is sedated for an MRI and a CT scan. Both are successfully completed. She sleeps for the rest of the day. Blood sugar ? 274 @ 5:09pm. ? Wednesday, April 14th ? Patient was asleep all day. Most of the day she isn?t responsive when nurses come in and do things like take blood. She normally responds even if she is asleep. Around 5pm she starts to respond and make noises; she briefly opens her eyes then falls asleep. She continues to run a temperature. ? Thursday, April 15th ? Patient is asleep most of the day. She is responsive when nurses do things like take blood. A spinal tap is performed. There was mention of dementia. Hospital is sharing little information, varying from she is retreating into herself vs. something worth isolating is going on. Temp was 102.3 at 7:37, but later dropped to 99.3 without meds. Dr. (neurologist) provides an update to the family. Tests so far are negative. EEG showed sleeping brain (she was asleep during test). MRI showed nothing. Spinal tap negative so far. No infection or anything has shown up. Orders another EEG and MRI ? Friday, April 16th ? Patient tried to open her eyes. ? Saturday, April 17th ? a met code was called on her and she was moved to ICU. A circulation issue was found in right leg. Occlusion was really bad. Initially the doctor was concerned about blood clots. None were found, just swelling. Pressure was relieved. Blood pressure issues. She was put on 2 blood pressure meds, at least. She was dehydrated and acidic. Diabetic ketoacidosis was mentioned. A cytokine storm was expected. ? Sunday, April 18th ? blood pressure not stable. She was put on dialysis. Peripheral circulation was worse. ? Monday, April 19th ? she coded around 5am. Doctors were trying to save her. She passed away about 30 minutes later .


VAERS ID: 1270973 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Bedridden, Cardiac arrest, Death, Muscle contracture, 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), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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:
Current Illness: female with a history of dementia, CVAs, hypertension, chronic indwelling Foley catheter with recurrent UTIs, peripheral neuropathy, breast cancer who presents with vomiting and abnormal results to the emergency room, patient was unable to give a history and is bedridden with severe contractures and is near nonverbal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine administered 4/8 at 1429 patient had a cardiac arrest on 4/8 at 2209 patient expired 4/10/21


VAERS ID: 1282687 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-04-08
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / N/A UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 12
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: see previous submission


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN SHE IS DECEASED
Current Illness: UNKNOWN SHE IS DECEASED
Preexisting Conditions: HISTORY OF MULIPLE SCLEROSIS
Allergies: UNKNOWN SHE IS DECEASED
Diagnostic Lab Data: Autopsy April 22
CDC Split Type:

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


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

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

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

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


VAERS ID: 1293257 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-08
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: J96.01 - Acute respiratory failure with hypoxia (CMS/HCC) R57.9 - Shock (CMS/HCC) A41.9 - Sepsis, unspecified organism


VAERS ID: 1272743 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-04-08
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: ARJNJFOC20210455424

Write-up: DEATH; This spontaneous report received from a patient via a company representative concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, 1 total administered on 05-APR-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 08-APR-2021, the patient died from unknown cause of death three days after vaccination (vaccinated on 05-APR-2021). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death); Sender''s Comments: 20210455424-Covid-19 vaccine ad26.cov2.s-death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1178887 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Unknown  
Location: Maryland  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1180565 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-01
Onset:2021-04-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Death, Feeling of body temperature change, Hyperhidrosis, Musculoskeletal stiffness, Peripheral coldness, Staring, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chemotherapy
Current Illness:
Preexisting Conditions: Stage 1 Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 04/07/2021 cold hands, alternating hot and cold sweats, arm stiffness, shaking, aphasic and blank stare. Date of death 04/07/2021.


VAERS ID: 1188126 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-03-02
Onset:2021-04-07
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Haematemesis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   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: Vitamin C, miralax, Rispedal, tamsulosin
Current Illness: Dementia, general debility
Preexisting Conditions: schizophrenia, general debility
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was on hospice for general debility for about 2 years. Patient was eating 100% and propelling self in wheel chair while living in nursing home. Received Covid vaccine #1 on 2/2/21 and #2 on 3/2/21. No other significant events occurred until starting 4/7/21 when patient started vomiting food. Then on 4/8/21 patient vomited large amount of coffee ground emesis. Then on 4/9/21 patient expired.


VAERS ID: 1196099 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH OF PATIENT REPORTED ON 04/07/2021 AT 11:25PM


VAERS ID: 1198157 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-07
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospice patient death within 60 days of receiving the COVID vaccine series


VAERS ID: 1198227 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-05
Onset:2021-04-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Fluid intake reduced, Incoherent, Influenza like illness
SMQs:, Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   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: ISOSORBIDE MONONITRATE 30MG, TELMISARTAN 80MG, HYDRALAZINE 100MG, OMEPRAZOLE 20MG, PREDNISONE 1MG, METHOTREXATE 25MG/ML INJ, ATORVASTATIN 80MG, LANTUS, NOVOLOG
Current Illness:
Preexisting Conditions: DIABETES, ARTHRITIS, HEART
Allergies: NKA
Diagnostic Lab Data: CONTACT HOSPITAL FOR INFORMATION
CDC Split Type:

Write-up: SON REPORTED THAT PATIENT WOKE UP 4/7/21 WITH FLU LIKE SYMPTOMS AND STAYED IN BED ALL DAY. PT DID NOT DRINK ANYTHING OR TAKE INSULIN ON 4/7/21. WHEN DAUGHTER ARRIVED AT PTS HOME THAT EVENING, PT WAS INCOHERENT. SHE CALLED 911 AND PT WAS TRANSPORTED TO THE HOSPITAL WHERE HE PASSED AWAY ON 4/9/21.


VAERS ID: 1198967 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-31
Onset:2021-04-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cerebral palsy, seizure disorder
Preexisting Conditions: Cerebral palsy, seizure disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest, death


VAERS ID: 1203902 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-13
Onset:2021-04-07
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Pneumonia, Pulmonary embolism, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: insulin methotrexate amlodipine hydralazine hydroxychlororoquine lisinopril folic acid
Current Illness: diabetes, rheumatoid arthritis
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood Clot which led to Pulmonary Embolism, Pneumonia, and death.


VAERS ID: 1207228 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-04-07
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1207428 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Known Drug Allergies
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient declared deceased the day after receiving second Moderna COVID vaccine. not her regular pharmacy to our knowledge. Have attempted to contact last known PCP with no response. Son notified pharmacy of patient passing away.


VAERS ID: 1207822 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: Hydromorphone, Cyclobenzaprine, Lisinopril, Duloxetine, Sildenafil, Trazodone, Amoxicillin, Sulfate Thoxazole, Buspirone, Metformin, Omeprazole, Carvedilol, Ibuprofen, Pregabalin, Tamsulosin, Gabapentin
Current Illness: back surgery 5 days prior
Preexisting Conditions: Intervertebral disc. disorders with radiculopathy, hypoxemia, atelectasis, type 2 diabetes, essential hypertension, chronic obstructive pulmonary disease, alcohol dependence, major depressive disorder, benign prostatic hyperplasia, gastro-esophageal reflux disease, nicotine dependence, spinal stenosis-lumbar region, syncope and collapse
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse symptoms from vaccination. Decedent died day after 2nd vaccination, death not related to vaccination


VAERS ID: 1208945 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-31
Onset:2021-04-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / N/A - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood sodium decreased, Brain natriuretic peptide increased, Cardiac failure congestive, Cardio-respiratory arrest, Chest X-ray abnormal, Death, Dyspnoea, Electrocardiogram, Endotracheal intubation, Fibrin D dimer increased, Troponin increased, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage laboratory terms (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   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: Aspirin, Atorvastatin, plavix, hydrochlorathiazide/lisinopril, nitroglycerin as needed, omeprazole, paroxetine
Current Illness:
Preexisting Conditions: heart attack, hypertension, dyslipidemia, depression, anxiety
Allergies: Codeine
Diagnostic Lab Data: 4/14/2021 sodium 119 Troponin 0.16 BNP 1,125 D Dimer 1039 Chest xray showed congestive heart failure
CDC Split Type:

Write-up: The patient received the vaccine on 3/31/2021. On 4/7/2021, patient developed weakness that continued until 4/14/2021. Patient also developed shortness of breath on 4/14/2021. The patient presented to the ER for weakness and shortness of breath. Patient had labwork, EKG, and an Xray. Troponin, BNP, and D-Dimer were elevated. Sodium was low. Chest xray showed congestive heart failure. Pt required intubation and then coded. Cardiac life saving procedures were started but the patient succumbed to death. Patient death pronounced per MD.


VAERS ID: 1209119 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-04-07
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Craniocerebral injury, Death, Dehydration, Fall, Pneumonia
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (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), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Dehydration Community acquired pneumonia Closed head injury, initial encounter Fall at home, initial encounter Acute hypoxemic respiratory failure


VAERS ID: 1212251 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Blood culture, Cerebrovascular accident, Computerised tomogram, Condition aggravated, Culture urine, Electrocardiogram, Fall, Full blood count, Metabolic function test
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin Cardizem CD Trelegy Ellipta Glimepiride Levemir Xalatan Synthroid Metformin Actos Zoloft Timolol
Current Illness: STROKE/FALL
Preexisting Conditions: #Acute CVA with left upper extremity hemiplegia #Acute hypercapnic/hypoxic respiratory failure #Underlying COPD #Peripheral vascular disease status post right femoropopliteal bypass 2/16/2021 #CT of the chest with 50-60% stenosis right and 50% stenosis left and plaque on the aorta that was concerning for ulceration #Diabetes mellitus type 2 with nephropathy and neuropathy #Paroxysmal atrial fibrillation #Anxiety/depressio
Allergies: NKDA
Diagnostic Lab Data: CT/CTA CMP/CBC Urine Blood cultures EKG
CDC Split Type:

Write-up: Fall and stroke


VAERS ID: 1212295 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Death, Disorganised speech, Headache, Musculoskeletal stiffness, Neck pain, Pain in extremity, Pyrexia, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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: 2021-04-09
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: Gastroparesis, current smoker
Allergies: No
Diagnostic Lab Data: None reported
CDC Split Type:

Write-up: Patients mom states 12 hours after vaccination dev: fever, chills, stiff neck. Symptoms got progressively worse throughout the day. on the evening of 4/8/21 patients mom describes patient talking "out of her head", fever, chills, leg pain, "bad" headache. On 4/9/21 patient woke up around 5:30 AM, sister helped to bathroom. reported leg pain, neck pain, headache. Laid back down. Sister found patient unresponsive around 9:00 AM. Sister performed CPR. Pronounced dead at patient''s home by EMS.


VAERS ID: 1214325 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-04-07
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Death, General physical health deterioration, Glycosylated haemoglobin, Hypoglycaemia, Metabolic function test, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: acidophilus, allopurinol, aspirin, Breo Ellipta, candesartan, vitamin D3, clopidopgrel, ferrous sulfate, insulin lispro, lactulose, lyrica, metformin, metoprolol tartrate, pantoprazole, senna plus, simvastatin, tradjenta, tramadol, vitamin
Current Illness: UTI, hypoglycemia, smoking cessation
Preexisting Conditions: Obesity, functional quadriplegia, COPD, Severe DJD, Osteoarthritis, Severe neuropathy, Smoking, R heel III ulcer, diabetes
Allergies: no known allergies, latex
Diagnostic Lab Data: CMP, A1C 4/5/21
CDC Split Type:

Write-up: Severe anxiety, Kidney Failure, Hypoglycemia, ER visits, Overall decline, Hospice care, Expired


VAERS ID: 1222366 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-23
Onset:2021-04-07
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: Norvasc, Losartan, Gabapentin, Atorvastatin, Prednisone, Aspirin, Vitamin D
Current Illness: None reported
Preexisting Conditions: Rheumatoid arthritis, Hypertension, Insomnia, Anxiety
Allergies: None reported
Diagnostic Lab Data: None reported
CDC Split Type: PR10321

Write-up: Died a natural death


VAERS ID: 1227451 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-03
Onset:2021-04-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Bilevel positive airway pressure, Blood culture, Blood lactic acid, Chest discomfort, Cough, Culture urine positive, Death, Dyspnoea, Escherichia test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, advair diskus 500/50, albuterol, captopril, famotidine, fluticasone, furosemide, gemfibrozil, imipramine, latanoprost opth., levothyroxine, montelukast, Incruse Ellipta, Vitamin D, Xarelto 20mg
Current Illness:
Preexisting Conditions: COPD, chronic respiratory failure on 2 L nasal cannula at night, congestive heart failure with biventricular pacemaker, chronic anticoagulation on Xarelto secondary to remote DVT-PE, history of IVC filter which is currently present. hypertension, hypercholesterolemia, PVD and hypothyroidism who presented to Emergency room with complaints of approximately 5 days of progressively worsening shortness of breath with a dry nonproductive cough, increased weakness, and wheezing. Symptoms not controlled with increased use of rescue inhaler albuterol. Patient''s daughter reached out and spoke with patient''s pulmonologist Dr. today who ordered oral steroids however patient reports she had not started taking them yet. Patient was initiated on 15 L non-rebreather and received 2 duo nebs EN route to the hospital. It was reported she did have some intermittent chest tightness although on my review, she denied this. Upon arrival to the emergency room, patient was initiated on BiPAP and receive 40 mg of IV Lasix at 125 mg of IV Solu-Medrol.
Allergies: Cephalexin, codeine, adhesive tape, latex, mirabegron, morphine, sulfa
Diagnostic Lab Data: 4/16/21 Blood cultures x 2 - NGTD 2 days, 4/17 Urine culture $g100k Ecoli,, Lactic Acid 9.3 (up to 11.6 prior to death).
CDC Split Type:

Write-up: presented to Emergency room with complaints of approximately 5 days of progressively worsening shortness of breath with a dry nonproductive cough, increased weakness, and wheezing. Symptoms not controlled with increased use of rescue inhaler albuterol. Patient''s daughter reached out and spoke with patient''s pulmonologist Dr. today who ordered oral steroids however patient reports she had not started taking them yet. Patient was initiated on 15 L non-rebreather and received 2 duo nebs EN route to the hospital. It was reported she did have some intermittent chest tightness although on my review, she denied this. Upon arrival to the emergency room, patient was initiated on BiPAP and receive 40 mg of IV Lasix at 125 mg of IV Solu-Medrol. Patient expired 4/19/2021


VAERS ID: 1233385 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-22
Onset:2021-04-07
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Cardiogenic shock, Faeces discoloured, Hypotension, Mental status changes, Multiple organ dysfunction syndrome, Pyrexia, Sepsis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Systolic heart failure, septic shock, metabolic encephalopathy, osteopenia, hx of MI, hypoxia, chronic pain, anemia, hx of skin cancer, hx of hep C, COPD, Alcoholic cirrhosis, afib, htn, hyperlipidemia, severe obesity, hypothyroidism, major depressive d/o, emphysema
Preexisting Conditions:
Allergies: Alendronate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented with abd pain, dark stool, altered mental status, febrile, hypotensive, septic, cardiogenic shock, progressed to multi organ dysfunction.


VAERS ID: 1233795 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Diarrhoea, Dyspnoea, Fatigue, Malaise, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 12
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: Vitamin D3, Celexa. Lisinopril, Trental, Coumadin, Multivitamin
Current Illness: unknown
Preexisting Conditions: HTN, Anxiety, Back pain, depression, obesity, Osterporosis, stroke, TIA
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Information obtained from the Hospital. Began to not feel well the next day, SOB, diarrhea and fatigue. Was admitted to hospital on 4/9/21, diagnosed with COVID, placed on a vent and died on 4/19/21.


VAERS ID: 1243206 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-07
Onset:2021-04-07
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1243358 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-04-07
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized and died within 60 days of receiving a COVID vaccine


VAERS ID: 1243596 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-04-07
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK - / IM

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

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

Write-up: Called to verify coming in for second dose on 4/21/21, family member confirmed death a few weeks ago (a few weeks after first covid dose). Cause of death unknown


VAERS ID: 1264171 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-10
Onset:2021-04-07
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt Deceased prior to dose 2. Reported by home health agency as unrelated to vaccination.


VAERS ID: 1176215 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-04-06
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital on 03/27/2021. He was symptomatic and died at the hospital on 04/06/2021.


VAERS ID: 1179444 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Unknown, patient found deceased at home evening after receiving vaccine.-Severe, Additional Details: called pharmacy inquiring about vaccine for patient. She received her COVID vaccine on 4/6/21 and later that evening was found at home deceased. Called to gather information on the patient/vaccine. Caregiver stated that the patient did not have a PCP, therefore they do not have much medical history on her. There were no notes on adverse reaction during post-vaccine observation. It is unknown at this time if vaccine played any role.


VAERS ID: 1180688 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Cardioversion, Chest pain, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Carbonate/Vitamin D 600 mg daily, Pantoprazole 40 mg daily, aspirin 81 mg daily, Fish oil 1200 mg daily, Multivitamin daily, Flaxseed oil 1000 mg daily, Metoprolol tartrate 25 mg BID, Enalapril 10 mg daily.
Current Illness: Hydrochlorothiazide (shortness of breath), Sulfamethoxazole/Trimethoprim (Hives)
Preexisting Conditions: cancer, GERD (with hiatal hernia), hypertension, anemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated on 4/6/21 at 9:05 am. Report received that patient was in the car on the way home from the vaccination and had chest pain and shortness of breath. Patient called their primary care doctor who requested reporting to the nearest emergency room immediately. Patient became unresponsive in the car. Patient arrived in cardiac arrest (arrival time noted to be 4/6/21 at 10:54 am, CPR began. Patient was intubated in the ER, and received epinephrine, amiodarone, and was defibrillated several times per ACLS protocol. Patient did not have return of spontaneous circulation and was subsequently pronounced. Per report, it was noted that patient was short of breath prior to receiving vaccination earlier in the day.


VAERS ID: 1189199 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-30
Onset:2021-04-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Haematemesis
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   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: Vitamin D3 - 250mcg
Current Illness: None
Preexisting Conditions: No diagnosed health issues
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach cramps, vomiting (coffee ground emesis), diarrhea that started on 04/06/2021 and lasted for 2 days.


VAERS ID: 1197795 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-04-06
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Opioids
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired at some point after infection; not in the immediate time period of injection


VAERS ID: 1198199 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-04-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Blood gases, COVID-19, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Fibrin D dimer, Full blood count, Influenza virus test, International normalised ratio, Lung infiltration, Metabolic function test, Resuscitation, SARS-CoV-2 test positive, Toxicologic test, Troponin
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 5
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: Albuterol, amlodipine, atorvastatin, Breo Ellipta AEPB inhaler, carvedilol, insulin glargine, loratadine, losartan and metphomin
Current Illness:
Preexisting Conditions: Hepatitis C, cirrhosis, uncontrolled DM, alcohol and cocaine abuse, obesity
Allergies: NSaids
Diagnostic Lab Data: COVID 19, CBC, CMP, troponin, Protime INR, toxicology, D-dimer, ABG''s, influenza
CDC Split Type:

Write-up: 62-year-old male with number of medical problems that include history of hepatitis-C, history of cirrhosis, history of alcohol abuse, cocaine abuse, history of diabetes hypertension who has initially presented to EMS with increasing shortness of breath. Patient suffered cardiac arrest during his transportation to the emergency room. A CPR was initiated and was given 3 rounds of epinephrine. Most of the history is taken from the ER physician chart review. ACUTE RESPIRATORY FAILURE SECONDARY TO HYPOXEMIA, COVID-19 , cardiac arrest, possible anoxic brain damage : Patient is 62-year-old male with complicated history with history of hepatitis-C, cirrhosis, alcohol use, cocaine abuse diabetes who presented after having cardiac arrest and possible anoxic brain damage. Patient was intubated after the arrest. Patient stayed in the hospital for number of days. Patient was found to have COVID-19 positive. Patient was found to have diffuse bilateral infiltrate. Patient was started on broad-spectrum antibiotics including cefepime Flagyl and Decadron. Due to patient''s cardiac arrest patient was started on hypothermia protocol. Patient was rewarming after that. There was no purposeful movement or neurological recovery. After long discussion with the family, patient has been made comfort care. Patient was extubated. Patient expired promptly after that. Family is notified.


VAERS ID: 1198939 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Death, Dyspnoea, Fatigue, Myalgia, Neutropenic sepsis, Pneumonia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per Medical Examiner, fourteen hours after receiving vaccine presenting symptoms were fatigue and muscle aches, went to Hospital Emergency Room and was released. Six hours later family stated symptoms had worsened, fever, shortness of breath and fatigue, admitted to Medical Center, diagnosed with sepsis and died within 48 hours of vaccination, deceased 4/7/2021, cause of death neutropenic sepsis with multi-lobar pneumonia, autopsy scheduled 4/13/2021.


VAERS ID: 1199642 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-15
Onset:2021-04-06
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid in 9/2020
Preexisting Conditions: Cancer - Multiple Myeloma
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient was not present for 2nd dose clinic today. Manager of facility reported that patient died in his sleep on 4/6/21


VAERS ID: 1200939 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-19
Onset:2021-04-06
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Brain natriuretic peptide increased, Chest pain, Death, Fibrin D dimer increased, Hypercoagulation, Pleuritic pain, Pulmonary embolism, SARS-CoV-2 test negative, Tachycardia, Tachypnoea, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pepcid
Current Illness: none.
Preexisting Conditions: No PMH, was healthy prior to vaccine.
Allergies: none.
Diagnostic Lab Data: D-dimer 5.2. Trop 0.17. COVID neg. PTT 18.7. BNP 204.
CDC Split Type:

Write-up: Massive PE, patient died. No history of DVT, we did a COVID test here and it was negative. She had no PMH, we suspect the vaccine made her hypercoagulable. Had pleuritic CP, tachycardia, tachypnea.


VAERS ID: 1203198 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: 4/11/21 taken to emergency room at hospital. Please contact for medical test and lab results showing PE.
CDC Split Type:

Write-up: Second vaccine received on 4/6/21. Pulmonary Embolism on 4/11/21. Death on 4/13/21.


VAERS ID: 1203475 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-04-06
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Advanced Age, Likely Sudden Acute MI


VAERS ID: 1204227 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-04-06
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   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:
CDC Split Type:

Write-up: Patient was hospitalized and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1204726 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-07
Onset:2021-04-06
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain stem thrombosis, Death, Dizziness, Dysarthria, Erythema, Pain in extremity, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypersensitivity (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: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated on 3/7/21, on 4/2 presented pain in left leg and some redness, on 4/3 some dizziness, lightheadedness, difficulty with vision in right eye, some slurred speech; on 4/5 his health agravated and EMS was called and taken to hospital; spouse informed that patient had a blood clot in stem of brain; on 4/6 patient died. No autopsy performed


VAERS ID: 1205282 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-26
Onset:2021-04-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a stroke 11 days later(on 4/6/21) and expired


VAERS ID: 1207600 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-04-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1213138 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-26
Onset:2021-04-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: diabetes type 2, hypertension
Allergies: PCN (anaphylaxis)
Diagnostic Lab Data:
CDC Split Type:

Write-up: The day after vaccination had a terrible headache. Stroke on 4/6/21. Died on 4/11/21


VAERS ID: 1214800 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: family states oral medication for diabetes and 2 medications for hypertension but unknown names
Current Illness: unknown
Preexisting Conditions: DM, HTN
Allergies: NKA
Diagnostic Lab Data: death
CDC Split Type:

Write-up: Patient per tracking received 2nd COVID vaccine on 4/5/2021 from Health Department. Patient to Hospital Emergency department via EMS 4/6/2021 with cardiac arrest and death


VAERS ID: 1215373 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-09
Onset:2021-04-06
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Proair, EQ Allergy Relief, Albuterol, HCTZ, Prednisone, Singulair, Symbicort, Bumetanide, Carvedilol, Azithromycin
Current Illness:
Preexisting Conditions: Chronic systolic congestive heart failure, Pulmonary fibrosis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt missed her scheduled appointment for COVID vaccine #2, so I called her to reschedule. Today I reached her mother, who informed me that pt passed away last Tuesday. I did not ask for any details of her death at this time.


VAERS ID: 1218764 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-10
Onset:2021-04-06
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9089 / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9089 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Brain herniation, Cerebral haemorrhage, Cerebral mass effect, Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Deep vein thrombosis, Haemoglobin decreased, International normalised ratio increased, Leukaemia recurrent, Leukapheresis, Leukocytosis, Lung infiltration, Lung opacity, Oedema peripheral, Platelet count decreased, Prothrombin time prolonged, Respiratory viral panel, Subdural haemorrhage, Thrombocytopenia, Viral test negative, White blood cell count increased
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol (Coreg), acyclovir, Lipitor, HCTZ, lisinopril, metformin, Ivosidenib (Tibsovo), Allopurinol (Zyloprim), Acetaminophen (Tylenol)
Current Illness: AML, CKD, T2DM, HTN, HLD
Preexisting Conditions: AML
Allergies: Sulfa drug, citrus, latex
Diagnostic Lab Data: INR 1.8. PT 20.1, PTT 24.7, WBC 102K, Hgb 6.7, platelet 57, respiratory viral panel negative. CXR: Patchy ground-glass opacities in the right upper lobe and right lower lobe. Mild interstitial infiltrates in the upper lobes bilaterally. Extensive DVT from the right common femoral vein through the distal popliteal vein. CT brain: Left occipital intraparenchymal hemorrhage measuring 5.8 x 2.8 x 3.1 cm as well as diffuse left hemispheric subdural hemorrhage measuring 11 mm, resulting in 16 mm rightward midline shift, subfalcine, and left uncal herniation.
CDC Split Type:

Write-up: Patient with Hx of AML received 1st dose COVID vaccine 2/10/2021, 2nd dose 3/4/2021. She developed DVT of the right leg, AML relapse. The patient has been diagnosed with AML back in 2016 and underwent several lines of therapy including chemotherapy with 7 and 3 and the last treatment was decitabine with maintenance treatment with ivosidenib. Having severe leukocytosis and right-sided leg edema with DVT raised concern about blast crisis and leukostasis. Patient was admitted to hospital and received. ceftriaxone and azithromycin for possible pneumonia. She underwent leukophoresis on the 4/6/2021, 4/7/2021. Patient received IV heparin gtt for DVT but later on was on hold given worsening thrombocytopenia. She was transferred from one hospital to another hospital. I do not think the development of DVT was due to COVID vaccine. But prior to COVID vaccine, patient was in AML remission.


VAERS ID: 1220223 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-22
Onset:2021-04-06
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OFEV, Metformin, Remeron, Prilosec, Prednisone, Xopenex, jardiance, Gabapentin
Current Illness: Interstitial Lung Disease, Bronchiectasis, Coronary Artery Disease, Diabetes
Preexisting Conditions: Interstitial Lung Disease, Bronchiectasis, Diabetes, Coronary Artery Disease
Allergies: Heparin, Furosemide, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1220264 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-17
Onset:2021-04-06
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Dementia
Allergies: Unkown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient was scheduled for second dose on 4/14/21. Wife called that morning to say that patient passed away on 4/6/21. Wife Callie stated he saw the neurologist on 4/1/21. On 4/6 he was doing very well in the am and pm. She put him to bed, he woke up and called to her, gasped and passed away. She reports he tolerated the 3/17 vaccination well. I called the doctor on 4/16/21 for more information but he has not returned my call as of yet.


VAERS ID: 1224836 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-04-06
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Death, Dehydration, Guillain-Barre syndrome, Laboratory test, Lethargy, Lumbar puncture, Urinary incontinence
SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Hypoglycaemia (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: Test Name: tests; Result Unstructured Data: Test Result:diagnosed with Guillain-Barre Syndrome; Test Name: lumbar puncture; Result Unstructured Data: Test Result:diagnosed with Guillain-Barre Syndrome
CDC Split Type: USPFIZER INC2021381625

Write-up: Guillain-Barre Syndrome; urinary incontinence; confusion; lethargy; dehydration; expired; This is a spontaneous report from a contactable physician. A 76-year-old male patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot and expiry were not reported), via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. The patient received first dose of bnt162b2 on an unspecified date for Covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The physician reported that the patient received his second Pfizer vaccine dose and 2 weeks after receiving the vaccine he presented to her office with urinary incontinence, confusion and lethargy. He was admitted to the hospital and within a few days later, day 5, he was diagnosed with Guillain-Barre Syndrome. Following tests and a lumbar puncture. He was hospitalized x2 weeks, received IVIG x 5days. He was then transferred to a Nursing Home. He was readmitted to the hospital with dehydration and expired 2 days later (last night). The physician asked, "have you seen this type of thing before, with GBS?" The physician considered the case as non-serious. The outcome of the events was unknown except for expired. The patient died on 06Apr2021 as he expired. There was no autopsy done. Information on the lot/batch number has been requested.; Sender''s Comments: Limited information precludes a medically meaningful assessment of the case. Based on the current available information, a possible contributory role of the suspect product to the development of events cannot be totally excluded. Additional information including relevant medical history, detailed clinical course, and specified concomitant medications is required to better assess the case. 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: expired


VAERS ID: 1229211 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-20
Onset:2021-04-06
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 2
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: Cat scan
CDC Split Type:

Write-up: hemorrhage in the brain


VAERS ID: 1233769 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-25
Onset:2021-04-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Injury, Road traffic accident
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: According to death certificate patient died of "blunt force injuries from a motorcycle accident"


VAERS ID: 1237434 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-04-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, 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: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Anoro Ellipta, Zyrtec, clonazepam, Co-Q10, Estradiol, Fish Oil, Magnesium, Metoprolol ER, Pravastatin, Probiotic, Vit B12, Vit C, Vit D, Prednisone
Current Illness: 3/31/21 - COPD Acute Exacerbation
Preexisting Conditions: Severe Chronic COPD; Anxiety, HTN; Hyperlipidemia, Osteoporosis
Allergies: PCN, Zoloft, Bactrim, Serevent
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient discovered down and unresponsive with immediate declaration of death. Pronounced dead 4/6/2021 11:45 PM


VAERS ID: 1237478 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Fatigue, Headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: Singulair
Current Illness: About two months before death, the patient presented to clinic, where she was diagnosed with anemia (hemoglobin 7.0, received two blood transfusions).
Preexisting Conditions: History of asthma and seasonal allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6-8 hours following the vaccine, the patient developed a severe head ache, SOB and fatigue. Patient took an unknown OTC medication, this did not help her symptoms. Her headache receded on 04/08, and her symptoms improved, but never fully resolved (per patient''s son).


VAERS ID: 1238326 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-04-06
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial flutter, Death, Generalised oedema, Hypothyroidism, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypothyroidism (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 82 year old male hospice patient received the Covid shot on 3/6/21 and went to the ED on 4/6/21 and was admitted on 4/6/21 with respiratory distress, acute hypoxemic respiratory failure, anasarca, atrial flutter, hypothyroid and died on 4/15/21. Please refer to the other details submitted within this report and contact the person who submitted this report via email for additional follow up details and investigation.


VAERS ID: 1241873 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-04-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER3787 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her first dose of Pfizer vaccine on 4/1/21. Patient has a stroke 4/6/21 and passed away on 4/10/21.


VAERS ID: 1248086 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-05
Onset:2021-04-06
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood immunoglobulin G, Cardiac arrest, Death, Deep vein thrombosis, Haematocrit decreased, Haemoglobin decreased, Platelet count decreased, Pulmonary embolism, Resuscitation, Thrombocytopenia, Transfusion
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin, apple cider vinegar, Excedrin migraine, atorvastatin, chlorthalidone, vitamin D3, cyclobenzaprine, doxycycline, escitalopram, ferrous sulfate, gabapentin, ginseng, ibuprofen, lisinopril, loratadine, potassium, teriparatide, Tob
Current Illness: progressive lower extremity paresthesias/myelopathies and gait/balance abnormalities, severe T11-12 stenosis (thoracic decompression 3/30/21)
Preexisting Conditions: anemia, osteoporosis, hyperlipidemia, hypertesnion, low testosterone, sleep apnea, spondylosis of lumbar region, hepatitis, obesity, history of spinal osteomyelitis, deep vein thrombosis
Allergies: lamotrigine, rifampin, tramadol
Diagnostic Lab Data: Heparin-induced thrombocytopenia antibody: negative (three days after surgery) Heparin induced IGG antibody, IA: positive (thirteen days after surgery) Prior to surgery: platelets 307 10*9/L, hemoglobin 13.3 g/dL, hematocrit 41.7% Intraoperative: Platelet: 89 10*9/L Fibribnogen: 223 mg/dL INR: 1.2 Immediately after surgery: Platelets: 5 10*9/L, hemoglobin: 3.2 g/dL, hematocrit: 10.1%
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: patient underwent L1-2 corpectomy, pedicle subtraction osteotomy, and extension of fusion from T4 to the pelvis two months after vaccination. During surgery patient became thrombocytopenic and required massive transfusion. Thirteen days after surgery found to have bilateral pulmonary embolisms and deep vein thromboses and placed on anticoagulation. Patient subsequently suffered cardiac arrest and was unable to be resuscitated.


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