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From the 10/15/2021 release of VAERS data:

Found 17,128 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

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VAERS ID: 1413743 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-21
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: 2021-05-01
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: USJNJFOC20210634485

Write-up: DEATH; This spontaneous report received from a consumer via a company representative via social media concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, administered on 02-MAY-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date in MAY-2021, she died from unknown cause of death. It was reported that, patient''s obituary news was on paper on 17-MAY-2021. It was unspecified that if the 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- 20210634485- Covid-19 vaccine ad26.cov2.s-Death.This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1413754 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-17
Submitted: 0000-00-00
Entered: 2021-06-21
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: 2021-06-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210637036

Write-up: This spontaneous report received from a company representative concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 17-JUN-2021, the the died from unknown cause of death. The father suspected that the death might be related to the Janssen Covid-19 vaccine. An autopsy was planned to be performed.. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20210637036- 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: 1413807 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-01
Onset:2021-06-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Death-Severe, Additional Details: Patient''s wife called and told us that on the day that he passed (6/13/21), he did yard work all morning, then came in for a meal and to watch the soccer game. He then went to their bedroom to lay down and about 15 mins later she heard a strage noise and went check on him. Upon entering the room is when she found that he had passed. Cause of death is unknown


VAERS ID: 1413849 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Arteriosclerosis, Chronic obstructive pulmonary disease, Death, Dyspnoea, Resuscitation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: COPD She was a resident at the Senior Living facility. My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m. She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing. Around 1:40, the nursing home called to let me know CPR was being performed. My sister rushed to the site and she was pronounced dead around 2:10. p.m.
Preexisting Conditions: COPD The death states she died of Atherosclerotic Heart Disease
Allergies: No
Diagnostic Lab Data: Death certificate
CDC Split Type:

Write-up: COPD She was a resident at the Senior Living facility. My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m. She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing. Around 1:40, the nursing home called to let me know CPR was being performed. My sister rushed to the site and she was pronounced dead around 2:10. p.m.


VAERS ID: 1414035 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-04
Onset:2021-05-05
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anti-neutrophil cytoplasmic antibody positive vasculitis, Biopsy kidney abnormal, Blood test abnormal, Chemotherapy, Death, Dysphagia, Dysphonia, Fatigue, Intensive care
SMQs:, Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vasculitis (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 42
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan Potassium Hydrochlorothiazide Levothyroxine Feosol Lantanaprost Bayer low dose aspirin Anastrozole
Current Illness:
Preexisting Conditions: 5 year breast cancer survivor Mini-stroke 05/23/2020 Another mini-stroke 04/2021, exact date uncertain
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 months after last dose, a routine bloodwork revealed high kidney numbers. Voice became hoarse and difficulty in swallowing ease was noted. Repeat blood work confirmed kidney numbers still high after hydration, IV fluids given at home. Fatigue increased and I took my mother to the ER. She was admitted and she spent 3 weeks in the hospital, 1 week in ICU. She was eventually diagnosed with the autoimmune disease ANCA Vasculitis. Biopsy confirmed. No previous kidney disease or abnormal blood work. She was treated with high dose steroids and chemotherapy. There was no positive response to treatment. Condition worsened and she was moved to Hospice care. My mother died on 05/16/2021


VAERS ID: 1414045 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-28
Onset:2021-02-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / UNK UN / ID

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: Aspirin 81 mg, Lasix 20 mg, Plavix 75 mg, Temazepam 30 mg.
Current Illness: Unknown.
Preexisting Conditions: Stroke, PEG, bed ridden.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 PCR lab test, not detected.
CDC Split Type:

Write-up: Unstable vital signs.


VAERS ID: 1414207 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-06-07
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Bronchiectasis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Culture positive, Death, Dyspnoea exertional, Hypercapnia, Lung infiltration, Lung opacity, Pneumonia pseudomonal, Pulmonary oedema, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, amlodipine, losartan, eliquis, lexapro, anastrozol
Current Illness: COPD
Preexisting Conditions: HTN, paroxysmal Afib, depression, endometrial CA, COPD
Allergies: NKDA
Diagnostic Lab Data: 6/10: SARS CoV2 PCR- positive 6/10: CXR- prominence interstitium w/airspace opacities w/in mid to upper lungs, findings of uncertain chronicity representing infiltrate, PNA, edema.
CDC Split Type:

Write-up: Pt w/hx significant for COPD (on 1L O2 a baseline) p/w cough, exertional dyspnea, and generalized weakness since 6/7/21). COVID test positive on 6/10 despite receiving Pfizer vaccines on 4/5 & 4/27. Pt was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. During admission received dexamethasone, convalescent plasma, remdesivir. Culture indicated pseudomonas PNA, but likely colonization given hx, however, due to illness and underlying bronchiectasis, was given cefepime. Hospital stay complicated by significant resistant hypercarbia and respiratory failure, pt placed on comfort measures given that death is imminent. Unfortunately, pt passed on 6/13/21.


VAERS ID: 1414219 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-16
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was vaccinated on 5/26/21 for dose one and 6/16/21 for dose two with Pfizer COVID-19 vaccine. Patient passed away the day following her second dose on 6/17/21.


VAERS ID: 1414259 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-03-01
Onset:2021-03-18
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016420A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Heart rate decreased, Oxygen saturation decreased
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosima, Prozac, Synthroid, Amaryl, Risperidone, Famotidine, Januvia, Isosorbide, Furosemide, Carvedidol, Atorvastatin.
Current Illness: Unknown.
Preexisting Conditions: Hyperthyroidisms, Hypertension, CHF, Hospice.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Low heart activity and low oxygenation.


VAERS ID: 1414492 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-05
Onset:2021-05-30
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Adenovirus test, Angiogram cerebral normal, Arteriogram carotid normal, Bordetella test negative, COVID-19, Chest X-ray abnormal, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Cough, Decreased appetite, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Ejection fraction decreased, Endotracheal intubation, Enterovirus test negative, Exposure to SARS-CoV-2, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Intensive care, Mycoplasma test negative, Oxygen saturation decreased, Respiratory syncytial virus test negative, Respiratory viral panel, Respirovirus test, SARS-CoV-2 test positive, Scan with contrast, Seizure, Viral test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg tablet acetaminophen (TYLENOL) 500 mg tablet acyclovir (ZOVIRAX) 400 mg tablet albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler alum-mag hydroxide
Current Illness:
Preexisting Conditions: Nervous Chronic pain syndrome Fibromyalgia Myofascial pain syndrome Recurrent seizures (CMS/HCC) Trochanteric bursitis of left hip Coronary artery disease of native artery of native heart with stable angina pectoris (CMS/HCC) Respiratory Moderate persistent asthma Chronic frontoethmoidal sinusitis Multiple pulmonary nodules determined by computed tomography of lung Pneumonia due to COVID-19 virus Acute respiratory failure with hypoxia (CMS/HCC) Circulatory Essential hypertension Hemorrhoids CAD (coronary artery disease), native coronary artery Pulmonary hypertension, unspecified (CMS/HCC) Digestive Chronic constipation Irritable bowel syndrome Gastroesophageal reflux disease Vitamin D deficiency Folate deficiency Genitourinary Kidney stone Urethral prolapse Hematuria due to acute cystitis Prolapsed urethral mucosa Stage 3a chronic kidney disease Musculoskeletal Disc degeneration, lumbar Generalized osteoarthritis Osteopenia Osteoarthritis of left hip Osteomyelitis (CMS/HCC) Osteonecrosis due to drugs, jaw (CMS/HCC) Osteomyelitis of mandible Endocrine/Metabolic Hyperlipidemia Hypoglycemia Hematologic Chemotherapy-induced neutropenia (CMS/HCC) Multiple myeloma without remission (CMS/HCC) Secondary thrombocytopenia Thrombocytopenia due to drugs Iron deficiency anemia due to chronic blood loss Infectious/Inflammatory Port or reservoir infection, initial encounter Immune Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (CMS/HCC) Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (CMS/HCC) Other Depressive disorder Occult blood in stools Patient has living will Generalized anxiety disorder Failure of outpatient treatment Knee joint replaced by other means Presence of drug coated stent in anterior descending branch of left coronary artery Dizziness Immunocompromised (CMS/HCC) Asymptomatic bacteriuria History of CVA (cerebrovascular accident)
Allergies: Levaquin [Levofloxacin]Hives / Urticaria PenicillinsSwelling , Rash Sulfa (Sulfonamide Antibiotics)Swelling , Rash, Hives / Urticaria SulfasalazineHives / Urticaria Cat DanderItching, Other (document details in comments) Dog DanderItching PhenytoinRash RanitidineRash
Diagnostic Lab Data: Pneumonia due to COVID-19 virus 6/3/2021 - Present Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (CMS/HCC) 6/12/2021 - Present New Results - Lab Updated Procedure 06/03/21 1606 Respiratory virus detection panel Collected: 06/03/21 1317 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Synctial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Resident Critical Care Procedures Signed Date of Service: 6/6/2021 8:47 PM Procedure Orders Central Line Insertion [3286736624] ordered by MD Arterial Line Insertion [3286736626] ordered by MD Post-procedure Diagnoses Acute respiratory failure with hypoxia Results Procedure Component Value Ref Range Date/Time X-ray chest 1 view Resulted: 06/12/21 0706 Order Status: Completed Updated: 06/12/21 0706 Narrative: XR CHEST 1 VW PORT IMPRESSION: 1. Unchanged diffuse bilateral airspace disease. 2. Indwelling tubes as detailed in the body of the report. END OF IMPRESSION: INDICATION: Dyspnea. TECHNIQUE: AP portable semierect projection of the chest is acquired. COMPARISON: Chest radiograph performed on June 11, 2021. FINDINGS: Redemonstrated are diffuse bilateral airspace opacities, similar compared to the prior study. No pleural effusion or pneumothorax identified. Endotracheal tube terminates approximately 5.9 cm superior to carina. An enteric tube terminates out of the field of view inferior to the diaphragm. A right-sided PICC line terminates in the SVC. Multilevel thoracic spondylosis and postoperative changes of prior thoracic vertebral plasty are redemonstrated. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 06/11/21 0644 Order Status: Completed Updated: 06/11/21 0644 Narrative: XR CHEST 1 VW PORT IMPRESSION: Stable lines and tubes. Diffuse opacities throughout the lungs persist, mildly increased at the right lung base. END OF IMPRESSION: INDICATION: cxr. TECHNIQUE: AP portable chest. COMPARISON: 6/9/2021 FINDINGS: Stable lines and tubes. Diffuse opacities throughout the lungs bilaterally, mildly increased at the right lung base. No pneumothorax or pleural effusion. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 06/09/21 0926 Order Status: Completed Updated: 06/09/21 0926 Narrative: XR CHEST 1 VW PORT IMPRESSION: Bilateral diffuse airspace opacities unchanged. Endotracheal and enteric tubes remain in satisfactory position. END OF IMPRESSION: INDICATION: cxr. TECHNIQUE: AP portable projection of the chest is acquired. COMPARISON: Portable chest on 6/7/2021. FINDINGS: Endotracheal and enteric tubes remain in satisfactory position. Bilateral diffuse airspace opacities remain unchanged. There is no pleural fluid or pneumothorax. The cardiomediastinal silhouette is stable. Kyphoplasty is noted in the lower thoracic spine. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Transthoracic echo (TTE) limited Resulted: 06/07/21 1307 Order Status: Completed Updated: 06/07/21 1310 LVIDd 4.40 3.70 - 5.60 cm LVIDs 2.80 2.00 - 3.80 cm IVSd 1.10 0.6 - 1.1 cm LVPWd 1.00 0.6 - 1.1 cm LADs 2.20 1.9 - 4 cm LVOT diameter 2.20 cm Aortic Root (2.0-3.7) 3.60 cm TR max PG 30.70 mmHg TR max vel 276.90 cm/sec Narrative: FINALIZED REPORT TWO-DIMENSIONAL ECHOCARDIOGRAPHIC FINDINGS LEFT VENTRICLE: Normal LV size with normal wall thickness. No regional wall motion abnormalities. RIGHT VENTRICLE: Normal size with mildly reduced function AORTIC VALVE: Trileaflet MITRAL VALVE: Normal TRICUSPID VALVE: Normal PULMONIC VALVE: Normal LEFT ATRIUM: Normal RIGHT ATRIUM: Normal INTERATRIAL SEPTUM: Intact AORTIC ROOT: Normal size PERICARDIUM: No effusion IVC: Normal size with normal collapse AORTIC ARCH: Not well seen COLOR AND SPECTRAL DOPPLER: PA systolic pressure in the range of 35 mmHg. Doppler evidence decreased LV compliance FINAL IMPRESSIONS: Normal LV size with normal wall thickness. No regional wall motion abnormalities. EF 55 to 60% Normal RV size with mildly reduced function No valvular abnormalities PA systolic pressure range 35 mmHg Doppler evidence decreased LV compliance X-ray chest 1 view Resulted: 06/07/21 0810 Order Status: Completed Updated: 06/07/21 0810 Narrative: XR CHEST 1 VW PORT IMPRESSION: 1. Unchanged bilateral airspace disease. 2. Indwelling lines and tubes as detailed in the body of the report. END OF IMPRESSION: INDICATION: Intubated. TECHNIQUE: AP upright portable projection of the chest is acquired. COMPARISON: Chest radiograph performed on June 6, 2021. FINDINGS: Redemonstrated is bilateral airspace disease, similar compared to prior study. No pleural effusion or pneumothorax identified. Endotracheal tube terminates approximately 4.6 cm superior to carina. An enteric tube terminates in the stomach. A right-sided PICC line is noted, with tip terminating in the distal SVC. Multilevel thoracic spondylosis and changes of prior thoracic vertebral plasty are noted. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram head with and without contrast Resulted: 06/06/21 1247 Order Status: Completed Updated: 06/06/21 1247 Narrative: CT ANGIOGRAM HEAD W WO CONTRAST, CT ANGIOGRAM NECK W WO CONTRAST, CT BRAIN PERFUSION W WO CONTRAST IMPRESSION: No CT perfusion evident infarct. No CT perfusion evident ischemia. No hemodynamically significant ICA stenosis by NASCET criteria. No cutoff occlusion, dissection, or measurable aneurysm. No measurable mass or abnormal enhancement. Known COVID-19 pneumonia and ARDS. END OF IMPRESSION: CONTRAST: 140mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. CLINICAL HISTORY: Stroke alert , initial encounter. TECHNIQUE: CT angiography head and neck: Helical CT scanning of the head and neck was performed in arterial phase after the uneventful IV administration of 140 cc Omnipaque 350. Multiplanar reformations and 3D volume renderings are created on a separate image postprocessing workstation under my concurrent supervision and permanently recorded. Dose limiting techniques utilized when possible. CT perfusion: CT perfusion was performed utilizing intravenous contrast at an injection rate of 4 ml/sec. RAPID software utilized for determination of cerebral blood flow/CBF, blood volume/CBV, Time to peak/Tma and mean transit time/MTT. COMPARISON: 10/4/2020 FINDINGS: NECK: Diffuse COVID-19 pneumonia and ARDS. ETT above carina; enteric tube in esophagus. No cut-off occlusion, dissection or measurable aneurysm. Minimal/mild left and mild right soft and calcific atherosclerosis of the bilateral carotid bifurcation/ICA origins - without hemodynamically significant stenosis by NASCET criteria. Patent left and normal-caliber right vertebral arteries - no dissection or hemodynamically significant stenosis. No suspicious mass or adenopathy. HEAD: Minimal calcific atherosclerosis of the bilateral cavernous, clinoidal, and ophthalmic segment intracranial ICAs - without hemodynamically significant stenosis, dissection or cut off occlusion. Patent bilateral M1 and M2 segment middle cerebral arteries; patent bilateral A1 and A2 segment anterior cerebral arteries; patent anterior communicating artery. Patent basilar artery; patent bilateral P1 and P2 segment posterior cerebral arteries; robust right posterior to indicating artery; hypoplastic versus absent left posterior communicating artery. No dural venous sinuses are major central cerebral veins thrombotic filling defects. No measurable mass, abnormal enhancement or acute process. No measurable aneurysm. PERFUSION: TOTAL HYPOPERFUSION: Using a threshold of Tmax $g 6 seconds, there is no diffuse or focal hypoperfusion. CORE INFARCT: Using the threshold of CBF < 30%, there is no evidence for irreversible ischemia. PENUMBRA: N/A. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram neck with and without contrast Resulted: 06/06/21 1247 Order Status: Completed Updated: 06/06/21 1247 Narrative: CT ANGIOGRAM HEAD W WO CONTRAST, CT ANGIOGRAM NECK W WO CONTRAST, CT BRAIN PERFUSION W WO CONTRAST IMPRESSION: No CT perfusion evident infarct. No CT perfusion evident ischemia. No hemodynamically significant ICA stenosis by NASCET criteria. No cutoff occlusion, dissection, or measurable aneurysm. No measurable mass or abnormal enhancement. Known COVID-19 pneumonia and ARDS. END OF IMPRESSION: CONTRAST: 140mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. CLINICAL HISTORY: Stroke alert , initial encounter. TECHNIQUE: CT angiography head and neck: Helical CT scanning of the head and neck was performed in arterial phase after the uneventful IV administration of 140 cc Omnipaque 350. Multiplanar reformations and 3D volume renderings are created on a separate image postprocessing workstation under my concurrent supervision and permanently recorded. Dose limiting techniques utilized when possible. CT perfusion: CT perfusion was performed utilizing intravenous contrast at an injection rate of 4 ml/sec. RAPID software utilized for determination of cerebral blood flow/CBF, blood volume/CBV, Time to peak/Tma and mean transit time/MTT. COMPARISON: 10/4/2020 FINDINGS: NECK: Diffuse COVID-19 pneumonia and ARDS. ETT above carina; enteric tube in esophagus. No cut-off occlusion, dissection or measurable aneurysm. Minimal/mild left and mild right soft and calcific atherosclerosis of the bilateral carotid bifurcation/ICA origins - without hemodynamically significant stenosis by NASCET criteria. Patent left and normal-caliber right vertebral arteries - no dissection or hemodynamically significant stenosis. No suspicious mass or adenopathy. HEAD: Minimal calcific atherosclerosis of the bilateral cavernous, clinoidal, and ophthalmic segment intracranial ICAs - without hemodynamically significant stenosis, dissection or cut off occlusion. Patent bilateral M1 and M2 segment middle cerebral arteries; patent bilateral A1 and A2 segment anterior cerebral arteries; patent anterior communicating artery. Patent basilar artery; patent bilateral P1 and P2 segment posterior cerebral arteries; robust right posterior to indicating artery; hypoplastic versus absent left posterior communicating artery. No dural venous sinuses are major central cerebral veins thrombotic filling defects. No measurable mass, abnormal enhancement or acute process. No measurable aneurysm. PERFUSION: TOTAL HYPOPERFUSION: Using a threshold of Tmax $g 6 seconds, there is no diffuse or focal hypoperfusion. CORE INFARCT: Using the threshold of CBF < 30%, there is no evidence for irreversible ischemia. PENUMBRA: N/A. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT brain perfusion with and without contrast Resulted: 06/06/21 1247 Order Status: Completed Updated: 06/06/21 1247 Narrative: CT ANGIOGRAM HEAD W WO CONTRAST, CT ANGIOGRAM NECK W WO CONTRAST, CT BRAIN PERFUSION W WO CONTRAST IMPRESSION: No CT perfusion evident infarct. No CT perfusion evident ischemia. No hemodynamically significant ICA stenosis by NASCET criteria. No cutoff occlusion, dissection, or measurable aneurysm. No measurable mass or abnormal enhancement. Known COVID-19 pneumonia and ARDS. END OF IMPRESSION: CONTRAST: 140mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. CLINICAL HISTORY: Stroke alert , initial encounter. TECHNIQUE: CT angiography head and neck: Helical CT scanning of the head and neck was performed in arterial phase after the uneventful IV administration of 140 cc Omnipaque 350. Multiplanar reformations and 3D volume renderings are created on a separate image postprocessing workstation under my concurrent supervision and permanently recorded. Dose limiting techniques utilized when possible. CT perfusion: CT perfusion was performed utilizing intravenous contrast at an injection rate of 4 ml/sec. RAPID software utilized for determination of cerebral blood flow/CBF, blood volume/CBV, Time to peak/Tma and mean transit time/MTT. COMPARISON: 10/4/2020 FINDINGS: NECK: Diffuse COVID-19 pneumonia and ARDS. ETT above carina; enteric tube in esophagus. No cut-off occlusion, dissection or measurable aneurysm. Minimal/mild left and mild right soft and calcific atherosclerosis of the bilateral carotid bifurcation/ICA origins - without hemodynamically significant stenosis by NASCET criteria. Patent left and normal-caliber right vertebral arteries - no dissection or hemodynamically significant stenosis. No suspicious mass or adenopathy. HEAD: Minimal calcific atherosclerosis of the bilateral cavernous, clinoidal, and ophthalmic segment intracranial ICAs - without hemodynamically significant stenosis, dissection or cut off occlusion. Patent bilateral M1 and M2 segment middle cerebral arteries; patent bilateral A1 and A2 segment anterior cerebral arteries; patent anterior communicating artery. Patent basilar artery; patent bilateral P1 and P2 segment posterior cerebral arteries; robust right posterior to indicating artery; hypoplastic versus absent left posterior communicating artery. No dural venous sinuses are major central cerebral veins thrombotic filling defects. No measurable mass, abnormal enhancement or acute process. No measurable aneurysm. PERFUSION: TOTAL HYPOPERFUSION: Using a threshold of Tmax $g 6 seconds, there is no diffuse or focal hypoperfusion. CORE INFARCT: Using the threshold of CBF < 30%, there is no evidence for irreversible ischemia. PENUMBRA: N/A. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT head stroke without contrast Resulted: 06/06/21 1234 Order Status: Completed Updated: 06/06/21 1234 Narrative: CT HEAD STROKE WO CONTRAST IMPRESSION: No acute intracranial abnormality. END OF IMPRESSION: INDICATION: Stroke alert, COVID-19 positive, initial encounter. TECHNIQUE: Helical CT scanning of the head is performed without IV contrast. Multiplanar reformations created and submitted for review. Dose limiting techniques utilized when possible. COMPARISON: MRI brain 5/8/2021, CT stroke series including perfusion angiography 10/3/2020 FINDINGS: No acute intracranial hemorrhage. No measurable mass or mass effect. Normal gray-white distinction and CSF spaces. No acute or aggressive osseous abnormality; no acute fluid. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 06/06/21 1108 Order Status: Completed Updated: 06/06/21 1108 Narrative: XR CHEST 1 VW PORT IMPRESSION: Endotracheal tube tip projects over the trachea 3.8 cm with the chin in neutral/slightly down position. Upper enteric tube courses below the diaphragm and inferior image edge. Patchy confluent COVID-19 pneumonia +/- ARDS are grossly stable. No pneumothorax or significant effusion; stable enlarged heart. Stable mediastinum and bones. END OF IMPRESSION: INDICATION: post ET and OG placement. TECHNIQUE: AP portable supine chest COMPARISON: 6/5/2021 back through 6/3/2021, reference chest CT 6/5/2021 This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Ultrasound lower extremity venous bilateral Resulted: 06/05/21 1414 Order Status: Completed Updated: 06/05/21 1414 Narrative: US LOWER EXTREMITY VENOUS BILATERAL IMPRESSION: Negative bilateral lower extremity venous ultrasound. END OF IMPRESSION: INDICATION: sob , rule out clot. Lower extremity swelling. TECHNIQUE: Multiple longitudinal and transverse 2D real-time ultrasound images were performed from groin to knee, and at the calf and ankle. Color and grayscale and duplex Doppler imaging was also performed. Permanently recorded images were obtained and stored. COMPARISON: None available. FINDINGS: No evidence of deep venous thrombosis. On each side, there is normal flow, compressibility and augmentation in the common femoral, greater saphenous, superficial and deep femoral veins and popliteal veins. There is also normal flow, compressibility and augmentation in the posterior tibial veins, peroneal veins and small saphenous veins in the calves. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram chest pulmonary embolism with and without contrast Resulted: 06/05/21 1155 Order Status: Completed Updated: 06/05/21 1155 Narrative: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: No evidence of pulmonary embolism or aortic dissection. Progressive diffuse patchy bilateral groundglass airspace disease related to changes of progressive multifocal COVID-19 pneumonia. END OF IMPRESSION: INDICATION: ?PE. Assess for pulmonary artery embolism. TECHNIQUE: Enhanced helical CTA scan of the chest was performed from the lung apices to below the diaphragm, including the pulmonary artery. Two mm axial reconstruction with MPR coronal, oblique, and sagittal images were created. Three-D post processing imaging were obtained and stored. CONTRAST: 80 mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUSLY. Quality of contrast opacification was adequate. COMPARISON: June 3, 2021. FINDINGS: There are no acute intravascular filling defects identified to suggest acute pulmonary embolism. No evidence of thoracic aortic aneurysm or dissection. No pleural or pericardial effusion is noted. No pathologic adenopathy. Prominent calcified nodes related to old granulomatous disease. There is a small hiatal hernia. Limited evaluation of the upper abdomen is unremarkable. On lung windows, progressive diffuse bilateral groundglass airspace disease related to multifocal COVID-19 pneumonia. Osseous structures are grossly intact with chronic compressive deformity of the T9 vertebral body status post vertebral augmentation. Healing sternal fracture is noted. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 06/05/21 0702 Order Status: Completed Updated: 06/05/21 0702 Narrative: XR CHEST 1 VW PORT IMPRESSION: 1. Some improved interstitial alveolar lung infiltrates, in keeping with COVID-19 infection. 2. See below report. END OF IMPRESSION: INDICATION: Shortness of breath, COVID-19, hypoxia, rule out CHF. TECHNIQUE: Single AP projection of the chest is acquired. COMPARISON: Chest radiograph dated June 3, 2021. FINDINGS: Right-sided PICC line is unchanged with the tip in the mid SVC. Mild cardiomegaly changes are stable. Diffuse interstitial lung marking prominence or infiltrates probably in keeping with COVID-19 infection may be mildly improved. No pneumothorax or effusion or consolidation is noted. Multilevel degenerative changes to the thoracic spine are reidentified. Lower thoracic spine vertebral augmentation/cement deposition is stable. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram chest pulmonary embolism with and without contrast Resulted: 06/03/21 1810 Order Status: Completed Updated: 06/03/21 1810 Narrative: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: No acute pulmonary embolism. Diffuse bilateral ground glass airspace disease, consistent with given history of COVID related lung disease. Trace bilateral pleural effusions. END OF IMPRESSION: INDICATION: COVID pneumonia with hypoxia, evaluate for pulmonary embolism TECHNIQUE: CT angiography of the chest was obtained from the thoracic inlet to the upper abdomen after the administration of intravenous contrast using a pulmonary embolism protocol. 3-D shaded surface display, Maximum Curved Intensity Projection (MIP) and multiplanar reconstructions were performed on an independent workstation and permanently recorded. This CTA exam was performed using one or more of the following dose reduction techniques: automated exposure control, adjustment of the mA and/or kV according to patient size, or use of iterative reconstruction technique. CONTRAST: 80mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: 5/8/2021. FINDINGS: Supportive devices: Right arm PICC terminates at the cavoatrial junction. Pulmonary arteries: Good bolus of contrast in pulmonary arterial system. Opacification through the distal subsegmental level. Respiratory motion artifact. No filling defects. Main pulmonary artery normal in size. No evidence of right heart strain. Remaining vasculature: Aorta and visualized branches normal in caliber without significant atherosclerotic disease. Mediastinum: Thyroid and thoracic inlet normal. No enlarged mediastinal, hilar, or axillary lymph nodes by radiographic criteria. Heart size enlarged. Coronary atherosclerotic calcifications. No pericardial effusion. Esophagus normal. Small hiatal hernia. Lungs/pleura: Central airways patent. Diffuse bilateral groundglass airspace disease. Trace bilateral pleural effusions. Abdomen: Visualized upper abdomen normal. Bones/soft tissues: No suspicious osseous or soft tissue lesions. Prior vertebral augmentation of the T9 vertebral body. Healing sternal fracture. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view Resulted: 06/03/21 1300 Order Status: Completed Updated: 06/03/21 1301 Narrative: XR CHEST 1 VW IMPRESSION: Worsening patchy bilateral airspace opacities, particularly in the right upper and left lower lobes. END OF IMPRESSION: INDICATION: Shortness of Breath. TECHNIQUE: AP projection of the chest is acquired. COMPARISON: 5/8/2021 FINDINGS: Interval worsening of patchy bilateral airspace opacities, particularly in the right upper and left lower lobes. No pneumothorax or pleural effusion. Stable heart size and cardiomediastinal silhouette. Right-sided PICC line terminates in the superior vena cava. Kyphoplasty changes are noted in the midthoracic spine.
CDC Split Type:

Write-up: Nursing Home Visit 6/2/2021 Geriatric Medicine COVID-19 virus infection +4 more Dx Progress Notes SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, CAD with history of stent, seizure disorder and hypertension was seen today. She has been complaining of sinus congestion for past 3 to 4 days. Apparently there has been other resident who tested positive for COVID-19 so rapid antigen test was performed on her. Unfortunately she also tested positive for COVID-19. She has received full dose of COVID-19 vaccine earlier in February. She denies any fever or chills. She denies any shortness of breath. She does complain of cough and sinus congestion going on for a week or so. Chief complaint: Acute hypoxic respiratory failure due to COVID-19 SUBJECTIVE: Patient with history of multiple myeloma, osteonecrosis of jaw on IV antibiotic, hypertension, CAD and seizure disorder was tested positive for COVID-19 yesterday. She has been complaining of sinus congestion for the past for 5 days. However this has been at her baseline. She has multiple allergies and taking antihistamine chronically. There has been Covid outbreak in the facility and multiple other residents are positive for COVID-19. She also tested positive for COVID-19 yesterday. Unfortunately this morning she declined and needed oxygen support. Her oxygen saturation dropped to mid 70s to upper 80s on 5 L O2. She was not using any accessory muscle. She did complain of mild cough but denied any chest pain. Her appetite is poor. She does not look toxic. Date: 6/3/2021 Admission Date: 6/3/2021 Assessments Patient is a 74 y.o. female on hospital day number 0 Medical Problems Hospital Problems POA * (Principal) Pneumonia due to COVID-19 virus Yes Plan Chief Complaint Patient presents with ? Shortness of Breath #. COVID-19 pneumonia with hypoxia. -Patient was offered plasma and she wants to get plasma therapy. Patient has signed a consent form for blood product transfusion. -Patient states she cannot take steroids due to her medical history. She is refusing steroid therapy. -IV remdesivir ordered for the patient. -Patient is consulted with the ID due to her complicated history. -Patient is on oxygen support via nasal cannula. #. Mandible osteomyelitis diagnosed recently. -Patient has been seen by infectious disease during the prior admission and has PICC line for long-term IV antibiotic. -Patient is reordered IV antibiotic in the form of imipenem and oral doxycycline as well as azithromycin. #. Essential hypertension -Patient continues on various antihypertensive medication. #. Diabetes mellitus type 2 -Patient is on insulin therapy while in the hospital. Patient is on polypharmacy and was advised to discuss with her family doctor to cut down on her unnecessary or unimportant medications if possible. History of Present Illness Patient is an 74 y.o. female. Patient is 74-year-old Caucasian female, who presented from a facility chief complaint of acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient has been at this facility since 5/12/2021 after being diagnosed with bisphosphonate related out for necrosis of the jaw with cellulitis and possible osteomyelitis. Patient had been transferred from a Hospital on 5/12/2021. Patient had been getting IV antibiotics for the osteomyelitis of the mandible and was apparently doing well until today when she was noted to be hypoxic. Patient has been complaining of sinus congestion over the past 5 to 7 days. According to the medical director, there has been Covid outbreak in the facility and multiple other residents are noted to be positive for COVID-19. Patient had a Covid test done yesterday and she was COVID-19 positive. Patient respiratory status declined. Patient required oxygen support. Her oxygen saturation had dropped into the mid 70s to upper 80s and patient was on 5 L/min of oxygen via nasal cannula. Patient had not been using accessory muscles. Patient also reports occasional cough and has yellowish phlegm production. Patient was referred to Hospital emergency department for further evaluation and treatment. ED to Hosp-Admission Discharged 6/3/2021 - 6/14/2021 (11 days) Last attending ? Treatment team Sepsis due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Principal problem DETAILS OF HOSPITAL STAY Presenting Problem/History of Present Illness/Reason for Admission Hypoxia COVID-19 virus infection Pneumonia due to COVID-19 virus Acute respiratory failure Hospital Course Patient is a 74 y.o. female with a history of multiple myeloma on fifth line treatment. Patient with recent diagnosis of osteomyelitis and on antibiotics per ID. She was admitted to the hospital 6/3 with acute shortness of breath and following 2 days on the general medical floor she required increasing oxygen supplementation and was transferred to the ICU. In the ICU patient had a seizure and required acute intubation for protection of her airway. Patient had further decline of her respiratory status. She did pass SBT''s and was extubated. Shortly after she experienced likely an episode of aspiration. She continued to have increased work of breathing following this event. Patient transitioned to comfort care per family request. She received morphine and Ativan as needed and experienced asystole at 0834 this morning.


VAERS ID: 1414536 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-10
Onset:2021-06-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient was homeless. Self-reported history of seizures; self-report of not walking well or being able to stand for more than 15 minutes at a time; shortness of breath
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This patient was homeless. Partner was with patient on the night of 6/12 when patient complained of not feeling well and attributed it to side effects of his COVID vaccine, which he received two days prior. Patient declined to go to the hospital. When partner woke up the morning of 6/13, the patient was found dead. A coroner''s report is expected sometime within the next 4-6 weeks.


VAERS ID: 1414703 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-05
Onset:2021-02-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Death, Hypertension, Oxygen saturation decreased, SARS-CoV-2 test negative, Urinary tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Carvedilol, Plavix, Folic Acid, Levoxin, Paxin, Prednisone, Lipitor, Temazepam.
Current Illness: Unknown.
Preexisting Conditions: Heart problems, Diabetes, Osteoporosis.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Molecular test, negative result.
CDC Split Type:

Write-up: High blood pressure, low oxidation, urine infection. cardiac arrest.


VAERS ID: 1414727 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-04-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Haematemesis, Insomnia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 1
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: acarbose (PRECOSE) 25 MG tablet ascorbic acid (VITAMIN C) 1000 MG tablet Cholecalciferol (VITAMIN D3) 25 MCG (1000 UT) CAPS cyanocobalamin (VITAMIN B-12) 1000 MCG tablet folic acid (FOLVITE) 1 MG tablet furosemide (LASIX) 20 MG tablet
Current Illness:
Preexisting Conditions: ETOH abuse with paracentesis
Allergies: NKDA/NKFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to ER with complaints of generalized weakness and report of insomnia for 4 days to getting his second covid shot. He reports having one episode diarrhea and emesis pta. He reports there was no blood in his stool , no black stool, no blood in emesis tonight pta. He reports he saw blood in emesis one day prior


VAERS ID: 1414947 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-02
Onset:2021-06-05
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Back pain, Computerised tomogram abdomen, Computerised tomogram thorax, Death, Deep vein thrombosis, Dysphagia, Dysphonia, Dyspnoea, Electrocardiogram, Full blood count, Guillain-Barre syndrome, Metabolic function test, Muscular weakness, Peripheral swelling, Vena cava filter insertion
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Norco 5/325mg 1 tab every 4 hours as needed, caltrate plus vitamin D-1 tablet daily, Fenofibric acid daily, Metformin 500 mg BID, Zyloprim 100 mg daily Synthroid 0.05mg daily, Vitamin D3 BID, Fish oil 1,200 mg daily, Claritin 10 mg QD, lipi
Current Illness: unknown was seen in the ER not a normal pt here at the Clinic
Preexisting Conditions: Acute Kidney injury, BPH, Type 2 diabetes, DVT, Gout, arthritis, HLD, Hypothyroidism ,renal rupture
Allergies: Warfarin, Lisinopril, Phenylbutazone
Diagnostic Lab Data: Consults-GI, Palliative care, rehab medicine, urology, IR and neuromuscular. Procedure: IVC filter placed on 6/11. CBC, CMP, CT chest,abd,pelvis, EKG all done on 6/5/2021
CDC Split Type:

Write-up: Pt showed up to the ER via EMS on 6/5/2021 with low back pain and weakness, bilateral leg swelling, shortness of breath. On 6/6/2021-developed bilateral upper and lower weakness that progressed to dysphagia and dysphonia. Transferred to ER on 6/8/2021 for Gillian Barre Syndrome On 6/11 had bilateral DVTS He was placed on palliative care and passed away on 6/19/2021


VAERS ID: 1414988 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-17
Onset:2021-05-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Blood glucose normal, Cardiac arrest, Death, Pulse absent
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), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   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: not that report source is aware of
Current Illness: none
Preexisting Conditions: none
Allergies: not that report source is aware of
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the 2nd vaccine on 5/15/21, on 5/16 patient had a "stomach ache", on 5/17 he went to work. At 9:30am, the camera''s show him going into the women''s restroom to service it, a lady tried to go into the restroom and could not go in, she called the supervisor, when the supervisor arrived there was no pulse. Report source believes he goes into work around 7:00AM. Report sources states she was told " his blood sugar was not elevated". Report source states that the death certificate states he had a cardiac arrest.


VAERS ID: 1414999 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-08
Onset:2021-04-22
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dementia Alzheimer's type
SMQs:, Dementia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Zoloft, Losartan, Aricept, Multivitamins, Ferrous Sulfate, Folic Acid, Lasix.
Current Illness: Unknown.
Preexisting Conditions: Hyperthyroidism, Type 2 Diabetes, Alzheimer, Nasogastric, Prostate Cancer, Hospice.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Dies due to Alzheimer complications.


VAERS ID: 1415021 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-03-30
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Cardiac arrest, death


VAERS ID: 1415083 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chills, Death, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 35 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Warfarin, Bystolic, Losartan, allopurinol
Current Illness: none
Preexisting Conditions: heart valve replacement from a birth defect in his heart when he was born
Allergies: none
Diagnostic Lab Data: the file is too large to attach.
CDC Split Type:

Write-up: My husband fell ill within hours of getting the first dose of the vaccine, he started running fever, chills, body aches-within 7 days he was admitted to the hospital and 12 hours after admission to the hospital he was diagnosed with Covid Pneumonia. or they thought- his lungs were showing signs of being attacked. He had no illness, no fever, no underlying health concerns, no allergies, he was not over weight, he was not diabetic, he was still young and within 6 weeks of getting the vaccine he was dead. Doctors could do nothing to save his life. The Moderna vaccine killed my husband and it is killing other perfectly healthy people.


VAERS ID: 1415200 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-03-31
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Death
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 56
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED and was subsequently hospitalized for atrial fibrillation within 6 weeks of receiving COVID vaccination. She died on 5/26/2021.


VAERS ID: 1415209 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-24
Onset:2021-02-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Discomfort, Nausea, Pyrexia, Restlessness, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown, but extensive. He was on Blood Pressure, cholesterol, supplemental oxygen and Welbutrin
Current Illness:
Preexisting Conditions: Chronic heart issues; COPD; high cholesterol
Allergies: Penicillin
Diagnostic Lab Data: none that I know of.
CDC Split Type:

Write-up: Fever, discomfort, restlessness. Administered Tylenol at Dr''s instruction; He collapsed and died. He first reported nausea occurring around 4 am on 2/25/21 and was uncomfortable all day. He felt worse that evening and was showing a fever. He was given Tylenol around 10 pm on 2/25/21. He fell asleep around 2:00 am on 2/26/21 and woke up around 3:00 or 3:15. He had a drink of water then collapsed. I performed chest compressions until the EMTs arrived but he was likely dead by the time they arrived.


VAERS ID: 1415237 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-05-04
Onset:2021-06-01
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hyperhidrosis, Palpitations, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   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: Unknown, bipolar medications
Current Illness: No
Preexisting Conditions: Bipolar disorder
Allergies: No
Diagnostic Lab Data: He had an appointment set but died before going in.
CDC Split Type: 043A21A

Write-up: My dad died after he had symptoms of sweating without doing anything to increase his heart rate. He had stated his heart had been racing recently. He died suddenly and unexpectedly.


VAERS ID: 1415239 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Anticoagulant therapy, Bilevel positive airway pressure, Blood cortisol, Blood creatinine increased, Blood lactic acid, C-reactive protein increased, Deep vein thrombosis, Fasciectomy, Fibrin D dimer, Intestinal ischaemia, Myocarditis, Myoglobin blood increased, N-terminal prohormone brain natriuretic peptide increased, Respiratory failure, SARS-CoV-2 test negative, Thrombosis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALPRAZOLAM (XANAX) 0.5 MG TABLET TAKE ONE-HALF TO ONE TABLET BY MOUTH THREE TIMES A DAY AS NEEDED FOR ANXIETY AMLODIPINE (NORVASC) 10 MG TABLET TAKE ONE TABLET BY MOUTH EVERY DAY ASPIRIN 81 MG CHEWABLE TABLET Take 1 tab
Current Illness: SOB after first covid shot.
Preexisting Conditions: ? Cholelithiases ? Clostridium difficile infection ? Diabetes mellitus (CMS/HCC) ? Enterocolitis ? Epistaxis ? Fracture of right hip (CMS/HCC) ? Hemoglobin A1c less than 7.0% 01/14/2018 6.2 ? History of bone density study unknown ? History of colonoscopy 04/03/2017 repeat 3 years ? Hypertension ? Myocardial infarction (CMS/HCC)
Allergies: Iodine Anaphylaxis Other reaction(s): see contrast passed out Severity: Unknown ? Sulfamethoxazole Hives Severity: Moderate ? Trimethoprim Hives Severity: Moderate ? Clopidogrel ? Codeine Nausea And Vomiting Severity: Severe ? Cyclobenzaprine Hcl ? Sulfamethoxazole-Trimethoprim ? Latex Rash
Diagnostic Lab Data: 6/18 - lactic acid 4.6 , CRP 13 6/16 -proBNP 19,000 6/15 - ddimer 5,513 6/10 - cortisol 145 5/18 Cr 2.58 5/17 myoglobin 1574 5/15 high sensitivity troponin 18,046, covid antigen rapid negative
CDC Split Type:

Write-up: Myocarditis in 2 days - diuretics, Respiratory Failure in 2 days Bipap and Airvo, Clotted off leg in a few weeks Angiogram and Fascitomy, Ischemic gut weeks - comfort care orders, DVT in arm in weeks could have been due to PICC also - Elquis


VAERS ID: 1415252 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-17
Onset:2021-06-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: Bullous Pemphigold, A fib, Type II Diabetes
Allergies: Amoxicillin, Spirolactone, Actos, Ace Inhibitors, PCN
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient died 06/20/2021.


VAERS ID: 1415288 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-02-24
Onset:2021-02-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cancer
Preexisting Conditions: cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: client died. Client had other underlining health conditions.


VAERS ID: 1415311 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-08
Onset:2021-06-04
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN619916022881 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bradykinesia, Brain oedema, Chest X-ray, Computerised tomogram abdomen, Computerised tomogram head abnormal, Computerised tomogram thorax, Condition aggravated, Confusional state, Death, Disorientation, Fall, Fatigue, Feeling abnormal, Gait disturbance, Glioblastoma, Hemiparesis, Impaired driving ability, Intracranial mass, Loss of consciousness, Loss of personal independence in daily activities, Magnetic resonance imaging head abnormal, Mental impairment, Muscular weakness, Myocardial infarction, Resuscitation, Scan with contrast
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 15
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hyperlipidemia
Allergies: None
Diagnostic Lab Data: CT Head WO Contrast 06/04/21 CT ABDMN & PELVIS W/IV CNTRST; CT THORAX W/IV CONTRAST 06/05/21 MRI BRAIN W/WO CONTRAST 06/05/21 CHEST PORT 1 VIEW 06/08/21
CDC Split Type:

Write-up: Patient received her 1st dose of the Pfizer-BioNTech vaccine on March 08, 2021. About a week later she started complaining of feeling fatigued, confused, and disoriented some days. These symptoms progressively got worse over the next 3 months. She received her 2nd dose of the Pfizer-BioNTech vaccine on April 05, 2021. A week later she mentioned waking up more disoriented in the mornings and would look at her hands and think to herself, "Who''s hands are these?" She said she felt like she wasn''t in her right mind. Soon after this she felt she couldn''t go to the grocery store alone or drive because she might get lost. She never had symptoms of Dementia prior to March 2021. On May 10, 2021 I noticed she was moving slower and using walls to guide her through her home as she walked. She mentioned she felt more fatigued at this time. On the weekend of May 21, 2021 we took a trip for her birthday and she was mentioning how it was a struggle for her to pack for the trip because she couldn''t think clearly and had made a mess in her room trying to find her clothes. She was a very tidy & organized person, so this was very unusual. A week after the trip she mentioned losing some strength in her left leg and needing to lean on walls as she walked through her home. On June 4, 2021 the weakness got worse and she mentioned she felt more "off" and wanted to shower before heading to the hospital to be evaluated - when she got out of the shower she completely lost strength in her left leg and fell to the ground, but was conscious. She was taken to Hospital where a CT scan was done that showed brain swelling and a mass. She was then transported to Medical Center where an MRI was done, confirming the swelling and 4cm mass - doctors there believed it could be a Glioblastoma and mentioned it is very aggressive. When asked if the vaccine may have caused this, we were quickly dismissed and told there could be no connection at all. After further research we found that GBM (Glioblastoma) could grow as quickly as .5mm per day and when calculating the time between her 1st dose and her hospitalization (approx. 90 days) it equated to 4.5cm, her mass was 4cm. Even if there was a mass there before her vaccine, there is reason to believe it may have been aggravated by the vaccine. Surgery was suggested, but after 4 days she expressed that she wanted to opt out of the surgery and pursue a second opinion or natural treatments. She was discharged on June 9, 2021 and taken home with medication. She was more alert and lively at home - able to converse and move around with assistance, but did not have strength in her left leg and was losing more strength in her left arm. On June 13, 2021 she suffered a heart attack and was rushed to the emergency room by ambulance. CPR was performed in the ambulance and she was taken to Hospital where they stabilized her but she never regained consciousness. She was taken home for Hospice on June 16, 2021 and passed away on June 19, 2021.


VAERS ID: 1415368 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-30
Onset:2021-05-28
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Autopsy performed by county coroner''s office.
CDC Split Type:

Write-up: Patient died of a sudden heart attack at age 70, just 2 months after receiving his 2nd dose of the vaccine. His parents lived well into their mid-eighties and patient spent the last 17 years of his working years as a door to door, getting lots of cardio exercise every day. At the time of his death he was a very low stress person and taking good care of himself.


VAERS ID: 1415480 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-16
Onset:2021-04-24
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031LZ0A, 047AZ1 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Pulmonary embolism, Pulseless electrical activity
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nortriptaline, gabapentin, simvastatim
Current Illness:
Preexisting Conditions: H/O breast cancer.
Allergies: none
Diagnostic Lab Data: CT pulmonary angiogram
CDC Split Type:

Write-up: Massive pulmonary embolism, pulseless electrical activity


VAERS ID: 1415733 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-13
Onset:2021-06-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cyanosis, Death, Fatigue, Impaired work ability, Injection site erythema, Injection site pain, Lethargy, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The pt received his 2nd Moderna covid vaccine on 6/13/21 at 10:45 am (approximately). Starting at 5pm he c/o pain, redness and tenderness in the injection site, chills, and lethargy . The next day he did not go to work b/o he felt tired and he stayed home with his 7 y/o daughter while his wife went to work. His wife spoke with him in the am and he reports he was making breakfast for their daughter and he was going to lie down and sleep afterward. He made lunch for daughter about 1 pm and he went to lie down in his chair. His brother called his wife at about 4:30 pm stating he was blue. 911 was called and they were unable to revive him.


VAERS ID: 1415978 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-26
Onset:2021-04-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Lower limb fracture, Magnetic resonance imaging head abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 76
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: depakote, quetipaine, lithium, buprenorphine, atorvastatin, methotrexate
Current Illness:
Preexisting Conditions: bi-polar, crohns, fibromyalgia, psoriatic arthritis
Allergies: tetanus, arithamacian, morphine,
Diagnostic Lab Data: MRI taken at Hospital 4/1/2021
CDC Split Type:

Write-up: Brain bleed, broken leg, death


VAERS ID: 1416338 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-04
Onset:2021-02-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriosclerosis, Cardiac failure congestive, Coronary artery disease, Death, Immediate post-injection reaction, Malaise, SARS-CoV-2 test negative
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypersensitivity (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: Covid 19 test was negative. Cause of death was ruled to be Acute and Chronic congestive heart failure with atherosclerotic coronary artery disease.
CDC Split Type:

Write-up: My dad died on February 19th after having been visibly sick immediately after being vaccinated until the day he died, according to his friends. Was told by a friend that he dropped something he was holding while hanging out with friends and they called an ambulance but he refused the ambulance. I do not know that exact date of that incident only that it was following vaccination. Was also told by numerous others that he seemed "sick". No other details are known.


VAERS ID: 1416476 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-05-14
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient died at home 3 weeks after receiving first dose of vaccine.


VAERS ID: 1416479 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-29
Onset:2021-05-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Dysphagia, Hyporesponsive to stimuli, Lethargy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 600 mg am & pm Senna 3 tab 1X daily Escitalopram 5 mg 1 tab daily Allopurinol 100 mg 1 tab daily
Current Illness: Chronic lower back issues
Preexisting Conditions: lower back issues
Allergies: None Known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: June 4, Became largic, could not speak aloud, but understood. could not swallow hardy even water shock head to answer, only last day, very little response Prior to that, was feeding self, carried on good conversation and was enjoyable to visit with


VAERS ID: 1416488 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Passed away; Had seizures 2 days after receiving his first dose; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Passed away) and SEIZURE (Had seizures 2 days after receiving his first dose) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Passed away) (seriousness criteria death and medically significant) and SEIZURE (Had seizures 2 days after receiving his first dose) (seriousness criterion medically significant). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, SEIZURE (Had seizures 2 days after receiving his first dose) outcome was unknown. No concomitant medication information was provided. No treatment medication information was provided. Reporter stated she knows of someone and is not totally sure which vaccine was taken, but says Moderna. Action taken with respect to mRNA-1273 was not applicable. This is a case of a sudden death of a Male patient who reportedly had seizures 2 days after receiving his vaccine. Reporter is unsure of vaccine that patient received and this can be a confounding factor. Very limited information has been provided regarding these events. Most recent FOLLOW-UP information incorporated above includes: On 18-Jun-2021: Sender''s Comments: This is a case of a sudden death of a Male patient who reportedly had seizures 2 days after receiving his vaccine. Reporter is unsure of vaccine that patient received and this can be a confounding factor. Very limited information has been provided regarding these events.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1416708 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
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: USJNJFOC20210628291

Write-up: BLOOD CLOT IN AORTIC ARTERY; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose not reported, 1 total administered on 27-MAR-202 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced a massive blood clot in her aortic artery blocking all the blood flow to her legs then, pieces broke off and went to her brain and heart. On 28-MAY-2021 13:45 in afternoon the patient''s life support was stopped. On 29-MAY-2021 at 2:01, 9 weeks after vaccination the patient died from blood clot in aortic artery. 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 spontaneous report from consumer concerns a female patient of unspecified age/race/ethnicity who developed "massive blood clot in her aortic artery blocking all the blood flow to her legs then, pieces broke off and went to her brain and heart" 62 days after receiving Janssen COVID-19 vaccine. The patient died on 63rd day post vaccination. No other details reported. The information available precludes a complete and meaningful assessment. Considering the temporal relationship, the events are assessed to have an indeterminate relationship with the vaccination.; Reported Cause(s) of Death: BLOOD CLOT IN AORTIC ARTERY


VAERS ID: 1416721 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-04-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac death, Cardiac disorder, Chest pain, Circulatory collapse, Decreased appetite, Dehydration, Dyspnoea, Electrocardiogram, Fatigue, Thirst
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 9
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: CHLORTHALIDONE; LOSARTAN POTASSIUM; MELOXICAM; METOPROLOL SUCCINATE; PANTOPRAZOLE SODIUM; TAMSULOSIN HCL; XARELTO; AMLODIPINE BESYLATE; TADALAFIL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: ECG; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive; Test Name: ECG; Test Result: Inconclusive ; Result Unstructured Data: Inconclusive
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Dehydrated; Collapsed; Cardiac death/the patient woke up and then grab it''s chest and collapsed; Started having heart issues; Chest pain; Lose it''s appetite; Thirsty; Short of breath/got very winded; Fatigue/ very tired; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of CARDIAC DEATH (Cardiac death/the patient woke up and then grab it''s chest and collapsed), DEHYDRATION (Dehydrated) and CIRCULATORY COLLAPSE (Collapsed) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included CHLORTHALIDONE, LOSARTAN POTASSIUM, MELOXICAM, METOPROLOL SUCCINATE, PANTOPRAZOLE SODIUM SESQUIHYDRATE (PANTOPRAZOLE SODIUM), TAMSULOSIN HYDROCHLORIDE (TAMSULOSIN HCL), RIVAROXABAN (XARELTO), AMLODIPINE BESILATE (AMLODIPINE BESYLATE) and TADALAFIL for an unknown indication. On 01-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In April 2021, the patient experienced DEHYDRATION (Dehydrated) (seriousness criterion hospitalization), CARDIAC DISORDER (Started having heart issues), CHEST PAIN (Chest pain), DECREASED APPETITE (Lose it''s appetite), THIRST (Thirsty), DYSPNOEA (Short of breath/got very winded) and FATIGUE (Fatigue/ very tired). On an unknown date, the patient experienced CIRCULATORY COLLAPSE (Collapsed) (seriousness criterion medically significant). The patient died on 10-Apr-2021. The reported cause of death was Cardiac death. An autopsy was not performed. At the time of death, DEHYDRATION (Dehydrated), CIRCULATORY COLLAPSE (Collapsed), CARDIAC DISORDER (Started having heart issues), CHEST PAIN (Chest pain), DECREASED APPETITE (Lose it''s appetite), THIRST (Thirsty), DYSPNOEA (Short of breath/got very winded) and FATIGUE (Fatigue/ very tired) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Electrocardiogram: inconclusive (Inconclusive) Inconclusive and inconclusive (Inconclusive) Inconclusive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Action taken with the mRNA-1273 vaccine due to the events was not applicable. The reporter informed that the patient had received both doses of mRNA-1273 vaccine. He first lost his appetite and started feeling thirsty on the following day after vaccination, which worsened progressively for the next five days. The patient then started having chest pain, was short of breath and experienced fatigue. He got very winded when he went to the bathroom and felt very tired for the next two days, When he went to the hospital, the doctor said that he would need to be admitted if he doesn''t feel well. On a Wednesday, the patient went to the hospital and an ECG was done. The reporter informed that when the doctor compared it with an ECG from few days before, he could not believe it was of the same patient''s. The patient was taken to the ER (emergency room) and was them transferred to ICU (intensive care unit) as he was dehydrated. Dehydration was treated and at the time the patient started having heart issues. By Friday, the patient started doing better and the doctor discussed discharging him. On Saturday, when the patient woke up he grabbed his chest and collapsed. The reporter informed that they were not able to get an autopsy but the death was assumed to be cardiac death. It was reported that the patient passed away approximately nine days after receiving the second dose of the vaccine. The reporter further informed that the patient was in good health and had a full ''cardiac work'' prior to his vaccination. Company comment: Very limited information regarding this event has been provided at this time. Details regarding medical history and course in the hospital is required for further evaluation.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Details regarding medical history and course in the hospital is required for further evaluation.; Reported Cause(s) of Death: Cardiac death


VAERS ID: 1416816 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-17
Onset:2021-05-03
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiomyopathy, Death, Depressed level of consciousness, Lethargy
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Death certificate states cardiomyopathy
CDC Split Type:

Write-up: Woke that morning very lethargic and hard to arouse. Mom states had been doing very well, exercising and losing weight. States he felt good up until that day. DEATH


VAERS ID: 1416951 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-20
Onset:2021-01-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure increased, Death, Disorientation, Gait inability, Incoherent, Oxygen saturation decreased, SARS-CoV-2 test positive, Seizure, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Dementia (broad), Convulsions (narrow), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   Days after onset: 8
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: Albuterol HGA 108 - PRN, aspirin, atorvastatin 80 mg, B-12, budesonide .05 mg, clopidogrel 75 mg dextromethorphan polistirex ER 30mg, doxycline 100 mg, escitalopram 10 mg, fluticasone 50 mct/ACT PRN, gabapentin 300 mg, ipratropium 0.02%, le
Current Illness: COVID
Preexisting Conditions: Dementia
Allergies: penicillin
Diagnostic Lab Data: COVID test on January 3, 2021
CDC Split Type:

Write-up: The first vaccine was administered on December 30, 2020 from a local pharmacy. She was diagnosed with COVID on January 3. She was in and out of ER for 3 days, when we finally took her home and got hospice care. On January 19, 2021 Dr''s office told us that she could get the 2nd vaccine the next day. She received the 2nd vaccine on January 20, 2021 from a local pharmacy. On January 21 she became disoriented and was sleeping most of the time, by Friday, January 22, she could not walk and was incoherent most of the time. The evening of January 22, we presume she had a stroke, but was not officially diagnosed. Her oxygen level dropped to 42 and her blood pressure was 287/182 with seizures that lasted about 1 minute. She died on January 29, 2021.


VAERS ID: 1416982 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-22
Onset:2021-01-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dyspepsia, Respiratory disorder, SARS-CoV-2 test negative
SMQs:, Acute central respiratory depression (broad), Gastrointestinal nonspecific dysfunction (narrow), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Pacemaker, heart problems, doesn''t pacify.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 PCR lab test on February 11, 2021, negative.
CDC Split Type:

Write-up: Burning sensation in the stomach, died of respiratory problems.


VAERS ID: 1416990 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Confusional state, Death, Fall, Hallucination, Headache, Infection, Myalgia, Nausea, Pain in extremity, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin (Type 2) , Omeprazole, Metoprolol, Losartan
Current Illness: Type 2 Diabetic , HBP
Preexisting Conditions: N/A
Allergies: Dairy, Pork, Beef
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient''s wife stated Husband 2021/03/12 muscle pain in legs, fever 2021/03/14 (100.4), chills (Treated temp down 99.8), stomach/muscle pains. Contact with Dr. 2021/03/17 (Fever 100.7) phoned. No treatments for nausea, headache, muscle pains. Hospital visit ER with confusion/hallucinations. Temp 100.4 BP 136/110, *8:30am 2021/03/19. Home incident of falling, EMS called (vitals normal) admitted in Hospital. Transferred to another Hospital (Covid Neg.), stated bad infections. Death 2021/03/21


VAERS ID: 1417056 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-04-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Gastrointestinal disorder, Mass
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 39
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''s wife reported that patient died a couple of days after second Moderna vaccine. About 2 days after vaccine, patient presented with lumps all around body and doctor''s could not figure out what was wrong. His digestive tract started to deteriorate and he passed away at home. Autopsy was performed but could not confirm cause of death.


VAERS ID: 1417063 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-28
Onset:2021-06-20
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Metoprolol
Current Illness: Atrial Fibrillation
Preexisting Conditions:
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 6/20/2021. Cause of death unknown.


VAERS ID: 1417109 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-18
Onset:2021-05-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 21
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: Not known
CDC Split Type:

Write-up: Patient received first dose of Moderna on May 18, 2021. Spouse came to the pharmacy and informed us that the patient passed away in the hospital on June 15, 2021. She was diagnosed with COVID-19 during her stay at the hospital.


VAERS ID: 1417142 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-22
Onset:2021-05-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Viral infection, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: 19-year-old male presenting for evaluation due to ongoing nausea and vomiting. Patient says he has had vomiting for approximately 4 days. Admits to daily marijuana use secondary to IBS. He states that he was in the emergency department yesterday and told that he has a acute viral infection. States that he struggled to keep food or liquid down even after discharge home. Patient denies other illicit substance abuse. Patient discharged with ondansetron. Of note, patient Qtc $g600ms before discharge.


VAERS ID: 1417175 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-04-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I do not know
Current Illness: none
Preexisting Conditions: Back problems
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Massive Heart Attack


VAERS ID: 1417182 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-01
Onset:2021-05-15
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Pre-Existing Conditions: CARDIOVASCULAR DISEASE, DIABETES MELLITUS, CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD)
Allergies: Unknown
Diagnostic Lab Data: + PCR on 5/15/2021 + Antigen on 5/17/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient who tested positive for COVID-19 via PCR on 5/15/21 after the completion of a full Pfizer vaccine series (Dose 1 on 2/8 and Dose 2 on 3/1). The patient later died on 5/28/21. Cause of Death is listed as ?Acute hypoxemic respiratory failure Pneumonia COVID-19?. Pre-existing conditions listed as: CARDIOVASCULAR DISEASE, DIABETES MELLITUS, CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD)


VAERS ID: 1417184 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-06
Onset:2021-05-16
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 19
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: Unknown
Current Illness: Acute Kidney Injury
Preexisting Conditions: Hypothyroidism due to Hashimoto''s thyroiditis High Blood Pressure Immunosuppressive therapy - DM
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test result on 05/17/2021
CDC Split Type: 6932126

Write-up: The patient died of COVID-19


VAERS ID: 1417204 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-05
Onset:2021-05-30
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, Upper gastrointestinal haemorrhage, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: PCR + 5/30/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient who tested positive for COVID-19 via PCR on 5/30/21 after the completion of a full Janssen vaccine series (Dose 1 on 5/5/21). The patient later died on 6/03/21. Cause of Death is listed as ?Upper gastrointestinal hemorrhage?. Comments:=======================nnJune 01, 2021 at 3:07 PM by HD nn6/1 3:06 Supervisor Review completed by HD): ICP needednPT resides at ..nPT admitted to hospital- as asymptomatic. No dates were provided. shows specimen collected via hospital on 5/30 and no notes regarding admittance.nClosed as medical barriers.nnn=======================nnJune 01, 2021 at 2:34 PM by CNA, case is hospitalized since 5/30. Head of Nursing sent her to hospital for vomiting and is not currently in the ICU or being treated for any respiratory issues related to COVID,


VAERS ID: 1417223 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-05-14
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, Ischaemic skin ulcer, Peripheral arterial occlusive disease, Peripheral ischaemia, Respiratory failure, SARS-CoV-2 test positive, Vascular graft
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), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 22
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: Pre-Existing Conditions: OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, DIABETES MELLITUS, CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD)
Allergies: unknown
Diagnostic Lab Data: PCR + 5/14
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient who tested positive for COVID-19 via PCR on 5/14/21 after the completion of a full Moderna vaccine series (Dose 1 on 4/1 and Dose 2 on 4/29). The patient later died on 6/5/21 . Cause of Death is listed as cardiac arrest; hypoxic RF; Extensive PAD and ischemic leg/foot ulcers s/p bypass surgery. Pre-existing conditions listed as: OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, DIABETES MELLITUS, CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD)


VAERS ID: 1417262 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-15
Onset:2021-05-16
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 10
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic Lung Disease
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test result 5/16/2021
CDC Split Type:

Write-up: Died of COVID-19


VAERS ID: 1417263 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-14
Onset:2021-04-28
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Bradycardia, COVID-19, Death, Endotracheal intubation, Hypotension, Intensive care, Mechanical ventilation, Pneumonia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 6
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: OTHER CHRONIC DISEASES, IMMUNOCOMPROMISED CONDITION
Allergies: Unknown
Diagnostic Lab Data: + Antigen 4/28 +PCR 4/29
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient who tested positive for COVID-19 via PCR on 4/29/21 after the completion of a full Pfizer vaccine series (Dose 1 on 1/24 and Dose 2 on 2/14). The patient later died on 5/04/21. Pre-existing conditions listed as: OTHER CHRONIC DISEASES, IMMUNOCOMPROMISED CONDITION. Comments:05/04/21:Patient was admitted to the hospital on 4/28/2021 for COVID-19 infection, pneumonia, and acute on chronic renal failure. He was transferred to the ICU on 4/29/2021 due to acute hypoxic respiratory failure requiring intubation. Despite maximum therapies, the patient''s respiratory status did not improve. He remained mechanically ventilated from 4/29 through 5/4. On 5/4, the patient became hypotensive and bradycardic. The patient died at 10:45.


VAERS ID: 1417278 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-11
Onset:2021-04-22
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 21
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: + PCR 4/22
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient who tested positive for COVID-19 via PCR on 4/22/21 after the completion of a full Moderna vaccine series (Dose 1 on 2/11 and Dose 2 on 3/11). The patient later died on 5/13/21 . Cause of Death is listed as ?Intestinal Obstruction?.


VAERS ID: 1417294 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-21
Onset:2021-04-14
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardio-respiratory arrest, Chest pain, Death, Hypoxic-ischaemic encephalopathy, Myocardial infarction, Myocardial necrosis marker increased, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Vaccine breakthrough infection, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 24
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: Pre-Existing Conditions: OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, IMMUNOCOMPROMISED CONDITION
Allergies: Unknown
Diagnostic Lab Data: PCR + 4/14
CDC Split Type:

Write-up: I am the epidemiologist for reporting on behalf of patient who tested positive for COVID-19 via PCR on 4/14/21 after the completion of a full Pfizer vaccine series (Dose 1 on 2/28 and Dose 2 on 3/21). The patient later died on 5/08/21. Cause of Death is listed as ?cardiopulmonary arrest; Anoxic encephalopathy; V. Fib cardiac arrest; Myocardial infaction?. Pre-existing conditions listed as: OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, IMMUNOCOMPROMISED CONDITION Case went to Hospital ER on 4/14 after experiencing chest pains for 2-3 days. Rapid COVID test on 4/14 was negative & PCR test on 4/14 was positive. Case remained in ER for retesting on 4/15 (PCR - negative) so she could be admitted to hospital for cardiac catheterization. Case reports having a mild fever at hospital on evening of 4/15 & morning of 4/16. Hospital Internist DX was mild case of COVID with elevated enzymes that indicated a cardiac event. Case is fully vaccinated (1st dose of Pfizer 2/28 & 2nd dose of Pfizer 3/21). Case has history of lupus & rheumatoid arthritis (immuno-suppressed). She receives PT 2-3x/week & biologic treatment (last infusion of Orencia was 4/13). Advised case to follow-up with her PCP & cardiac specialist. Case agreed to isolation guidelines. Case lives alone but has 2 adult sons who live nearby that will provide food drop-offs at door. Emailing vaccination breakthrough info to Epidemiologist & supervisors.nnn=======================nnApril 15, 2021 at 3:28 PM ET Left SMS/VM.


VAERS ID: 1417329 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-18
Onset:2021-04-05
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Rectal cancer metastatic, SARS-CoV-2 test positive
SMQs:, Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Pre-Existing Conditions: OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, IMMUNOCOMPROMISED CONDITION, DIABETES MELLITUS
Allergies: Unknown
Diagnostic Lab Data: PCR + 4/5
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient who tested positive for COVID-19 via PCR on 4/5/21 after the completion of a full Pfizer vaccine series (Dose 1 on 12/28/20 and Dose 2 on 1/18/21). The patient later died on 4/9/21. Cause of Death is listed as ?Metastatic Rectal cancer?. Pre-existing conditions listed as: OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, IMMUNOCOMPROMISED CONDITION, DIABETES MELLITUS Comments: Spoke to the case adult daughter. She informed that the case resides at a rehabilitation center. The case''s daughter stated that her mother is not having any symptoms and was fully vaccinated. The daughter did not have all the information on dates of vaccine. called center spoke to the administrator who provided the information. The case was at the hospital from 3/27-4/1. Rehab requires a (-) test result to return and a (-) test four days after returning. The case test (+) on her 4th day 4/5.nnn


VAERS ID: 1417642 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-24
Onset:2021-06-07
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   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: vimpat Depakote dr
Current Illness:
Preexisting Conditions: epilepsy learning disabilities
Allergies: clindamycin topamax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient father reported he passed away in his sleep the night of 06-07-21 and was pronounced diseased on 6-8-21


VAERS ID: 1417680 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-19
Onset:2021-02-07
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 19
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: UNK
Current Illness: UNK
Preexisting Conditions: chronic heart and kidney disease, high blood pressure, congestive heart failure and cirrhosis
Allergies: UNK
Diagnostic Lab Data: COVID-19 positive
CDC Split Type:

Write-up: presented with a cough, difficulty breathing, sinus congestions and headache on 2/7. tested positive for COVID-19. admitted to the hosp. completed 5 days of remdesivir 2/16 and 10 days of dexamethasone 2/21


VAERS ID: 1417729 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-12
Onset:2021-04-22
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Areflexia, Cardiac arrest, Catheterisation cardiac normal, Chest pain, Death, Dyspnoea, Electrocardiogram ST segment elevation, General physical health deterioration, Intra-aortic balloon placement, Mydriasis, Pulmonary embolism, Pulse absent, Pulseless electrical activity, Pupil fixed, Respiratory arrest, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: This was very unfortunate 51 years old male with past medical history of hypertension, hyperlipidemia, obesity. Patient presented with chief complaint of shortness of breath and chest pain. EMS reported that the patient has been complaining of some shortness of breath and chest pain intermittent for couple of weeks. 12 leads EKG showed evidence of anterior ST elevation myocardial infarction. Code heart was called. Patient developed PEA arrest in the Cath Lab. CPR ACLS was initiated. ROSC was achieved initially after 30 minutes of CPR. Intra-aortic balloon pump was placed. Coronary arteries were essentially clean. Due to high suspicion for massive PE-TPA was given 100 mg without meaningful clinical improvement. CPR was continued for more than an hour. Despite all aggressive measures patient continued to deteriorate. At 3:26 PM patient has no spontaneous breathing, no peripheral pulses, no heartbeats by auscultation or by monitor. Pupils were fixed and dilated. No cough no gag reflexes . patient was pronounced dead.


VAERS ID: 1417752 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-09
Onset:2021-02-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure, Cardiac failure congestive, Cough, Death, Dyspnoea, Fatigue, General physical health deterioration, Loss of personal independence in daily activities
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Severe cough, shortness of breath, exhaustion leading to emergency room visit followed by hospitalization wherein it was discovered Pt was diagnosed with acute congestive heart failure. Prior to this vaccine he was living alone, preparing meals, driving to errands, etc. Over the following few weeks after release he became unable to live at home so he was moved to an assisted living facility where he rapidly declined and was put on hospice less than 2 weeks after his second Covid shot on 3/2/21 (Lot EN9581) (which he only took because his doctor pressured him). He died on 6/2/21 of heart failure.


VAERS ID: 1417790 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-18
Onset:2021-06-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Condition aggravated, Death, Epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Family reported that she had a seizure following 1st dose of COVID vaccine. If so, it does not appear that she sought medical tr
Other Medications: Unknown - reportedly non-compliant with prescribed medications.
Current Illness: Nothing acute. Reportedly had a seizure after her first COVID vaccine dose 3 weeks prior.
Preexisting Conditions: Epilepsy, Obesity
Allergies: Unknown.
Diagnostic Lab Data: Autopsy on 6/21/21 was essentially unremarkable. Death is likely due to epilepsy in the setting of noncompliance with anticonvulsants, but I thought I would make this report to cover all the bases.
CDC Split Type:

Write-up: 37 yo woman with a history of epilepsy and medical noncompliance found dead in her bed less than two days after receiving 2nd COVID vaccine (believed to be Pfizer). Reportedly experienced a seizure following the 1st dose approximately 3 weeks prior.


VAERS ID: 1417870 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-08
Onset:2021-03-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / UNK AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Colonoscopy, Intensive care, Magnetic resonance imaging, Rectal haemorrhage, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Thrombophlebitis (broad), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Coronary artery disease, arthritis, peripheral vascular disease, abdominal aortic aneurism
Allergies: None
Diagnostic Lab Data: Hospitalized in ICU, colonoscopy, MRI
CDC Split Type:

Write-up: Profuse rectal hemorrhaging and blood clots


VAERS ID: 1417871 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-03-18
Onset:2021-03-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Diarrhoea, Fatigue, Myalgia, Nausea, Sudden death, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: Cyclobenzaprine, Atorvastatin, Lorsartan, Hydroxyzine and Vitamin B-12
Current Illness: None known
Preexisting Conditions: Hyperlipidemia, hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, vomiting, diarrhea, muscle pain with fatigue with the first and second dose. Was reported to not be able to hold anything down with second dose and sudden death while sleeping (nap for fatigue). Found dead in bed 3/21/2021. No allergic reactions were reported. No unusual electrolyte findings suggested the cause.


VAERS ID: 1417918 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-18
Onset:2021-06-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043821A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, acetaminophen, fish oil, garlic
Current Illness: Aortic stenosis, coronary artery disease COPD
Preexisting Conditions: Aortic stenosis, coronary artery disease COPD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1418055 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-01
Onset:2021-06-20
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   Days after onset: 1
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: Oral contraceptives
Current Illness: anxiety
Preexisting Conditions: anxiety; herpes simplex
Allergies: clarithromycin; penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary Embolism


VAERS ID: 1418084 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-04-27
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   Days after onset: 55
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: 4/29/2021 SARS CoV-2 RNA, TMA positive
CDC Split Type:

Write-up: Developed s/s of COVID on 4/27/2021, hospitalized, then transferred to another HCF was inpatient ICU 5/8-6/21 expired 6/21/21


VAERS ID: 1418095 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-07
Onset:2021-06-11
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA EC 81 mg, tadalafil 20 mg, Vitamin C, Nizoral 2% shampoo, ibuprofen 200 mg, Flexeril 10 mg , triamcinolone 0.1% cream, metFORMIN XR 500 mg 2 tabs daily, Lipitor 40 mg, hydrocortisone 2.5% cream
Current Illness: n/a
Preexisting Conditions: obesity class III Type 2 Diabetes Borderline high blood pressure Hyperlipidemia Sabaceous cyst
Allergies: Oxycodone Hcl - hives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found dead in his bed on June 11, 2021.


VAERS ID: 1419747 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USJNJFOC20210635272

Write-up: PASSED AWAY; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a consumer via a company representative via social media concerned a patient of unspecified age, sex, unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported, expiry: unknown) dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, patient had suspected Covid-19, suspected clinical vaccination failure and patient passed away from unknown cause. It was unknown if the autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was passed away on an unspecified date. The outcome of suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to 20210629346.; Sender''s Comments: V0: 20210635272-Covid-19 vaccine ad26.cov2.s-Passed away 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). 20210635272-Covid-19 vaccine ad26.cov2.-Suspected Clinical Vaccination Failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1419805 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-20
Onset:2021-03-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Fall, Haemorrhage, Myocardial infarction, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   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: Diabetes (was on anti-diabetic medicine.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Died due to heart attack; Lot of blood was on the floor; He fell on bathroom tiles; Feeling weakness/Could not coming out of bed; Fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Died due to heart attack) and HAEMORRHAGE (Lot of blood was on the floor) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes (was on anti-diabetic medicine.). On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Mar-2021, the patient experienced ASTHENIA (Feeling weakness/Could not coming out of bed), PYREXIA (Fever) and CHILLS (Chills). On 23-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (Died due to heart attack) (seriousness criteria death and medically significant), HAEMORRHAGE (Lot of blood was on the floor) (seriousness criterion medically significant) and FALL (He fell on bathroom tiles). The patient died on 23-Mar-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, HAEMORRHAGE (Lot of blood was on the floor), FALL (He fell on bathroom tiles), ASTHENIA (Feeling weakness/Could not coming out of bed), PYREXIA (Fever) and CHILLS (Chills) outcome was unknown. Concomitant medication included was anti-diabetic medicine. The treatment information was not provided. Very limited information regarding this events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: heart attack


VAERS ID: 1419824 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Died; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were provided. It was reported that a person died after receiving a COVID-19 vaccine. No further details were provided. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1419839 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-04-23
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Feeling abnormal, Illness
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 33
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: Surgery (Bladder surgery on 25 Feb.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Stated going downhill; He died; Got a little sick,he stated going downhill; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DEATH (He died) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Surgery (Bladder surgery on 25 Feb.). On 16-Apr-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, the patient experienced ILLNESS (Got a little sick,he stated going downhill). On an unknown date, the patient experienced FEELING ABNORMAL (Stated going downhill). The patient died on 26-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, ILLNESS (Got a little sick,he stated going downhill) and FEELING ABNORMAL (Stated going downhill) outcome was unknown. Treatment and concomitant information was not provided by the reporter. Patient had the modera shot on 16-Apr-2021 and he was recovering from a bladder surgery. Very limited information regarding this events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1419925 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021702371

Write-up: patient died recently after getting the vaccine; This is a spontaneous report from a contactable consumer. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died recently after getting the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information about lot/batch number has been requested.; Reported Cause(s) of Death: patient died recently after getting the vaccine


VAERS ID: 1419934 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021711228

Write-up: with no health conditions died after the vaccine; This is a spontaneous report from a contactable consumer (patient''s friend). A 25-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. A friend''s 25 year old daughter (the patient) with no health conditions died after the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: with no health conditions died after the vaccine


VAERS ID: 1420118 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210644799

Write-up: DEATH; This spontaneous report received from a parent via a company representative via social media concerned a 30 year old male, unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported, expiry: unknown) dose was not reported, 1 total, administered on APR-2021 for prophylactic vaccination. The batch number was not reported. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient was died. The patient died from unknown cause of death. It was unknown if the autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210644799-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: 1420121 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Inappropriate schedule of product administration, Vaccination site pain
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: passed away; received second vaccine 44 days after receiving the first dose; Pain the injection site from the first dose; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away) in a 91-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 31-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 31-Mar-2021, the patient experienced VACCINATION SITE PAIN (Pain the injection site from the first dose). On 14-May-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received second vaccine 44 days after receiving the first dose). On 05-Apr-2021, VACCINATION SITE PAIN (Pain the injection site from the first dose) had resolved. On 14-May-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received second vaccine 44 days after receiving the first dose) had resolved. The patient died on 09-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was reported. Company comment: This report refers to a case of Inappropriate schedule of product administration for mRNA-1273, with associated Adverse Events of Vaccination site pain and Death in a 91-year-old female subject who died 25 days after receiving second dose of vaccine. Very limited information regarding these events has been provided at this time. Further information has been requested. This case was linked to US-MODERNATX, INC.-MOD-2021-132760 (Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 14-Jun-2021: Case upgraded to Serious due to death.; Sender''s Comments: This report refers to a case of Inappropriate schedule of product administration for mRNA-1273, with associated Adverse Events of Vaccination site pain and Death in a 91-year-old female subject who died 25 days after receiving second dose of vaccine. Very limited information regarding these events has been provided at this time. Further information has been requested. US-MODERNATX, INC.-MOD-2021-132760:Son; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1420192 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-07
Onset:2021-01-30
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ferrous Sulfate, Folic Acid, Lorazepam, Temazepam.
Current Illness: Unknown.
Preexisting Conditions: Dementia and Alzheimer.
Allergies: Unknown.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Died do to unknown reasons, did not present symptomology.


VAERS ID: 1420194 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-01-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Bedridden, Cerebrovascular accident, Death, Dysarthria, General physical health deterioration, Hemiparesis, Mobility decreased
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), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   Days after onset: 7
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Simvastatin, baby aspirin
Current Illness:
Preexisting Conditions: Terminal ovarian cancer
Allergies: Latex, dairy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild stroke on morning of day following administration of the vaccine (first in series). Stroke resulted in weakness and limited mobility on left side and slurred speech. Patient was bedridden following the stroke. Patient had terminal cancer but the stroke following the vaccine seemed to trigger a swift decline and patient died one week later.


VAERS ID: 1420208 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-18
Onset:2021-04-04
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Tid, Atrovent, Losartan, Galantamine, Remeron, Aricef, Vitamin D.
Current Illness: Unknown.
Preexisting Conditions: Keratosis, Respiratory failure, Stroke, Alzheimer''s, Aricept.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Antigen test. In April, 4 2021.
CDC Split Type:

Write-up: Died, unknown reasons, no symptomology reported.


VAERS ID: 1420257 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-12
Onset:2021-06-22
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (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: 2021-06-22
   Days after onset: 0
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: asthma, depression, hypothyroid
Allergies:
Diagnostic Lab Data: PCR positive SARs CoV2
CDC Split Type:

Write-up: hospitalized with respiratory distress and death


VAERS ID: 1420492 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-06-16
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   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 hospitalized after testing positive for COVID-19. Patient died. Patient was fully vaccinated.


VAERS ID: 1420514 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-06-10
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Myalgia, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Tested positive for COVID-19 via PCR on 12/31/2020 and again on 4/16/2021.
CDC Split Type:

Write-up: Symptom onset was 12/26/2020, with nausea, fever, chills, rigors, fatigue, cough, & myalgia.


VAERS ID: 1420517 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-27
Onset:2021-05-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Atrial fibrillation, Bandaemia, Blood urea increased, C-reactive protein increased, Cough, Death, Dyspnoea, Hypoxia, Leukocytosis, Lung consolidation, Pneumonia, Red blood cell count decreased, Septic shock, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: chronic Hepatitis C Subarachnoid hemorrhage
Allergies: Penicillin
Diagnostic Lab Data: WBC = 10.4 at 14:35 6/5, 26.2 at 22:00 6/5, 30.9 at 06:40 6/6 RBC = 2.98, 2.8, 2.47 CRP = 19.9 at 14:35 6/5 BUN = 71, 66, 62
CDC Split Type:

Write-up: 1 week history of shortness of breath and nonproductive cough beginning shortly after receipt of second dose. Patient became hypoxic and had diffuse consolidation through left lung with wedge-shapes consolidation involving the right upper and midlateral lungs. Leukocytosis and bandemia noted and acute renal failure. Developed atrial fibrillation and rapid ventricular response. Multilobal pneumonia, septic shock, non-q-wave myocardial infarction, acute renal failure. Patient expired.


VAERS ID: 1420630 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-13
Onset:2021-04-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, General physical health deterioration, Haemophagocytic lymphohistiocytosis, Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 73
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 32 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Artane, azithromycin, calcium carbonate, dicyclomine, doxycycline, escitalopram, flovent, gabapentin, lansoprazole, melatonin, ondansetron, tedizolid,
Current Illness: disseminated mycobacterium chelonae infection
Preexisting Conditions: ataxia telangiectasia; EBV-associated lymphoma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: ~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died.


VAERS ID: 1420707 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-01-13
Onset:2021-01-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Respiratory symptom, 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: 2021-02-02
   Days after onset: 19
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: Flonase, Amlodipine, Atenolol, HCTZ, Losartan, Metformin, Simvastatin, Vitamin D3
Current Illness: Unknown
Preexisting Conditions: Diabetes Type II Diastolic Dysfunction Hypertension Obesity Hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: 01/18/2021
CDC Split Type:

Write-up: Patient presented to ER on 01/18/2021 and stated respiratory symptoms began on 01/14/2021. Positive Covid test that day. Patient was released from ER and admitted as inpatient to the hospital on 01/23/2021 and expired of Covid related symptoms on 02/02/2021.


VAERS ID: 1420722 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-23
Onset:2021-02-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood glucose decreased, Cardiac failure congestive, Fluid retention
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 101
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: a-fib heart condition
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low blood sugar, fluid retention, congestive heart failure.


VAERS ID: 1420750 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-06-12
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Liver disorder, Sepsis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

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

Write-up: Severe Sepsis with Acute Hypoxic Resp failure Chronic liver disease


VAERS ID: 1420762 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-06-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   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: Vienva 0.1-20 mg-mcg per tablet
Current Illness: No.
Preexisting Conditions: Obesity, Family history of clotting disorder (her workup with negative), and depression.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest without resuscitation. Unknown cause of cardiac arrest. Awaiting autopsy report.


VAERS ID: 1420765 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-04-19
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Intestinal perforation, Metastases to bone, Renal cancer metastatic, Renal cell carcinoma
SMQs:, Gastrointestinal perforation (narrow), Ischaemic colitis (broad), Non-haematological malignant tumours (narrow)

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

Write-up: Renal cell carcinoma of right kidney metastatic to other site ? Bone metastasis ? Perforated bowel


VAERS ID: 1421063 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-05-22
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Alcoholism, Dyspnoea, Seizure
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PAF Seizure , ETOH dependency , Dyspnea


VAERS ID: 1421090 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-06-09
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiopathy, Chronic obstructive pulmonary disease, Coronary artery disease
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Advanced coronary artery disease, Arteriovascular risk factors, Chronic obstructive lung disease.COVID-19 2/10/2021, Recurrent GI bleed with iron deficiency


VAERS ID: 1421273 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-18
Onset:2021-06-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 0
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg tablet 650mg TABLET NG-Tube PRN Every 4 Hours CO acetaminophen 325 mg tablet 650mg TABLET NG-Tube PRN Every 4 Hours DC albuterol sulfate HFA 90 mcg/actuation aerosol inhaler 2 PUFFS HFA AEROSOL WITH ADAPTER (GRAM) Inhal
Current Illness: REPIRATORY FAILURE WITH HYPOXIA C4 FRACTURE STAGE 4 PRESSURE INJURY OF SACRUM DYSPHAGIA PNEUMONIA SEVERE CALORIE MALNUTRIRION
Preexisting Conditions: DM TYPE 2 HYPERTENTION HYPERCHOLESTEROL ASTHMA
Allergies: PCN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: DEATH WITHIN 24 HOURS


VAERS ID: 1421316 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-29
Onset:2021-05-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Culture wound positive, Death, Enterobacter infection, Oedema, Refusal of treatment by patient, Wound drainage, Wound infection
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol Tablet 100 MG Calcitriol Capsule 0.25 MCG cefTRIAXone Sodium Solution Reconstituted 1 GM Inject 1 gram intramuscularly Cozaar Tablet 50 MG dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Fluticasone Propionate Suspensio
Current Illness: Admitted to facility 4/9/2021 with progressive decline in medical conditionsESRF, CHF, CAD with CABBG x 5, DM, HTN, A-Fib, Hyperlipidemia, and asthma. She was using O2 supplementation as needed when desatting below 90%. Pitting edema with sloughing erosions and scabs to BLE. Labs revealed significantly elevated BUN and Creatinine. Dartmouth nephrology consulted and pt and dtr delined Dialysis. 4/13 pneumonia diagnosed-started Rocephin. Diuretics were reviewed and changed 4/19/2021 Dr. reviewed lab,BUN/CR-65/3.23, See n.o. to consult nephrology,CBC,BMP,BNP in am,CXR today,hold torsemide today. 4/20/2021 Dr reviewed lab,BUN/CR 71/3.26, SEE N.O. to hold torsemide, BMP in am 4/21/2021 APRN in and updated with overall condition with family request for palliative care, see n.o. 4/21/2021 Dr. updated with BUN/CR OF 64/3.17, N.O. Check BMP,CR in am,con''t to hold torsemide 4/21/2021 Order written for Palliative Consult. Per ADPOA, request, faxed referral to Hospice Care. 4/22/2021 Dr. reviewed lab,BUN/CR-69/3.04, D/C previous torsemide,start torsemide 20mg po qd.Nephrelogy consult pending today 4/22/2021 Out to follow up visit with nephrologist,returned, see n.o?s Continue NAS diet. Recommendation for Dialysis, however, resident and ADPOA declines 4/24-BLE with increased weepind and drainage, increased weight gain. Ongoing communications with Dartmouth Nephrology, ADPOA/Dtr, Dr. and APRN. 4/28 Consent given for Covid Vaccine and medical clearance as well. 4/29, received Covid Vaccine. 4/30 Palliative Care consult completed. 4/30-5/1 BLE progressively worsened with profuse weeping edema and copious wound drainage. Drainage was cultured and started on Keflex for infection. 5/4 Moderate growth Enterobacter cloacae complex(this isolate demonstrates possible carbapenemase production). C&S referred to Public Health lab for confirmation. Infection control and wound nurse updated and contact precautions initiated. Wound nurse assessed legs and consulted with Dr. for treatment. New orders received to d/c Keflex and start Cipro 500mg PO daily x 7 days. 5/4-5/7 Progressive overall decline and continued to decline Dialysis.
Preexisting Conditions: UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE CHRONIC KIDNEY DISEASE, STAGE 4 (SEVERE PNEUMONIA, UNSPECIFIED ORGANISM TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE ATHEROSCLEROSIS OF CABG W/O ANGINA PECTORIS WEAKNESS UNSPECIFIED ABNORMALITIES OF GAIT AND MOBILITY COGNITIVE COMMUNICATION DEFICIT HYPERPARATHYROIDISM, UNSPECIFIED ESSENTIAL (PRIMARY) HYPERTENSION UNSPECIFIED MACULAR DEGENERATION HYPERLIPIDEMIA, UNSPECIFIED LOCALIZED EDEMA UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE UNSPECIFIED ATRIAL FIBRILLATION VERTIGO OF CENTRAL ORIGIN OTHER OSTEOPOROSIS WITHOUT CURRENT PATHOLOGICAL FRACTURE DIAB WITH PROLIF DIABETIC RTNOP WITHOUT MACULAR EDEMA, UNSP PERSONAL HISTORY OF PEPTIC ULCER DISEASE UNSPECIFIED ASTHMA, UNCOMPLICATED GOUT, UNSPECIFIED
Allergies: NKA
Diagnostic Lab Data: See Notes critical BUN and Creatinine results throughout stay with multiple repeated labs Wound culture leg wounds results-CRE, reported to DPH, isolated and on contact precautions
CDC Split Type:

Write-up: 5/4-5/7 Progressive overall decline and continued to decline Dialysis. 5/7-passed away at 1420


VAERS ID: 1421500 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-18
Onset:2021-04-08
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiomyopathy, Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Cardiomyopathy (narrow), 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: 6
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: Names unknown
Current Illness: Sarcoidosis
Preexisting Conditions: Sarcoidosis
Allergies: None known
Diagnostic Lab Data: Respirator - tests unknown
CDC Split Type:

Write-up: Covid 19, Blood Clot in Lung, Myocardia


VAERS ID: 1421533 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-21
Onset:2021-06-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Death, Dyspnoea, Feeling abnormal, Pyrexia, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, lisinopril, metoprolol, eliquis, sertraline, pregabalin, hydrocodone, trazodone, clonazepam, on an insulin pump
Current Illness: Left fore-foot amputation with open wound, improving and undergoing appropriate care
Preexisting Conditions: diabetes mellitus - most recent check A1c 7.3 (well controlled) with complications (nephropathy, neuropathy, gastroparesis); history of SVT and HTN well controlled; history of venous thromboembolism on eliquis life-long; carotid artery stenosis , severe; obstructive sleep apnea
Allergies: NSAID (rash and throat swelling), latex, penicillin
Diagnostic Lab Data: Unclear, patient was hospitalized when she died. I am reporting as her PCP and the location that gave the vaccine. Per her husband, he has not been given a cause of death, and was not offered an autopsy.
CDC Split Type:

Write-up: Per report from patient''s husband, the patient developed a fever to 103 on the evening of 6/21/21. She awoke in the morning and was "not herself". He describes her as having difficulty breathing and not being lucid. He took her to the hospital where she was hospitalized and then he got a call from the hospital in the evening reporting that she had walked to the restroom and then collapsed. Per his report, she had CPR performed for 30 minutes prior to being declared deceased. His phone number is the one included in this report.


VAERS ID: 1421767 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aciphex Vit E 400mg Metoprolol 100mg Aspirin 81mg B Complex Vit 2 50,000mg Trulicity 1.5 shot Pralvent 1.5 shot Fish Oil COQ10 SG 100 Clindamycin 150mg Colace Flomax .4 1000mg Metformin
Current Illness: Had Stint and Quadruple by pass, High Cholesterol, High Triglycerides, Coronary Heart Disease, Sleep Apnea, Acid Reflex, Diabetes Had Surgery 1 week prior for prostrate cancer.
Preexisting Conditions:
Allergies: Penicillin Suffa Terramycin All Statin - drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died


VAERS ID: 1421796 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-02-06
Onset:2021-05-16
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none known
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Case was hospitalized and passed away. 2nd vaccine given 2/27/2021


VAERS ID: 1421819 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-04-02
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Death, Feeling abnormal
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), Dementia (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt took a diuretic and another unknown medication for hypertension
Current Illness: None
Preexisting Conditions: Hypertesnsion
Allergies:
Diagnostic Lab Data: unknown- Pt was transported to Medical Center ER 4/19/2021
CDC Split Type:

Write-up: Pt was vaccinated on 3/31/2021. His long time partner reported that he started feeling a little off 2 days post vaccination, he thought he had indigestion. Over the next few weeks he began feeling worse especially with exertion. While at work on 4/19/2021 he told his friend that he hadn''t been feeling well for 3 weeks. Shortly after reporting this he went into Cardiac arrest. He was transported to Medical Center, where he was pronounced dead. His partner reports he was healthy with the exception of hypertension. She reports he was thin, never smoked, didn''t drink alcohol and rarely used marijuana. She reports only a visual autopsy was performed and pt was cremated.


VAERS ID: 1422827 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1422836 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-04
Onset:2021-05-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Cough, Death, Dyspnoea, Fatigue, Nasopharyngitis, Sleep disorder, Weight increased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: He took medicine for high blood pressure and diabetes. Also vitamin c & d and fish oil
Current Illness: Slight cold/allergies
Preexisting Conditions: Diabetes and high blood pressure both under control with medication
Allergies: Codine
Diagnostic Lab Data: He did not get a chance to see his primary care doctor
CDC Split Type:

Write-up: Slight cold on day of vaccine. The doctor said give him the vaccine anyway. Patient woke up the next morning with a cold that did not go away. He started gaining a lot of weight (10pounds in 2 weeks), he couldn?t sleep laying on his back, he was fatigued, coughing, short of breath. He passed away May 27th, 2021.


VAERS ID: 1423008 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-14
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210633197

Write-up: DEATH; SHEER NIGHTMARE THE SPIKE PROTEINS; This spontaneous report received from a patient via a company representative concerned a female of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: UNKNOWN) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up was requested for this case. No concomitant medications were reported. On 14-JUN-2021, the patient experienced sheer nightmare the spike proteins and died from unknown cause of death on 14-JUN-2021, and the outcome of sheer nightmare the spike proteins was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210633197-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1423010 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebral thrombosis, Coma, Death
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210637172

Write-up: DEATH; COMA; BLOOD CLOTS ON BRAIN; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On an unspecified date, the subject experienced death, coma, and blood clots on brain. On an unspecified date, the patient died from blood clots on brain, and coma. 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: V0-20210637172-COVID VACCINE AD26.COV2.S-Death, Coma, Blood clots on brain. This events are considered un-assessable. The events have a compatible/suggestive temporal relationship, are unlabeled, and have unknown scientific plausibility. There is no information on any other factors potentially associated with the events.; Reported Cause(s) of Death: BLOOD CLOTS ON BRAIN; COMA


VAERS ID: 1423016 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Maine  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Rheumatoid arthritis (Treated by immune-suppressing drug (Unspecified))
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 test positive; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210644468

Write-up: DIED FROM COVID-19; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a company representative and a physician via social media concerned a 74 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included rheumatoid arthritis and patient was taking unspecified immune-suppressing medication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported) dose, start therapy date were not reported for an unspecified indication. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date the patient experienced Covid-19, and suspected clinical vaccination failure. The patient tested positive for Covid-19 four weeks after receiving the vaccine & later died from Covid-19. Her case was extremely rare. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of Covid-19 on an unspecified date and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20210644468-COVID-19 VACCINE AD26.COV2.S-DIED FROM COVID-19. 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. 20210644468-COVID-19 VACCINE AD26.COV2.S-SUSPECTED CLINICAL VACCINATION FAILURE. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.; Reported Cause(s) of Death: COVID-19


VAERS ID: 1423055 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-13
Onset:2021-05-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Myocardial infarction, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: suffered a massive heart attack; Feeling of faintness; Palpitations; Shortness of Breath; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (suffered a massive heart attack), SYNCOPE (Feeling of faintness), PALPITATIONS (Palpitations) and DYSPNOEA (Shortness of Breath) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 13-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-May-2021, the patient experienced SYNCOPE (Feeling of faintness) (seriousness criterion medically significant), PALPITATIONS (Palpitations) (seriousness criterion medically significant) and DYSPNOEA (Shortness of Breath) (seriousness criterion medically significant). On 09-Jun-2021, the patient experienced MYOCARDIAL INFARCTION (suffered a massive heart attack) (seriousness criteria death and medically significant). The patient died on 09-Jun-2021. The reported cause of death was suffered a massive heart attack. It is unknown if an autopsy was performed. At the time of death, SYNCOPE (Feeling of faintness), PALPITATIONS (Palpitations) and DYSPNOEA (Shortness of Breath) outcome was unknown. No concomitant information was reported. No treatment information was reported. Action taken with mRNA-1273 was not applicable. A Patient called to report that two weeks after the first dose of the Moderna Covid-19 vaccine on 27-May-2021, his boyfriend began to experience palpitations, shortness of breath and feeling of faintness. The caller stated that her boyfriend did not want to go to the emergency room and only set an appointment with his Health Care Provider, but on the 09-Jun-2021, the day that he was going to the appointment, he suffered a massive heart attack and passed away. This is a case of sudden death in a 59-year-old male subject, who died 23 days after receiving first dose of vaccine. Very limited information has been provided at this time. Patient medical history was not provided.; Sender''s Comments: This is a case of sudden death in a 59-year-old male subject, who died 23 days after receiving first dose of vaccine. Very limited information has been provided at this time. Patient medical history was not provided.; Reported Cause(s) of Death: suffered a massive heart attack


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