National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

Found 14,925 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

This is page 51 out of 150

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150   next


VAERS ID: 1423127 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-15
Onset:2021-05-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aneurysm (about 2017, 2015-2017 area. He wants to say 2015, because he was there when he found out about them.); Blood pressure high (all about the same time.); Heart disorder (around 1997-1999.); Open heart surgery (about 1997, 1995, somewhere around there.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021719579

Write-up: His dad took the shot and died 3 days later, mucked up his arteries, his heart; This is a spontaneous report from a contactable consumer (patient son). A 64-year-old male patient received second dose of BNT162B2 on 15May2021 (at age of 64-year-old) at single dose for COVID-19 immunization. Medical history included Heart Condition (around 1997-1999), High Blood Pressure (all about the same time), Aneurysm (about 2017, 2015-2017 area. He wants to say 2015, because he was there when he found out about them) and open heart surgery (about 1997, 1995, somewhere around there). Concomitant medications were not reported. Historical vaccine included first dose of BNT162B2 on 05Apr2021 (at age of 64-year-old) for COVID-19 immunization. Family Medical History Relevant to AE(s): Caller states not that he knows of. All he knows from the emergency technician is that it looked like he went back to his car and his dog was in the car and he dropped dead. According to you guy''s thing, it says muscle cramps, muscle pains and chest pains are all side effects of this and he does believe that the vaccine contributed to the chest pain which contributed to the heart attack that exploded his heart. He states his dad took the shot and died 3 days later (18May2021, also reported as died on Memorial day weekend. He died on Sunday). Caller stated the coroner''s has already stated that he died by the coronavirus shot and mucked up his arteries, his heart. It is pretty sad. He was doing something he enjoyed, watching the races, gets up takes two steps, falls dead in his tracks. Vaccination Facility Type was hospital. He does not know Additional Vaccines Administered on Same Date of the Pfizer Suspect, but he highly doubts it. Events not require a visit to Emergency Room or Physician Office. Information about lot/batch number is requested.; Reported Cause(s) of Death: His dad took the shot and died 3 days later, mucked up his arteries, his heart: Death


VAERS ID: 1423128 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
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 (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 INC2021719708

Write-up: Died 3-5 days after getting the Pfizer COVID vaccine; This is a spontaneous report from a contactable consumer. An elderly female patient received bnt162b2 (Pfizer COVID vaccine), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Consumer stated that her aunt, who was going to be 100 years old, died 3-5 days after getting the Pfizer COVID vaccine. Consumer stated that they were healthy people. She stated that she is a transfusion medical specialist. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on lot/batch number has been requested.; Reported Cause(s) of Death: Died 3-5 days after getting the Pfizer COVID vaccine


VAERS ID: 1423211 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-22
Onset:2021-06-23
   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 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies: No w
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden unexpected death the day after the vaccine


VAERS ID: 1423241 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-12
Onset:2021-01-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Mechanical ventilation, Mobility decreased, Peripheral swelling, Posture abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID positive in December 2020
Preexisting Conditions: COPD, CHF, Kidney Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 24 hours, my mom''s arms swelled up from shoulder to fingertips and she had never had swelling in her arms prior. She also was hanging her head as if she had fallen asleep, but actually was unable to lift her head. 4 days following the vaccine she started having breathing issues and was intubated, we had the ventilator removed (she was actually a DNR and was not supposed to be intubated). On January 19, 2021 she died. She went into this facility for rehab regarding an infection she had in her leg.


VAERS ID: 1423287 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-02-24
Onset:2021-02-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   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: Will provide -
Current Illness: none
Preexisting Conditions: Aortic stenosis COPD Fatty liver
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his second Moderna vaccine on 02-24-21. He began to experience chest pains on mild exertion on 02-26-21. He then suffered a heart attack on 03-08-21 and passed away.


VAERS ID: 1423305 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-04-25
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Death, Mobility decreased
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Warfarin, Vitamin D, lipitor, insulin
Current Illness: none
Preexisting Conditions: In remission from cancer for 6 months. No sign of active cancer as per oncologist. All other systems functioning reasonably well for 85 according to doctors who did many tests.
Allergies: None
Diagnostic Lab Data: This list is not available to me at this time but it can be found.
CDC Split Type:

Write-up: Patient started to become progressively weaker within 3-4 days after getting vaccine. Family members became concerned and started taking him to doctor -- primary and oncologist and cardiologist -- they ordered multiple tests and could find nothing. No sign of cancer which had been in remission for months. Patient became progressively weaker over the next 2 weeks, was hospitalized, became unable to get out of bed; hospice was called, and he died May 13. No explanation could be offered by his doctors.


VAERS ID: 1423308 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-06-07
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Endotracheal intubation, Lymphadenopathy, Lymphoproliferative disorder, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological tumours of unspecified malignancy (narrow), Sepsis (narrow), Opportunistic infections (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xanax 1mg, chlorthalidone 25mg, celexa 40mg
Current Illness:
Preexisting Conditions: Bipolar 1, HTN, Obesity
Allergies: clavulanic acid, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient complained of intermittent fevers since the first administration of the Moderna vaccine on 4/7/21. fevers continued intermittently until second moderna dose on 5/5/21. Patient developed lymphadenopathy and eventually was hospitalized on 6/6/21 for sepsis symptoms. Patient was intubated and found to have an acute lymphoproliferative disorder that caused cardiac arrest and the patient expired on 6/8/21. She has no lab abnormalities suggesting a lymphoproliferative disorder prior to these events.


VAERS ID: 1423365 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-23
Onset:2021-03-30
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Product administration error, Respiratory disorder, SARS-CoV-2 test negative, Urinary tract infection
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Medication errors (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown.
Current Illness: Unknown.
Preexisting Conditions: Alzheimer, respiratory problems.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 antigen test, negative result.
CDC Split Type:

Write-up: Died in the hospital. Was admitted due to respiratory problems, had urinary tract infection, had complications with medications administered at the hospital ( did not specified which ones).


VAERS ID: 1423394 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-06-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident passed away on 6/1/2021 with family at bedside.


VAERS ID: 1423438 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-04-21
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Hypopnoea, Hyporesponsive to stimuli, Mydriasis, Pulse absent, Pupil fixed, Respiratory arrest, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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: 2021-05-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease Chronic Lung Disease ( Asthma or COPD) Hypertension Former Smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PMH Afib, BiV PPM, HTN, pHTN, hypothyroidism, hemorrhoids, hearing loss, macular degeneration, squamous cell carcinoma, Parkinsons brought to ED after her caregiver found her in bed in AM w/a "dark substance in her bed" and minimally responsive. On admission vomiting x1, no cough, no SOB, abnormal CXR, covid+ Admission originally planned by IMS, but CCM asked to take over due to rapid decline.Pt w/ shallow breathing, guarded prognosis.In the morning on May 1, 2021 around 830 in the morning patient found to be without any pulse or breathing. DNR DNI with pupils fixed and dilated without any spontaneous breathing. No pulse palpated.pronounced dead at 8:30 a.m.


VAERS ID: 1423516 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-04-16
Onset:2021-05-11
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration, Incomplete course of vaccination
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin Tablet 10 MG; Melatonin Tablet 3 MG; Senna-S Tablet 8.6-50 MG;traZODone HCl Tablet Give 25 mg; CycloSPORINE Emulsion 0.05 % Instill 1 drop in both eyes; Artificial Tears PF Solution 0.1-0.3 % (Dextran 70-Hypromellose (PF)) Instill
Current Illness: Resident had Covid in January and had received Monoclonal antibodies which precluded her from having the vaccine until eligible in April. She was admitted to Hospice in March with weight loss and overall decline. ADPOA and MD approved for her to have vaccine April 16th and she received the Pfizer vaccine. She continued to progressively decline and was receiving Hospice services. She passed away peacefully on 5/11/2021.
Preexisting Conditions: HEART FAILURE, UNSPECIFIED ATHSCL HEART DISEASE OF NATIVE COR ART W UNSP ANG PCTRS TYPE 2 DIABETES W OTH DIABETIC NEUROLOGICAL COMPLICATION UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE PERSONAL HISTORY OF COVID-19 ESSENTIAL (PRIMARY) HYPERTENSION MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED DYSPHAGIA, UNSPECIFIED CEREBROVASCULAR DISEASE, UNSPECIFIED HYPOMAGNESEMIA OTHER DISEASES OF LARYNX FOOT DROP, RIGHT FOOT DYSPHONIA ANXIETY DISORDER, UNSPECIFIED ADJUSTMENT DISORDER WITH DEPRESSED MOOD ACUTE POSTHEMORRHAGIC ANEMIA CHOLECYSTITIS, UNSPECIFIED OLD MYOCARDIAL INFARCTION PRESENCE OF OTHER BONE AND TENDON IMPLANTS CHEST PAIN, UNSPECIFIED ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS HYPOKALEMIA ALLERGIC RHINITIS, UNSPECIF PRSNL HX OF TIA (TIA), AND CEREB INFRC W/O RESID DEFICITS PERSONAL HISTORY OF (HEALED) TRAUMATIC FRACTURE ACUTE RESPIRATORY FAILURE WITH HYPOXIA
Allergies: Amoxicillin, Lisinopril, Neomycin, Aggrenox, Plavix
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident continued to progressively decline and was receiving Hospice services. Family and MD declined 2nd Covid vaccine on 5/3. Resident passed away peacefully on 5/11/2021.


VAERS ID: 1423619 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-06
Onset:2021-04-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic rupture, Cardiomegaly, Death, Myocardial infarction
SMQs:, Cardiac failure (broad), Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My husband died of ?heart Attack? on April 17, 2021 Had an enlarge hearth and rupture in the Aortic Artery


VAERS ID: 1423625 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-06
Onset:2021-05-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   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: *Azelastine HCL 0.05 Ophthalmic Solution; *Celecoxib 200 MG Oral Capsule; -Citalopram Hydrobromide 10 MG Oral Tablet; *Fexofenadine HCL 180 MG Oral Tablet; *Fluticasone Propionate 50 MCG/ACT Nasal Suspension; Lovastatin 40 MG Oral Tablet; *
Current Illness: Dementia
Preexisting Conditions:
Allergies: *Demeral *Macrolides and Ketolides *Penicillin G Benzathine *Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two hours after receiving her 2nd dose of the Pfizer Covid Vaccine, patient had a Stroke (large brain bleed). She never recovered and passed away May 18th, 2021


VAERS ID: 1423631 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-19
Onset:2021-06-12
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

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

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: albuterol sulfate simvastatin prazosin amLODIPine
Current Illness:
Preexisting Conditions: cardiac pacemaker in situ essential hypertension
Allergies: Sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data:
CDC Split Type:

Write-up: FAMILY PRACTICE was notified by a County coroner that the patient died on 12 June 2021. It is unknown to us if this is related to the Moderna vaccine received 19 May 2021. Dr. had seen this patient one time as a new patient of FAMILY PRACTICE to establish a primary care provider 25 May 2021 FAMILY PRACTICE provided the 1st dose Moderna vaccination 19 May 2021


VAERS ID: 1423777 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-01-14
Onset:2021-03-08
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiac failure, Condition aggravated, Death, Dementia, Dysphagia, Hypophagia, Laboratory test, Pneumonia, Respiratory failure
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (narrow), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pneumonia
Preexisting Conditions: Nstemi, dysphagia secondary to severe dementia., Other: Severe debility, dementia, dysphagia, poor po intake
Allergies:
Diagnostic Lab Data: Antigen test Causes of death listed on patient''s death certificate: 1) Respiratory failure secondary to pneumonia and heart failure, 2) pneumonia, 3) Nstemi, 4) dysphagia secondary to severe dementia., Other: Severe debility, dementia, dysphagia, poor po intake
CDC Split Type:

Write-up: Death 3/8/2021


VAERS ID: 1423807 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-18
Onset:2021-03-13
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Death, Polymerase chain reaction
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: 2021-04-08
   Days after onset: 25
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: Causes of death listed on patient''s death certificate: 1) Acute respiratory failure secondary to COVID 19 pneumonia
Allergies:
Diagnostic Lab Data: Specimen collection date 3/13/2021 - RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/8/2021 1) Acute respiratory failure secondary to COVID 19 pneumonia


VAERS ID: 1423845 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-15
Onset:2021-03-18
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Condition aggravated, Death, Physical deconditioning, Polymerase chain reaction
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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: acute on chronic deconditioning
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 3/25/2021 Causes of death listed on patient''s death certificate: 1) COVID-19 Infection, 2) Acute Hypoxic Respiratory Failure, 3) Acute on Chronic Deconditioning


VAERS ID: 1423868 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-03
Onset:2021-03-18
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Death, Polymerase chain reaction
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Severe symptomatic aortic stenosis, coronary artery disease status post percutaneous coronary intervention
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 3/18/2021 Causes of death listed on patient''s death certificate: 1) Acute cessation of cardiac function Other: Severe symptomatic aortic stenosis, coronary artery disease status post percutaneous coronary intervention


VAERS ID: 1423882 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-08
Onset:2021-03-21
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Condition aggravated, Death, Metastatic carcinoid tumour, Nucleic acid test, Pneumonia, Polymerase chain reaction, Spindle cell sarcoma
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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Metastatic spindle cell malignancy Other: COVID-19, pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/1/2021 Causes of death listed on patient''s death certificate: 1) Acute on chronic respiratory failure 2) Metastatic spindle cell malignancy Other: COVID-19, pneumonia


VAERS ID: 1424014 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-04
Onset:2021-03-22
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Obesity, Respiratory failure, Rheumatoid arthritis, Type 1 diabetes mellitus
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Arthritis (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 27
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: Rheumatoid Arthritis, Insulin Dependent Diabetes, Chronic Hypoxic Respiratory Failure, Morbid Obesity
Allergies:
Diagnostic Lab Data: 1) Sequelae of SARS-Coronavirus 2019 Other: Rheumatoid Arthritis, Insulin Dependent Diabetes, Chronic Hypoxic Respiratory Failure, Morbid Obesity
CDC Split Type:

Write-up: Death 4/18/2021 Causes of death listed on patient''s death certificate: 1) Sequelae of SARS-Coronavirus 2019 Other: Rheumatoid Arthritis, Insulin Dependent Diabetes, Chronic Hypoxic Respiratory Failure, Morbid Obesity


VAERS ID: 1424021 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-24
Onset:2021-04-15
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Death, Dizziness, Feeling abnormal
SMQs:, Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: furesomide carvedilol spironolactone
Current Illness: chf
Preexisting Conditions: chf
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had an acute MI died after within 8 weeks of last vaccine patient had been complaining of dizziness and feeling different since second vaccine


VAERS ID: 1424049 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-01-31
Onset:2021-03-22
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiopulmonary failure, Condition aggravated, Death, Dementia, Immune thrombocytopenia, Nucleic acid test, Polymerase chain reaction, Respiratory distress
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Dementia (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19
Preexisting Conditions: Dementia
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 3/30/2021 Causes of death listed on death certificate: 1) Respiratory distress 2) ITP 3) COVID 19 4) Dementia Other: acute cardiopulmonary failure


VAERS ID: 1424069 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-17
Onset:2021-03-22
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cardiac arrest, Death, Nucleic acid test, Polymerase chain reaction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 pneumonia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 3/31/2021 Causes of death listed on death certificate: 1) Cardiac arrest 2) covid 19 pneumonia


VAERS ID: 1424081 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-23
Onset:2021-03-26
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Chronic kidney disease, Condition aggravated, Death, Diabetes mellitus, Nucleic acid test, Polymerase chain reaction
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: COVID-19
Preexisting Conditions: Chronic kidney disease, diabetes mellitus, atrial fibrillation
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/7/2021 Causes of death listed on death certificate: 1) Acute respiratory failure 2) Chronic kidney disease 3) Diabetes mellitus 4) Atrial fibrillation Other: COVID 19


VAERS ID: 1424095 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-05
Onset:2021-03-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Myocardial infarction, Nucleic acid test, Polymerase chain reaction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 3/23/2021 Cause of death listed on death certificate: Myocardial Infarction


VAERS ID: 1424098 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-22
Onset:2021-04-03
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Chronic kidney disease, Condition aggravated, Death, Encephalopathy, Hypoxia, Left ventricular failure, Nucleic acid test, Plasma cell myeloma, Polymerase chain reaction, Type 2 diabetes mellitus
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 COVID-19 PNEUMONITIS MULTIPLE MYELOMA
Preexisting Conditions: STAGE 3 CHRONIC KIDNEY DISEASE, TYPE 2 DIABETES MELLITUS
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/27/2021 Causes of death listed on death certificate: 1) ADULT RESPIRATORY DISTRESS SYNDROME WITH HYPOXIA 2) RAPID ATRIAL FIBRILLATION WITH DIASTOLIC HEART FAILURE 3) COVID-19 Other: COVID-10 ENCEPHALOPATHY, COVID-19 PNEUMONITIS, MULTIPLE MYELOMA, STAGE 3 CHRONIC KIDNEY DISEASE, TYPE 2 DIABETES MELLITUS


VAERS ID: 1424120 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-11
Onset:2021-04-23
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Diabetes mellitus, Hypertension, Nucleic acid test, Polymerase chain reaction, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19
Preexisting Conditions: Diabetes Mellitus Hypertension
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 04/23/2021 Causes of death listed on death certificate: 1. hypoxic respiratory failure 2. covid 19 3. diabetes mellitus 4. hypertension


VAERS ID: 1424124 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-19
Onset:2021-06-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   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: The pharmacist was contacted by patients daughter on 6/23/2021. She said that patient was found deceased on the morning of 6/20/2021. They believe he passed away sometime on 6/19/2021.


VAERS ID: 1424154 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-06
Onset:2021-04-09
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Death, Nucleic acid test, Polymerase chain reaction
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: 2021-04-24
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: death 4/24/2021 causes of death listed on death certificate: 1) Pneumonia Due to COVID 19 2) Acute Respiratory Failure with Hypoxia 3) COVID 19 4) Acute Exacerbation of Chronic Obstructive Pulmonary Disease


VAERS ID: 1424166 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-05
Onset:2021-04-09
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Blood loss anaemia, COVID-19 pneumonia, Cardiac failure acute, Cardiac failure congestive, Chronic obstructive pulmonary disease, Condition aggravated, Death, Ischaemic hepatitis, Left ventricular dysfunction, Nucleic acid test, Polymerase chain reaction, Septic shock, Type 2 diabetes mellitus
SMQs:, Cardiac failure (narrow), Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 pneumonia Septic shock, liver shock due to COVID-19
Preexisting Conditions: COPD Diabetes Mellitus II
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/30/2021 Causes of death listed on death certificate: 1) Acute hypoxemic respiratory failure due to COVID-19 pneumonia 2) COVID-19 pneumonia 3) Acute on chronic left ventricular systolic congestive heart failure 4) Septic shock, liver shock due to COVID-19 Other: Exacerbation of chronic obstructive pulmonary disease, chronic blood loss anemia, diabetes mellitus type II


VAERS ID: 1425204 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine Clonidine Atorvastatin Risperidone Buspirone Metformin Carvedilol
Current Illness: Death 7 days after vaccination, deceased on June 11th
Preexisting Conditions: Congestive heart failure disease stage 3 Diabetes type 2 Atherosclerotic cardiovascular disease
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced shortness of breathe resulting in death cardiac arrest.


VAERS ID: 1425840 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-27
Onset:2021-04-10
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 1284 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chronic lymphocytic leukaemia, Condition aggravated, Death, Nucleic acid test, Polymerase chain reaction
SMQs:, Haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid
Preexisting Conditions: chronic lymphocytic leukemia
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Died 5/11/2021 Causes of death listed on death certificate: 1) covid 2) chronic lymphocytic leukemia


VAERS ID: 1425844 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-19
Onset:2021-04-13
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Nucleic acid test, Respiratory failure, 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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: covid 19 pneumonia
Preexisting Conditions: respiratory failure
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/21/2021 Causes of death listed on death certificate: 1) respiratory failure 2) covid 19 pneumonia


VAERS ID: 1425847 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-31
Onset:2021-04-14
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Coronary artery disease, Death, Diabetic nephropathy, End stage renal disease, Hypertension, Nucleic acid test, SARS-CoV-2 test, Type 2 diabetes mellitus
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Other ischaemic heart disease (narrow), Chronic kidney disease (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 1) End Stage Renal Disease 2) Diabetes Type 2 with nephropathy 3) Hypertension 4) Coronary Artery Disease
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 04/23/2021 Causes of death listed on death certificate: 1) End Stage Renal Disease 2) Diabetes Type 2 with nephropathy 3) Hypertension 4) Coronary Artery Disease


VAERS ID: 1425897 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-26
Onset:2021-04-14
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Coronary artery disease, Death
SMQs:, Other ischaemic heart disease (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   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: Pneumonia Covide-19
Preexisting Conditions: Coronary Artery Disease
Allergies:
Diagnostic Lab Data: Antigen
CDC Split Type:

Write-up: Death 4/26/2021 Causes of death listed on death certificate: 1) Pneumonia 2) Coronary Artery Disease Other: Covid 19


VAERS ID: 1425907 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-19
Onset:2021-04-15
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cardiac arrest, Condition aggravated, Coronary artery disease, Death, Haemodialysis, Nucleic acid test, Polymerase chain reaction
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID 19, AKI needing HD
Preexisting Conditions: CAD
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 5/5/2021 Causes of death listed on death certificate: 1) cardiac arrest 2) unknown cause Other: COVID 19, CAD, AKI needing HD


VAERS ID: 1425911 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-11
Onset:2021-04-15
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   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:
Current Illness: Covid
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen
CDC Split Type:

Write-up: Death: 04/20/2021 Causes of death listed on death certificate: 1) Covid


VAERS ID: 1425918 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-03
Onset:2021-04-15
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriosclerosis, COVID-19, Condition aggravated, Death, Dementia, Hypertension, Malnutrition, Nucleic acid test, Peripheral vascular disorder, Pneumonia, Polymerase chain reaction, Squamous cell carcinoma of skin
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Skin malignant tumours (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-31
   Days after onset: 46
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: recent Cove at 19, pneumonia
Preexisting Conditions: atherosclerotic heart disease, peripheral vascular disease, hypertension, dementia, extensive squamous cell carcinoma of skin of scalp, protein calorie malnutrition
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 5/31/2021 Causes of death listed on death certificate: 1) atherosclerotic heart disease Other: recent Cove at 19, pneumonia, peripheral vascular disease, hypertension, dementia, extensive squamous cell carcinoma of skin of scalp, protein calorie malnutrition


VAERS ID: 1425926 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-30
Onset:2021-04-16
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Condition aggravated, Death, End stage renal disease, Hypertension, Nucleic acid test, Sarcoidosis, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 sepsis
Preexisting Conditions: Sarcoidosis End stage renal disease Hypertension Congestive heart failure
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death: 5/7/2021 Causes of death listed on death certificate: 1) COVID-19 2) Sepsis 3) Sarcoidosis 4) End stage renal disease Other: Hypertension, Congestive heart failure


VAERS ID: 1426105 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-03
Onset:2021-04-16
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cardiac failure acute, Cardiac failure congestive, Death, Nucleic acid test, Polymerase chain reaction
SMQs:, Cardiac failure (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), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   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:
Current Illness: COVID Pneumonia (onset interval 1 week) acute on chronic congestive heart failure
Preexisting Conditions: Acute respiratory failure (onset interval 1 week) Other: acute on chronic congestive heart failure
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/21/2021 Causes of death listed on death certificate: 1) Acute respiratory failure (onset interval 1 week) 2) COVID Pneumonia (onset interval 1 week) Other: acute on chronic congestive heart failure


VAERS ID: 1426130 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-18
Onset:2021-04-17
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Death, Nucleic acid test, Polymerase chain reaction
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   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: Covid Pneumonia
Preexisting Conditions: Chronic obstructive pulmonary disease, unspecified
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/30/2021 Causes of death listed on death certificate: 1) Covid Pneumonia 2) Chronic obstructive pulmonary disease, unspecified Other: none


VAERS ID: 1426131 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-21
Onset:2021-02-01
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nasacort allergy, cetiriine hydrochloride, prednisone, anoro ellipta, albuterol
Current Illness: asthma
Preexisting Conditions: Chronic Obstructive pulmonary disease, Chronic Sinusitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: mild fever, asthma flare-ups


VAERS ID: 1426140 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-25
Onset:2021-02-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Saturday, 2/27/21, a little over 24 hours after receiving vaccine, sudden death occurred.


VAERS ID: 1426143 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-15
Onset:2021-04-18
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Condition aggravated, Death, Diabetes mellitus, Emphysema, Nucleic acid test, Polymerase chain reaction, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid-19 pneumonia
Preexisting Conditions: Emphysema diabetes
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death: 4/22/2021 Causes of death listed on death certificate: 1) Respiratory failure 2) Emphysema Other: Covid-19 pneumonia, diabetes


VAERS ID: 1426149 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-25
Onset:2021-04-23
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Amyotrophic lateral sclerosis, COVID-19 pneumonia, Condition aggravated, Death, Nucleic acid test, SARS-CoV-2 test
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: 2021-04-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID 19 Pneumonia
Preexisting Conditions: advanced amyotrophic lateral sclerosis
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 4/29/2021 Causes of death listed on death certificate: 1) COVID 19 Pneumonia 2) Acute hypoxic respiratory failure 3) advanced amyotrophic lateral sclerosis


VAERS ID: 1426151 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-16
Onset:2021-01-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chest pain, Computerised tomogram abdomen, Death, Dyspnoea, Fatigue, Flank pain, Full blood count, Hepatic enzyme increased, Illness, Intensive care, Metabolic function test, Platelet count increased, Urine analysis normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-25
   Days after onset: 159
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: Ropinirole, ,dabigatran, famotidine, KCl, ASA, Docusate, Trospium, Telmisartan, Fluticasone, HCTZ, montelukast, omeprazole, simvastatin, fexofenadine, losartan, metoprolol, pregabalin
Current Illness: Acute right sided abdominal pain onset 4 months after vaccination. HTN, Chronic back/leg pain, CAD, GERD,DM2, BPH, Sleep apnea
Preexisting Conditions: HTN, Chronic back/leg pain, CAD, GERD,DM2, BPH, Sleep apnea
Allergies: nkda
Diagnostic Lab Data: Contact MC
CDC Split Type:

Write-up: On May 6, 2021, patients were relatively normal. On June 4th he started complaining of right sided abdominal pain along with increasing generalized weakness/fatigue. On June 10th CT Abdomen/Pelvis ordered by PCP, it was completed on 6/16/21. On 6/17/21 patient started c/o of right flank pain as well as ongoing right abdominal pain, U/A collected, normal results. On 6/22/21 patient contact PCP office c/o acute shortness of breath, chest pain and increased weakness. He was advised to call 9-1-1 and go to the ER. He was transported to local Medical Center and found to have extremely elevated platelet count as well as elevated liver enzymes. He was admitted to the ICU he ultimately succumbed to this acute illness on 6/25/21


VAERS ID: 1426155 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-06
Onset:2021-04-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID 19
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Antigen
CDC Split Type:

Write-up: Death: 5/2/2021 Causes of death listed on death certificate: Covid 19


VAERS ID: 1426460 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-08
Onset:2021-04-25
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Atrial fibrillation, COVID-19 pneumonia, Cardiac failure acute, Death, Depression, Dysphagia, Hypertension, Left ventricular failure, Malnutrition, Nucleic acid test, Polymerase chain reaction, Toxic encephalopathy, Type 2 diabetes mellitus
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (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: 2021-05-03
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Covid 19 pneumonia Acute toxic encephalopathy
Preexisting Conditions: Acute on chronic diastolic heart failure Atrial fibrillation Hypertension Type 2 diabetes Esophageal dysphagia Debility Depression Moderate malnutrition.
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death: 5/3/2021 Causes of death listed on death certificate: -1) Acute hypoxic respiratory failure 2) Acute on chronic diastolic heart failure 3) Atrial fibrillation 4) Covid 19 pneumonia Other: Hypertension. Acute toxic encephalopathy. Type 2 diabetes. Esophageal dysphagia. Debility. Depression. Moderate malnutrition.


VAERS ID: 1426471 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-04
Onset:2021-04-28
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Death, Nucleic acid test, Polymerase chain reaction, Small intestinal obstruction, Small intestine carcinoma
SMQs:, Gastrointestinal obstruction (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Small-bowel obstruction Carcinoma of small-bowel
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 5/2/2021 Causes of death listed on death certificate: 1) Small-bowel obstruction 2) Carcinoma of small-bowel


VAERS ID: 1426477 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-06
Onset:2021-04-29
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19 pneumonia, Condition aggravated, Death, Hypertension, Nucleic acid test, Obesity, Polymerase chain reaction, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Hypertension (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: 2021-05-15
   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:
Current Illness: COVID 19 pneumonia
Preexisting Conditions: Paroxysmal atrial fibrillation obesity hypertension
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 5/15/2021 Causes of death listed on death certificate: 1) COVID 19 pneumonia 2) Acute respiratory failure with hypoxia 3) Pulmonary embolism 4) Paroxysmal atrial fibrillation Other: obesity, hypertension


VAERS ID: 1426483 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-02
Onset:2021-05-05
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Bronchopulmonary aspergillosis, COVID-19, COVID-19 pneumonia, Cardiac failure, Cardiac failure acute, Death, Nucleic acid test, Polymerase chain reaction
SMQs:, Cardiac failure (narrow), Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID 19 pneumonia Acute heart failure with reduced ejection fraction aspergillus pneumonia
Preexisting Conditions: history of prostate cancer history hypertension
Allergies:
Diagnostic Lab Data: RT-PCR or other NAAT test
CDC Split Type:

Write-up: Death 5/26/2021 Causes of death listed on death certificate: 1. COVID 19 pneumonia 2. acute respiratory distress syndrome due to COVID 19 3. Acute heart failure with reduced ejection fraction 4. aspergillus pneumonia 5. history of prostate cancer, history hypertension


VAERS ID: 1426770 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-18
Onset:2021-04-27
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia
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: 2021-05-13
   Days after onset: 16
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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 PNEUMONIA, ACUTE RESPIRATORY FAILURE WITH HYPOXIC


VAERS ID: 1426836 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-09
Onset:2021-06-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Aspiration, Death, Sepsis
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   Days after onset: 3
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: acetaminophen, amlodipine, carvedilol, lisinopril, melatonin, memantine, quetiapine, terazosin, warfarin
Current Illness:
Preexisting Conditions: dementia, hypertension, atrial flutter, BPH
Allergies: quinine, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received his first dose of Pfizer COVID vaccine 6/9/21 at pharmacy. He was then admitted 6/20/21 at hospital with abdominal pain, sepsis and a suspected aspiration event and expired on 6/23/21. This was felt by the treating physicians to be most likely not related to or associated with the vaccine, but given the close proximity it was asked that this be reported.


VAERS ID: 1426843 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-26
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021415137

Write-up: chest pain; had some acute shortness of breath; This is a spontaneous report from a contactable nurse (Registered Nurse) via Medical Information Team. This nurse reported for 7 patients. This report is 7 of 7 patient. A female patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection) via an unspecified route of administration on 26Mar2021 (Lot number: EL9269, Expiry date: 01May2021) as single dose for Covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On an unspecified date, the patient had some acute shortness of breath and chest pain. Reportedly she was calling from the nursing home stated that she was trying multiple times and she needed to speak to someone to report adverse reactions, she had been reporting to the VAERS system since they started giving vaccines in January, stated: "she had summitted probably 30 reports at that point of all different various things in any of the patients even if they were in hospice if they had a vaccine and proceeded to pass away, she done all the reporting. She had a very abnormal large volume of patients that got vaccinated on 16th of April, with the first doses of Pfizer (PFIZER-BIONTECH COVID-19 VACCINE) one specific lot number and she had 7 adverse events in one group of patients out of 30. And it was way too complicated to get that information quickly, so she spoke to somebody as there was a chance that those could be a significant event and needed to tell somebody what was going on". Caller stated: "because all the reports involving one lot it was more suspicious than even all the other reports that she had ever done. It was just one whole group and now she had 3 deaths. She had 3 deaths and have 2 strokes in this group". Caller stated that she would file reports online she just wanted someone to call her back about the side effects and the lot involved. Stated "she got the whole group, who were due to get their second dose on Friday, two days from now, so obviously she not giving it to any of these people there was a 7 of them out of 33. She had 20 staff that have received it the same day she did not have any side effects in any of the staff but definitely little weary at the moment." Offered to forward provide information to safety. Caller provided lot EL9269, Expiry date 01May2021 (stated that it was weird because it was very close to the expiration date). Caller stated: "All those people were dosed on March 26th. Caller stated that she was going to give just basics (in terms of information to start the process) and that she would file a form online. Caller stated: "That day 31 patients received a vaccine and she had 7 patients worth investigating (caller stated that she had that portion written if there was a way to forward. Explained that there was an option to contact through our website but for adverse reports specifically she would refer them to Pfizer safety explained that she also had a fax, but caller declined she already had that information. Verified that she was reporting adverse events (7 patients, gender: 5 females and 2 males). Caller stated "three patients were send out and subsequently passed away in the hospital, one patient with bradycardia, hypotension and she passed away in the ER, critical labs, she did not even make it one day, we send her out and she passed away in the ER. She had one male patient who had acute stroke she did not have all the details because he was still hospitalized in ICU. She have one (patient) who we sent to the ER hypoxic, hypotensive, short of breath, she ended up passing away in the hospital, her diagnosis there was hypoxia and acute CHF. She had another male patient who had an acute CVA we send him to the hospital he had acute CVA, he had a right artery occlusion, he passed away. She had another female patient who was sent out with shortness of breath and increased confusion, she wound up in the ER with hypoxia and sepsis and she passed away. She was sure that she did not have hospital records, only know what she was told. And then had two others one that was send to the ER with shortness of breath and elevated D-dimer, she actually returned to us her scans were negative, so she was one of those we are not really 100 percent sure, but she did get send out to the ER. And we have another one (female) chest pain, shortness of breath, she was not sent out her D-dimer and her studies that we have done here were within normal limits but definitely had some acute shortness of breath and chest pain. Done troponin and bunch of cardiac labs there, she did not go out. So those were the seven that she had at the moment that were concerning. Outcome of the events was unknown. No follow up attempts are possible. No further information is expected.


VAERS ID: 1426917 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021683252

Write-up: pass away recently due to blood clots; This is a spontaneous report from a contactable nurse (parent) and consumer. The nurse reported similar events for three patients. This is the first of three reports. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient pass away recently due to blood clots on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. It was reported that even though the event was outside of reporting timelines & deemed by the PI to be unrelated to study drug. Information on batch and lot number is requested.; Sender''s Comments: Based on available information, a possible contributory role of the subject product, BNT162B2 vaccine, cannot be excluded for the reported event of thrombosis with fatal outcome due to temporal relationship. However, the reported event may possibly represent intercurrent medical condition in this patient. There is limited information provided in this report. Additional information is needed to better assess the case, including complete medical history, diagnostics including vascular imaging studies, coagulation panel and autopsy results, counteractive treatment measures and concomitant medications. This case will be reassessed once additional information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.,Linked Report(s) : PFIZER INC-2021688670 same reporter, event and suspect drug; different patient; PFIZER INC-2021688671 same reporter, event and suspect drug; different patient; Reported Cause(s) of Death: blood clots


VAERS ID: 1426921 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kentucky  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021688670

Write-up: Patient died due to Blood clots; This is a spontaneous report from a contactable nurse. This nurse reported similar events for 3 patients. This is the 2nd of 3 reports. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as unknown dose, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient pass away recently due to blood clots. The agency also stated that all 3 of these nurses had received the Pfizer vaccine. Document submitted for patient even though the event was outside of reporting timelines and deemed by the PI to be unrelated to study drug. It is not reported if autopsy was performed. information about lot/batch number has been requested.; Sender''s Comments: Based from current drug profile, the event thrombosis is assessed as unrelated to suspected drug BNT162B2 . It is difficult to provide possible cause of the event due to limited patient medical information or background.,Linked Report(s) : PFIZER INC-2021683252 same reporter, same drug, same event, different patient;PFIZER INC-2021688671 same reporter, same drug, same event, different patient; Reported Cause(s) of Death: Blood clots


VAERS ID: 1427004 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-19
Onset:2021-02-09
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 UN / UN

Administered by: Senior Living       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: 2021-05-21
   Days after onset: 100
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Dementia Protein calorie malnutrition second degree heart block Intermittent slow AFib
Allergies: Unknown
Diagnostic Lab Data: Positive test result for COVID-19 04/20/2021
CDC Split Type: 10670021

Write-up: Died of COVID-19


VAERS ID: 1427073 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-01-21
Onset:2021-03-12
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, 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: 2021-03-12
   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: COPD, Alzheimer''s, hypertension, dementia
Preexisting Conditions: COPD, Alzheimer''s, hypertension, dementia
Allergies:
Diagnostic Lab Data: COVID-19 antigen positive test collected from Hospital 2/13/2021, and later a positive COVID-19 PCR test collected 3/5/2021.
CDC Split Type:

Write-up: Death on 3/12/2021. Primary cause of death was COPD, with COVID-19 listed as an underlying cause.


VAERS ID: 1427108 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-24
Onset:2021-03-16
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

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: 2021-04-01
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus, heart disease
Preexisting Conditions: Diabetes mellitus, heart disease, immune suppressed, kidney transplant 5 years prior
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR test collected 3/19, another positive COVID-19 PCR collected 3/22
CDC Split Type:

Write-up: COVID symptoms began 3/16, positive test 3/19, hospital admission 3/22, death 4/1


VAERS ID: 1427367 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-30
Onset:2021-06-05
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Intracranial aneurysm
SMQs:, Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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

Write-up: A friend of the patient called us today to inform us that the patient had recently passed away from a brain aneurysm. The friend asked it it were possible that this occurrence was somehow related to patient receiving his covid vaccination. The friend did not have a lot of information about the occurrence; he only stated that the patient''s brain aneurysm was about 6 weeks after his 2nd dose of the covid vaccine. Patient was not a regular patient of ours so we have no additional medical history for him. We administered his first Moderna vaccine on 4-2-2021, and he returned for his second dose on 4-30-2021. I assured the friend I would report this to VAERS and thanked him for reaching out to us on behalf of patient.


VAERS ID: 1427402 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Death, Dyspnoea, Injection site pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   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: albuterol, zolpidem, sertraline, amlodipine Methamphetamine user
Current Illness:
Preexisting Conditions: Hypertensive and atherosclerotic cardiovascular disease, chronic methamphetamine use, pulmonary emphysema, anxiety disorder
Allergies: Not known
Diagnostic Lab Data:
CDC Split Type:

Write-up: 6/23/2021 - pain at injection site, shortness of breath 6/24 /2021 - found dead in bed at 7AM


VAERS ID: 1427448 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-06-15
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: listed in chart are OTC tylenol as needed and meclizine for vertigo
Current Illness: Dizzyness and vertigo
Preexisting Conditions: not listed in chart
Allergies: Not listed in medical chart or history
Diagnostic Lab Data: n/a sudden death
CDC Split Type:

Write-up: Notified on 6/16 /2021 patient died. Death by PE 1 month after prime dose of Moderna-since unexpected- reported to VAERS


VAERS ID: 1427462 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-12
Onset:2021-06-11
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / IM

Administered by: Public       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: None listed
Current Illness: None listed
Preexisting Conditions: None listed
Allergies: None listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client did not have immediate adverse event following vaccine administration. Client died on 6/11/2021, approximately 8 weeks after receiving COVID19 Janssen vaccine. Cause of death is unknown by this reporter.


VAERS ID: 1427475 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 98
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1427664 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-02
Onset:2021-02-16
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 - / -

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: 2021-03-06
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ASTHMA, HEART DISEASE, HYPOTHYROIDISM
Preexisting Conditions: ASTHMA, HEART DISEASE, HYPOTHYROIDISM, DIVERTICULITIS
Allergies:
Diagnostic Lab Data: Positive COVID-19 antigen test collected 2/16, and another positive antigen test collected 3/4/21
CDC Split Type:

Write-up: Died 3/6/2021


VAERS ID: 1427666 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-12
Onset:2021-06-08
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None listed
Current Illness: None listed
Preexisting Conditions: Hypertension/High Blood Pressure
Allergies: None listed
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client did not experience any immediate adverse events following vaccination. Client died on 6/8/2021, approximately 8 weeks after vaccination with Janssen product. Cause of death is unknown to this reporter.


VAERS ID: 1427697 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-01-28
Onset:2021-03-17
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Liver cancer
Preexisting Conditions: Liver cancer
Allergies:
Diagnostic Lab Data: COVID-19 PCR positive test collected 3/7/2021
CDC Split Type:

Write-up: Tested positive for COVID-19 on 3/7, likely an incidental finding. Died of liver cancer 3/17.


VAERS ID: 1427795 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-01-28
Onset:2021-04-24
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), 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: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cancer, diabetes, hypothyroidism, hypertension
Preexisting Conditions: Cancer, diabetes, hypothyroidism, hypertension
Allergies:
Diagnostic Lab Data: COVID-19 PCR positive test collected 4/16/2021
CDC Split Type:

Write-up: Died 4/24. Immediate cause of death acute hypoxic respiratory failure, underlying cause COVID-19 associated respiratory distress syndrome and COVID-19 viral pneumonia


VAERS ID: 1427845 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-30
Onset:2021-05-24
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1427848 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-02-19
Onset:2021-04-12
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Hepatic cirrhosis, Hepatic encephalopathy, SARS-CoV-2 test positive, Sepsis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Noninfectious encephalopathy/delirium (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Liver disease
Preexisting Conditions: Liver disease
Allergies:
Diagnostic Lab Data: COVID-19 PCR positive tests collected on both 4/19/2021 and 4/20/2021
CDC Split Type:

Write-up: Symptom onset 4/12, hospital admission date 4/19, died 4/25. Primary cause of death COVID-19, underlying causes sepsis secondary to COVID-19, hepatic encephalopathy, liver cirrhosis


VAERS ID: 1427855 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-24
Onset:2021-05-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT''S MOTHER REPORTED TO PHARMACY THAT PATIENT DIED 6 DAYS AFTER RECEIVING THE JANSSEN COVID 19 VACCINE.


VAERS ID: 1427858 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-04-06
Onset:2021-04-23
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus
Preexisting Conditions: Diabetes mellitus
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR test collected 4/30/2021
CDC Split Type:

Write-up: COVID-19 symptom onset 4/23, hospital admission date 4/30, died 5/14. Primary cause of death COVID-19 viral pneumonia


VAERS ID: 1427870 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-19
Onset:2021-05-03
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Death, Pneumonia viral, 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: 2021-05-18
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus, rheumatoid arthritis, chronic immunosuppression
Preexisting Conditions: Diabetes mellitus, rheumatoid arthritis, chronic immunosuppression
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR tests collected 5/6 and 5/11/2021
CDC Split Type:

Write-up: COVID-19 symptom onset 5/3, hospital admission 5/11, and death on 5/18/2021. Primary cause of death acute hypoxic respiratory failure, underlying cause COVID-19 viral pneumonia


VAERS ID: 1427880 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-13
Onset:2021-06-06
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1427893 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-09
Onset:2021-06-16
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial flutter, Bacterial sepsis, COVID-19 pneumonia, Death, Mental status changes, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Kidney cancer, heart disease
Preexisting Conditions: Kidney cancer, heart disease
Allergies:
Diagnostic Lab Data: Positive COVID-19 PCR test collected 5/31/2021
CDC Split Type:

Write-up: Hospitalized 5/30-6/10 for altered mental status following recent bacterial sepsis and atrial flutter, discharged to hospice, died 6/16. Primary cause of death acute respiratory failure, underlying cause COVID-19 pneumonia


VAERS ID: 1427998 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin, lipitor, not sure what else
Current Illness: Type 1 Diabetes; hospitalized May 16-18 acute ketoacidosis
Preexisting Conditions: Type 1 Diabetes
Allergies: don''t know of any
Diagnostic Lab Data: The final autopsy has not yet been completed, and I don''t know if they''re even checking for Covid-19 vaccine reaction.
CDC Split Type:

Write-up: Patients appointment was either 2:15 or 2:30. His Apple watch recorded it''s last heart beat reading at 3:15 pm, 05/21/2021, within an hour after receiving his second Moderna Covid-19. His heart rate increased rapidly from 3:00 to 3:15, reading 104 - 106 - 108 - 116 bpm. I can provide a photo of these last four readings if you need them. I don''t know other symptoms. His body was found by police who were called for a well-check three days later, 05/24/2021. Patient died unattended, at home, alone. I only know for sure the vaccine was administered at a Target store near his home. Patient texted me at 2:48pm saying that Target gave him a $5 coupon for getting his vaccine, and he was going to use it to buy Tylenol.


VAERS ID: 1428001 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-17
Onset:2021-06-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Hypotension, Jaundice, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   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: hypertension medication (name of medication unknown)
Current Illness: hypertension
Preexisting Conditions: hypertension
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received their vaccine on 6/17 and had no complaints of adverse effects. The patient was found unconscious at some point between 6/17-6/18. They appeared jaundice and had low BP. They were airlifted to the hospital and died on 6/18/21.


VAERS ID: 1428029 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-23
Onset:2021-06-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Flagyl, Quinolones
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: N/A -- patient was perfectly fine during wait time


VAERS ID: 1428052 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-20
Onset:2021-02-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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: Chronic steroid use
Current Illness: UNK
Preexisting Conditions: diabetes mellitus, chronic heart disease, chronic kidney disease, DVT, GERD, HTN, AFIB
Allergies: UNK
Diagnostic Lab Data: positive COVID-19 lab PCR 2/8/2021
CDC Split Type:

Write-up: cough, difficulty breathing, productive cough, 02 requirement, weakness resulting in hospitalization and death. received treatment : Azithromycin and Decadron 02/09/2021-02/19/2020


VAERS ID: 1428447 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-02
Onset:2021-04-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Aspiration, Brain injury, Dyspnoea, Fall, Intensive care, Life support, Mechanical ventilation, Respiratory arrest, Resuscitation, Rib fracture
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Osteoporosis/osteopenia (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CARBIDOPA LEVADOPA, SERTRALINE, FLUDROCORTISONE, RYTARY, ENTACAPONE, ATROPINE
Current Illness:
Preexisting Conditions: MSA (MULTIPLE SYSTEM ATROPHY)
Allergies: SULFA ANTIBIOTICS
Diagnostic Lab Data:
CDC Split Type:

Write-up: My dad suffered what I believe to be a blood clot in his lung on April 6th, directly related to the second pfizer covid vaccination. Though chronically ill, he was not sick at the time, which was 4 days after the vaccine. He walked up the stairs, collapsed at the top, walked again to the chair, collapsed and then made his way into the chair where he told me "I can''t breathe." and then slumped over. My mom and I lifted his limp body up and noticed he was not breathing. We moved him to the floor and started life support measures. About 5 minutes later the paramedics arrived. They were eventually able to get his heart and breathing going again about 14 minutes later. He was moved to critical care. After it became apparent he suffered irreparable brain damage, I stopped the life support measures (ventilator) and he passed away shortly after on Friday the 9th. They were continuously removing blood from his lungs while he was there. There was no indication he would die prior to this incident. Though we attempted to tell the critical care doctors about his recent vaccination, they were not receptive to the suggestion that this may have caused the incident that proceeded his passing. My mom did try the heimlich and there were indications that he had breathed in vomit, but he had stopped breathing before this and therefore his cause of death WAS NOT aspiration. He also had fallen the day after the vaccination (Saturday) and the notes indicated his broken ribs were from the CPR measures but this is in error as well as he had broken his ribs in the fall. It is my opinion the broken ribs caused a bruise in the lungs, the vaccination caused excessive clotting, and when he was coughing shortly before the incident it loosened the clots that then caused a pulmonary embolism.


VAERS ID: 1428887 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-11
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Intracranial aneurysm, Life support, Resuscitation
SMQs:, Acute central respiratory depression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: no known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden Brain Aneurysm on May 11, 2021, Revived and kept alive on machines until taken off life support and subsequently died on May 21, 2021


VAERS ID: 1428895 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-08
Onset:2021-02-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Atrioventricular block, Death, Dysstasia, Fall, Haemorrhage urinary tract, Hypotension, Loss of consciousness, Myocardial infarction, Pneumonia, Stent placement, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine 2015, developed pneumonia
Other Medications: Levothyroxine 0.075 mg 1 every morning 2 hours before a meal (also binds to coffee) Ecitalopram 5 mg 1 every morning Donepazil Hcl 5 mg 1 every morning Carbidopa/Levodopa 25/100 mg 4 times per day (7am-11am-3pm-7p) Benazapril 20 mg 1 every
Current Illness:
Preexisting Conditions: Parkinson''s
Allergies: COQ10- nosebleeds Glycopyrrolate ? hives/Rash No Known food allergies
Diagnostic Lab Data: Feb 10th to March 9th he had numerous tests at two hospitals.
CDC Split Type:

Write-up: Feb 8th 2nd vaccination. Next day lost consciousness, fell no injuries. Following day Feb 10th weak and could not stand, BP low, Dr sent him via ambulance. EMS identified him having a heart attack that started Feb 9th. He had no cardiac history He was hospitalized for a sudden blockage, had a vtach episode, did not lose consciousness, one stent placement, had a 2nd vtach episode and did lose consciousness. Placed on blood thinner, within a few days had uncontrolled urinary bleeding, catheter to irrigate, changed blood thinners and did not stop. Continued weakness and decline. Then developed pneumonia the following week. Placed on antibiotics, oxygen 2-7 L/nc. Went to rehab, back and forth to hospital. Came home twice, once Feb 14th for 24 hours, then 2nd time March 9 (his birthday) for his final 2 weeks t home where I cared for him until he passed March 21st. On 4L/NC, did not have catheter, bleeding had stopped.


VAERS ID: 1429240 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-19
Onset:2021-05-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dysarthria, Lethargy
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Back surgery (History of multiple back surgeries including a rod placement.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Death; Dysarthria; Lethargy; This case was received via FDA VAERS (Reference number: 1358542) on 15-Jun-2021 and was forwarded to Moderna on 15-Jun-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DEATH (Death), DYSARTHRIA (Dysarthria) and LETHARGY (Lethargy) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. The patient''s past medical history included Back surgery (History of multiple back surgeries including a rod placement.). On 19-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-May-2021, the patient experienced DEATH (Death) (seriousness criteria death and medically significant), DYSARTHRIA (Dysarthria) (seriousness criterion death) and LETHARGY (Lethargy) (seriousness criterion death). The patient died on 27-May-2021. The cause of death was not reported. An autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not reported. On 27 May 2021, autopsy was performed. As per the spouse, the autopsy results were pending. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.Very limited information regarding the events have been provided at this time.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.Very limited information regarding the events have been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1429304 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210648705

Write-up: PEOPLE HAD DIED; This spontaneous report received from a consumer via social media concerned multiple patients of unspecified ages with unknown ethnicity and race. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry: Unknown) dose not reported, 1 total, start therapy date were not reported 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, reporter stated that people had died from vaccine and they were healthy before the vaccination. Patients were died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the event patient had died was fatal. This report was serious (Death). This case, from the same reporter is linked to 20210648176; Sender''s Comments: V0: 20210648705- covid-19 vaccine ad26.cov2.s-People had died . 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: 1429416 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-26
Onset:2021-04-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? 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: Test Date: 202104; Test Name: Covid-19; Result Unstructured Data: Test Result:Contracted COVID
CDC Split Type: USPFIZER INC2021694061

Write-up: Contracted COVID in April before they could receive the 2nd dose and were hospitalized for 2 weeks; Contracted COVID in April before they could receive the 2nd dose and were hospitalized for 2 weeks; Husband passed away; This is a spontaneous report from a contactable pharmacist. This pharmacist (Patient''s wife) reported for a male patient (Reporter''s husband). A 70-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection. Lot number: unknown), dose 1 via an unspecified route of administration on 26Mar2021 as dose 1, single for COVID-19 immunization. No medical and concomitant medication history were reported. She and her husband (who also received the vaccine) contracted COVID in April 2021 before they could receive the second dose and were hospitalized for 2 weeks. The husband passed away on an unspecified date, while the patient recovered from a severe (not mild) COVID infection. She was asking if she can get the second dose and when should she receive the second dose.The patient underwent lab tests and procedures which included SARS-CoV-2 test contracted COVID-19 in Apr2021.It was not reported if an autopsy was performed. The outcome of the event death was fatal and rest on events was unknown. information about lot/batch number has been requested.; Sender''s Comments: As there is limited information in the case provided, the causal association between the event and the suspect drug cannot be excluded. The case will be reassessed once new information is available. The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: husband passed away


VAERS ID: 1429581 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Cardiac amyloidosis, Coronary artery disease, Death, Drowning, Hypertensive heart disease, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Found deceased collapsed over edge of overflowing bath tub with head and upper torso submerged. Autopsy revealed signs of drowning and severe heart disease (hypertensive and coronary heart disease and cardiac amyloidosis). There was no evidence of anaphylaxis or myocarditis. Cause of death = Drowning Contributory causes = Hypertensive and coronary heart disease; Cardiac amyloidosis


VAERS ID: 1429643 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-01
Onset:2021-02-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 13
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: She had been treated for liver cancer
Current Illness:
Preexisting Conditions: COPD OSTEOPOROSIS
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lethal stroke


VAERS ID: 1429713 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-06-13
Onset:2021-06-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Brain oedema, Death, Intensive care, Malaise, Mechanical ventilation, Organ failure, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness:
Preexisting Conditions: Ulcerative colitis, bipolar, advanced degenerative arthr
Allergies: No
Diagnostic Lab Data: June 18 + 19 2021
CDC Split Type:

Write-up: My son had been complaining of racing heart and became a week after the first dose of Moderna then started vomiting once or twice a week thereafter I tried to get him to go the doctor but he kept saying he was ok. He said he feels like something was wrong but didn?t know what. He received his second dose of moderna 6/13/2021, 5 days later on 6/18/2021 he didn?t feel well laid down around 9 pm was checked on at 9:21 he was unresponsive no heart beat no breathing 911 was called. They resuscitated him after 45 minutes then he was transported to hospital then to medical center. he was in ICU on a ventilator unresponsive brain swollen , totally unresponsive and organs shutting down. He passed away 9:45 pm June 19


VAERS ID: 1429777 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-17
Onset:2021-03-26
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coumadin DM medications
Current Illness:
Preexisting Conditions: Diabetes A fib HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead 9 days after vaccine


VAERS ID: 1429848 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-11
Onset:2021-06-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PNS#360 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-25
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain which started 6/17, improved 6/19 and 6/20. Chest pain worsened 6/21 and persisted through the week. Became acutely short of breath and passed away 6/25 at hospital


VAERS ID: 1430291 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-31
Onset:2021-04-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER3781 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Cardiac failure, Chest X-ray, Chest discomfort, Computerised tomogram, Condition aggravated, Death, Dyspnoea, Echocardiogram, Electrocardiogram, Gait disturbance, Laboratory test, Pain, Palpitations, Peripheral ischaemia, Pulmonary hypertension, Skin discolouration, Ultrasound Doppler, Ventilation/perfusion scan
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole before vaccine Albuterol after 1st vaccine
Current Illness: Gastritis
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Multiple Lab blood tests done 5-6 to 5-10-21 TTE 5-7-21 Chest X-rays 5-9-21 Echocardiogram 5-6-21 Nuclear medicine ventilation perfusion lung 5-7-21 US lower extremity veins 5-7-21 ECG 12 lead 5-9-21 CT
CDC Split Type:

Write-up: Started with body aches, joint pain and weakness, followed by SOB that was aggravated over time- especially after the 2nd dose- Then, she started having increase heart palpitations and chest pressure. Eventually noted ischemic changes with purplish discoloration face, hands and feet. At this time it became great effort to walk due to lack of air- SOB was severe. She was taken to ER at hospital where she was admitted with possible PE, MI or heart failure. After few days no improvement was achieved and patient trans ported to another Hospital to receive more advance care but she was pronounced death in the morning of 5-11-21. The death certificate heart failure as immediate cause of death, preceded by PE and pulmonary hypertension.


VAERS ID: 1430452 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-27
Onset:2021-05-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Death, Diarrhoea, Laboratory test, Pain in extremity, Pyrexia, Sepsis, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: None known
Preexisting Conditions: none known
Allergies: Penicillin
Diagnostic Lab Data: Check patient medical records from hospital. Multitude of blood, urine, and other tests performed.
CDC Split Type:

Write-up: Fever, pain in thigh, vomiting, diarrhea, sepsis, eventually died two weeks later. Time of death 6-11-21 1am


VAERS ID: 1430563 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-15
Onset:2021-04-05
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Decreased appetite, Dyspnoea, Fatigue, Headache, Loss of consciousness, Nausea, Pain, Thrombotic thrombocytopenic purpura
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Renovascular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On April 2, 2021, person went to the ED at 10:15 AM, where she complained of shortness of breath, fatigue, mild headache and nausea. Patient symptoms were going on for about 3 days. She also reported feeling a bit achy and decreased appetite. She was treated and discharged home the same day. It was later reported by a family member that this person was found unconscious on floor of her bedroom by family members and taken to hospital where she passed away. It was reported hat Doctors were thinking that this was caused by a rare blood disorder (Thrombotic thrombocytopenic purpura, a disease which causes small blood clots and interrupts the blood''s ability to deliver oxygen properly).


VAERS ID: 1430566 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-27
Onset:2021-06-17
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Intra-cerebral aneurysm operation, Intracranial aneurysm
SMQs:, Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   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: atorvastatin and collagen peptides
Current Illness: none
Preexisting Conditions: none
Allergies: aspirin
Diagnostic Lab Data: brain surgery
CDC Split Type:

Write-up: on 06/18/2021 my husband suffered a central brain aneurysm and passed away om 06/19/2021


VAERS ID: 1430600 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-04-08
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Acute kidney injury, Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Asthenia, Biopsy, COVID-19, Cardiac valve vegetation, Chemotherapy, Cholangiocarcinoma, Computerised tomogram abdomen, Computerised tomogram abnormal, Computerised tomogram thorax abnormal, Critical illness, Death, Deep vein thrombosis, Depressed level of consciousness, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Electrocardiogram, Encephalopathy, Fatigue, Hepatic mass, Hypotension, Intracardiac mass, Laparoscopic surgery, Myocardial ischaemia, Oliguria, Ovarian vein thrombosis, Pain in extremity, Paracentesis, Platelet count decreased, Platelet transfusion, Pulmonary embolism, SARS-CoV-2 test positive, Scan with contrast, Shock, Thrombocytopenia, Troponin increased, Ultrasound Doppler abnormal, Ultrasound abdomen abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Biliary malignant tumours (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   Days after onset: 66
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: No PF4 collected, admission platelets 65, lowest platelets 21 Novel Coronavirus PCR- SARS-CoV-2 detected (6/9/2021)
CDC Split Type:

Write-up: 69 YO female received one dose of J&J vaccination on 3/12/21. 4/8: Patient complaint of epigastric abdominal pain almost nightly since March 12 (coincided with her COVID vaccination) described as 10/10, crampy and without radiation. CT abdominal and pelvis with contrast showed infiltrating mass in the left hepatic lobe concerning for intrahepatic cholangiocarcinoma with reactive adenopathy. Additionally, left mid ovarian vein thrombus found. No thrombus in the renal veins or IVC. 4/28: Venous duplex demonstrated bilateral leg acute DVT. Eliquis was started. 5/7: Pt underwent laparoscopic biopsy/paracentesis. Eliquis was held 2 days prior to laparoscope...5/11: Pt presented to hospital with complaints of generalized weakness, fatigue and leg pain. CTPA showed bilateral PE. Pt received heparin drip and was switched back to Eliquis on discharge. Echocardiogram on 5/12 noted mobile round mass in RV junction, right atrial mass; presumed to be a thrombus. Pt additionally with elevated troponin, determined to likely demand ischemia related to PE; EKG without any acute changes. Discharged on 5/24. 5/27: Patient started on chemotherapy with gemcitabine/cisplatin for metastatic intrahepatic cholangiocarcinoma. 6/4: Presented to the ED again due to worsening dyspnea and home pulse ox readings in the 70s. CT chest showed moderate burden of bilateral obstructive pulmonary emboli with no overt RV strain. EKOS and clot retrieval was contraindicated d/t thrombocytopenia. Was noted to have demand ischemia, and transitioned from eliquis to heparin gtt. Vascular was consulted for eval of her ischemic right foot, and deemed that it needed amputation, but would be a high risk surgery. 6/8: Patient was transferred to this reporting institution for second opinion requested by the family. Upon arrival, patient was found to be obtunded and hypotensive requiring heated high flow nasal cannula and vasopressor with norepinephrine. Code status was deemed DNRCCA/Do not intubate per family. Bedside ultrasound was concerning for an LV mass. Cardiology and Vascular surgery were consulted and recommended that the foot be amputated as well, but requested further workup with ECHO and CTA chest/abdomen/pelvis to further evaluate the LV mass. During admission workup, she was incidentally found to be COVID PCR positive. She was started on DEXA-ARDS prednisone dosing, remdesivir, and placed in enhanced droplet isolation. Her hospital course was complicated by acute hypoxemic respiratory failure due to pulmonary emboli, COVID-19 infection, and underlying malignancy requiring heated high flow nasal cannula. Empiric cefepime was started to treat any underlying superimposed pneumonia. Due to extensive clot burden with limb ischemia, as well as + COVID, she was systemically anticoagulated with a heparin drip despite her thrombocytopenia. She was intermittently given platelet transfusions in order to keep platelet count $g30. TTE was obtained on 6/11 which showed large masses in right ventricle and right atrium, vegetations on mitral valve, aortic valve, and tricuspid valve, and probable mass in IVC. She also developed AKI with oliguria related to shock and critical illness. Medical oncology was consulted and she unfortunately was not a candidate for further chemotherapy at the time due to critical illness, as well as ischemic limb. (If further treatment was pursued, she would need a left leg amputation, then would require 4-6 weeks of recovery before additional chemotherapy could be given.) She slowly became more encephalopathic and had increased oxygen requirements, requiring continuous heated high flow nasal cannula. Goals of care were discussed with her family. Given her advanced cancer, it was decided to transition to comfort-focused care. Her code status was changed to DNRCC. Symptoms were controlled with IV pain and anxiety medication. She expired on 6/13/2021 at 0225.


VAERS ID: 1430652 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-06-11
Onset:2021-06-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Scopolamine 1 mg/3 day patch, Flora Q, Colace, Synthroid, ASA, Theragran-M, Flonase, Mag Ox, Azithromycin 500 mg QD X7 days, Vitamin C, Vitamin D3, Zinc, Midodrine, Provide, Sulfasalazine, Morphine Sulfate, Tylenol, Guaifenesin Dm, Imodium
Current Illness: COPD, Crohn''s Disease
Preexisting Conditions: Crohn''s Disease, COPD
Allergies: Wellbutrin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient noted with decline in condition starting from his first vaccine and expired shortly after 2nd vaccine.


VAERS ID: 1430661 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-05
Onset:2021-02-27
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Cholecalciferol, Famotidine, Finasteride, Losartan, Metoprolol succinate, Multaq
Current Illness:
Preexisting Conditions: Bilateral Carotid Stenosis, Hypertension, Hypercholesterolemia, Paroxysmal Atrial Fibrillation, Cva due to embolism of cerebellum artery (hcc)
Allergies: Dabigatran Etexilate Mesylate, Rivaroxaban
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, chills, fever, exhaustion. The following Sunday, 9 days after his second dose he went to bed and never woke up.


VAERS ID: 1430874 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-14
Onset:2021-06-20
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / 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:
Current Illness: ALS/Respiratory Failure
Preexisting Conditions:
Allergies: Cyclobenzaprine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1430959 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-15
Onset:2021-06-27
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Death, SARS-CoV-2 test
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), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID test on 6/27 inconclusive
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: COVID test indeterminate
CDC Split Type:

Write-up: Patient expired following cardiac arrest. COVID test indeterminate for infection.


VAERS ID: 1430978 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-31
Onset:2021-04-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: Received COVID-19 monoclonal antibodies 02/2021
Current Illness: tested positive for COVID-19 on 01/28/2021 via PCR testing
Preexisting Conditions: Obesity
Allergies:
Diagnostic Lab Data: 01/28/2021 COVID-19 PCR test positive
CDC Split Type:

Write-up: 03/31/2021 received 1st dose of Moderna COVID-19 vaccine 04/01/2021 104 F fever, dizziness, nausea 04/03/2021 symptoms subsided 04/04/2021 case expired as a result of undetermined natural causes per medical examiner final report


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=51&PERPAGE=100&VAX=COVID19&VAXTYPES=COVID-19&DIED=Yes


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166