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

Found 14,925 cases where Vaccine is COVID19 and Patient Died



Case Details

This is page 54 out of 150

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VAERS ID: 1450294 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-13
Onset:2021-04-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Autopsy, Death, Diffuse alveolar damage
SMQs:, Interstitial lung disease (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Found dead. Evidence of diffuse alveolar pulmonary damage (ARDS, DAD).


VAERS ID: 1450298 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   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: Recovering from heart surgery.
Preexisting Conditions: Chronic Lymphocytic Leukemia
Allergies: None
Diagnostic Lab Data: None - Funeral home refused to do testing. All doctors related to the patient refused to do testing. We were faced with hiring a private autopsy to get any results.
CDC Split Type:

Write-up: Pfizer Dose #1 - Jan 22, 2021 - Symptom: arm pain, fatigue Pfizer Dose #2 - Feb 16, 2021 (11:57am) - Death approximately 12 hours later before 1am 02/17/2021.


VAERS ID: 1450341 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-05-08
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Death, Facial paresis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I61.9 - Nontraumatic intracerebral hemorrhage, unspecified R29.810 - Facial weakness I63.9 - Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC)


VAERS ID: 1450387 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-01-25
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 9
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke


VAERS ID: 1450510 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Death, Pneumonia
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 104
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Pneumonia, unspecified organism abdominal pain


VAERS ID: 1450558 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-03-15
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 110
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1450563 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-06-14
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Hyponatraemia
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), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I63.9 - CVA (cerebral vascular accident) E87.1 - Hyponatremia


VAERS ID: 1450577 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-06-06
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1450601 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-06-13
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I61.9 - Nontraumatic intracerebral hemorrhage, unspecified


VAERS ID: 1450612 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-05-22
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 42
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death AKI (acute kidney injury) Pneumonia, unspecified organism


VAERS ID: 1450632 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-05-21
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Hyponatraemia, Hypoosmolar state
SMQs:, Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - Hypo-osmolality and hyponatremia


VAERS ID: 1450643 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-04-29
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1450647 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-05-27
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung


VAERS ID: 1450691 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-05-12
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0163L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death R56.9 - Unspecified convulsions R56.9 - Focal seizures


VAERS ID: 1450702 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dizziness, Feeling abnormal, Myocardial infarction, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Trazodone 100MG- 1x 2. Potassium 8 meq 3. Atorvastatin 80mg-1x 4. Pantoprazole sod dr 40mg-1x 5. Carvedilol 6.25mg-2x 6. Linisopril 20mg-2x 7. Ferosemide-20 1x 8. Plavix 75mg-1x Lantus 20 units
Current Illness:
Preexisting Conditions: Diabetes, kidney disease, congestive heart failure, high blood pressure, cholesterol, copd
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within a few minutes of his 2nd dose, he said his throat felt tight like it was closing. I alerted staff. They checked his blood pressure. 155/50. Made us wait another 20 minutes and my dad said he felt better after drinking water. Once we got home he said he felt brain fog and a bit dizzy. He passed away on May 4th, 2021. 3 days after his 2nd dose of Pfizer. It was ruled a heart attack.


VAERS ID: 1450703 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-24
Onset:2021-06-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Decreased appetite, Fluid intake reduced, Loss of consciousness, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna dose 1 Dept. Public Health
Other Medications: Tylenol Levothyroxine Quietedine Ldopa Today?s date is 7/6/2021 form will not accept.
Current Illness: Parkinson?s Disease
Preexisting Conditions: Parkinson?s Disease
Allergies: None known
Diagnostic Lab Data: None. Hospice Nurse refused all treatment except sub lingual Morphine and refused to allow patient to be visited by a physician. stating patient is ?Hospice Appropriate.
CDC Split Type:

Write-up: Patient sparked a high fever shortly after receiving vaccine, was treated with Tylenol suppositories and Morphine. Patient was on 1.5 liters of Oxygen. Hospice refused any additional treatment including IV fluids or doctor visit requested. Patient stopped eating and drinking and lapsed into unconsciousness. He died on June 29. 2021 after Hospice nurse recommended removing Oxygen. At home nurse insisted on maintaining oxygen until his death a few hours later.


VAERS ID: 1450706 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 256A21A / 1 AR / IM

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: 2021-07-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death


VAERS ID: 1450712 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-06-27
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1450909 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, Craniocerebral injury, Death, Fall, Fatigue, General symptom, Malaise
SMQs:, Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Was informed by local Medical Examiner that on 04/10/2021, 4 days after receiving second Covid-19 vaccine, that the pt slipped on a rug and hit her chin very hard and that she died. The family informed Medical Examiner that she was not feeling very well after receiving her vaccine and felt more fatigued than usual. Family raised concerned that the cause of her fall was due to vaccination. Medical Examiner ruled cause of death as a closed-head injury or cardiac arrhythmia, with significant other conditions at time of death being "mild symptoms following covid-19 vaccination"


VAERS ID: 1453619 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dizziness, Hot flush
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Hot flashes; Dizziness; Death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, the patient experienced HOT FLUSH (Hot flashes) and DIZZINESS (Dizziness). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HOT FLUSH (Hot flashes) and DIZZINESS (Dizziness) outcome was unknown. Concomitant medication use was not provided by reporter. Treatment information was not provided by reporter. Very limited information regarding this patient''s death has been provided at this time. Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded. Most recent FOLLOW-UP information incorporated above includes: On 29-Jun-2021: Followed up Received on 29-jun-2021 that includes TCR: patient passed away.; Sender''s Comments: Very limited information regarding this patient''s death has been provided at this time. Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1453698 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-05
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Completed suicide, Fatigue, Tinnitus
SMQs:, Suicide/self-injury (narrow), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: MS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021577024

Write-up: Tinnitus; Committed suicide; Fatigue; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; Lot Number: ER8730), on 05Mar2021 11:15 and second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; Lot Number: ER8730), on 26Mar2021 10:30; both via an intramuscular route of administration, administered in Arm left (left shoulder), as single dose, for covid-19 immunization. Medical history included multiple sclerosis (MS) from 07Jul2002 and ongoing. Patient''s prior vaccination was none. The patient''s concomitant medications were not reported. Caller reported the side effects after the administration of the Covid-19 vaccine. On unknown date in Mar2021, after the first shot his tinnitus started and he was also fatigued; and he committed suicide eventually. The caller went to a specialist and was told that he had heard about that symptom before from 6 patients who reported the same thing. Later the reporter mentioned he didn''t know the guy other than he was a founder of one organization (name no provided) and he committed suicide. Had spoken with one of his friends who knew of a friend who also had tinnitus shortly after getting Covid and it was serious because the guy committed suicide. The guy was about his age and he ended up committing suicide and he had similar symptoms. This all happened around the same time in March when he had his vaccine and it''s kind of eerie. It stated on the guy''s obituary he had covid and tinnitus, but caller unable to clarify if guy had covid virus or vaccine. He didn''t know the guy, but his other friend who have friends that were doctors said that you could go crazy. No further details provided for this person or other persons. This was the report two of three. Upon receipt of the follow up, it was stated that approximately 1-2 days after just vaccine, the patient started with hissing second on both ears which stated was diagnosed as tinnitus. As of today, 12Jun2021, the "hissins" was consistent or worse than the start and it fall day and night. On an unspecified date in Mar2021, the patient died, and the autopsy was not performed. The outcome of the events committed suicide and tinnitus was fatal while the outcome of the event fatigue was unknown. Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Tinnitus; committed suicide


VAERS ID: 1454063 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-02
Onset:2021-06-26
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dysarthria, Heart rate decreased, Oxygen saturation decreased, SARS-CoV-2 test positive, Sepsis
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: CARDIOVASCULAR DISEASE
Preexisting Conditions: CARDIOVASCULAR DISEASE
Allergies: Unknown
Diagnostic Lab Data: + PCR on 6/26/2021
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient. Patient received two doses of Pfizer on 01/09/21 and 02/02/21. Case was admitted to hospital on 6/26 due to slurred speech, low heartrate, and low oxygen (75%) and tested positive for COVID-19 via a PCR test. The patient passed away on 07/01/21. Cause of death is listed as sepsis. Death cert # 20210042573.


VAERS ID: 1454101 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-30
Onset:2021-04-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Biopsy skin abnormal, Blindness unilateral, Computerised tomogram, Cutaneous vasculitis, Death, Dyschromatopsia, General physical health deterioration, Magnetic resonance imaging, Photopsia, Vasculitis, Vision blurred, Visual impairment, Vitreous floaters, Weight bearing difficulty
SMQs:, Severe cutaneous adverse reactions (narrow), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Vasculitis (narrow), Skin tumours of unspecified malignancy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 64
Permanent Disability? Yes
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: Prednisone 10 mg Levothyroxine 25 mcg Biotin Vitamin C Vitamin D
Current Illness: Cough (tested NEGATIVE for Covid)
Preexisting Conditions: Osteo arthritis
Allergies: Meds: Sulfa, Nitrofurantoin, Cephalex, Celebrex, Salsalate, Cipro, Actonel Food: Almonds Other: Seasonal, hayfever
Diagnostic Lab Data: Biopsy, MRI, CT scan - during each hospital stay mentioned.
CDC Split Type:

Write-up: Several days following 2nd Covid vaccine, patient began experiencing visual changes including seeing "sparkles", black spots, loss of color and blurriness. 8 days following the vaccine, patient lost vision in left eye and was taken to the ER and diagnosed with vasculitis. Large doses of Prednisone were administered as a means of protecting the other eye from loss of vision. A biopsy determined that the diagnosis was small cell vasculitis. Patient was in hospital for one week and returned home. Patient was under the care of specialists but becoming weaker. Approximately 6 weeks later, patient could no longer bear her own weight and was re-admitted to the hospital where additional tests were run. Medical staff were unclear what was causing the decline and patient passed away while still under their care.


VAERS ID: 1454152 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-31
Onset:2021-06-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Death, Dehydration, Endotracheal intubation, Extubation, Intensive care, Nephropathy toxic, Pulseless electrical activity, Resuscitation, Somnolence, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, duloxetine, nitroglycerin SL tablets prn, rosuvastatin 5 mg daily, tamsulosin
Current Illness: None
Preexisting Conditions: sleep apnea, TIA, HTN, CVA, asthma, alcohol dependence, cardiac murmur, CAD, Cervical fusion 2017 (C3-6), Lumbar spine surgery 2018 (L2-4 hemilaminectomy)
Allergies: Cefazolin - anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: 73 year old male, vaccinated with the Janssen Covid-19 vaccine at the time of hospital admission (5/31/21) for a type 3 odontoid fracture; C2 vertebral body fracture extending into bilateral transverse foramina and nasal bone fracture from a fall from standing. Admitted to the trauma service for pain control. Noted to be somnolent throughout admission. On 6/2, developed AKI, likely related to dehydration vs. contrast nephropathy. On the early morning of 6/3, found unresponsive. Given naloxone 0.02 mg x 3 with no documented response. Transferred to the ICU, intubated and had PEA arrest on induction for intubation. CPR was initiated and he received epi x 1 with ROSC within 3 minutes. Remained intubated and sedated in the ICU with labile pressures on 2 pressors throughout the day on 6/3. The patient expired following compassionate extubation 6/3 2211.


VAERS ID: 1454169 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-22
Onset:2021-06-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Heart Surgery May 18th
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Contact Hospital
CDC Split Type:

Write-up: Death


VAERS ID: 1454205 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-04
Onset:2021-05-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardiac disorder, Cardiac failure congestive, Computerised tomogram abnormal, Death, Dysphagia, Pulmonary oedema, X-ray abnormal
SMQs:, Cardiac failure (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lokelma: 3 doses administered over 10 days prior to death, about one day every 3 days..
Current Illness: Gout, incontinence, high potassium level in blood. Difficulty swallowing on 08 May 2021. On afternoon 10 May 2021, X-rays by Advanced Radiology, revealed fluid buildup in both lungs. Dr reviewed X=rays and determined fluid buildup is due to heart condition. Recommended going to the emergency room at 9:30pm. Pt died at 10:00 pm 10 May 2921, before we were able to bring her to the hospital.. 911 Response team confirmed time of death at 10:45PM. Dr determined death was due to congestive heart failure.
Preexisting Conditions: gout, urinary tract infection, kidney illness
Allergies: None
Diagnostic Lab Data: On afternoon of 10 May 2021, Advanced Radiology performed X-rays on patient. X-rays reviewed by Dr who observed there was large fluid build up on both lungs and determined this was due to a heart condition .. Dr recommended at 9:30pm going to the emergency room. Pt died at 10pm 10 May 2021 as we were preparing to call 911. The 911 Response Team confirmed the time of death at 10:45 10 May 2021. Dr. determined the cause of death was congestive heart failure.
CDC Split Type:

Write-up: Unable to swallow food and liquids beginning Saturday 7pm 08 May 2021.


VAERS ID: 1454242 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-05
Onset:2021-05-29
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Haematoma, Platelet count normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   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: Predzone, Pludrocortosine, Levothyroxine, a blood thinner, methotyxriate, metoprolol, Fosamax
Current Illness: Multilemona, Addison''s Disease, overactive thyroid, heart murmur, rheumatoid arthritis, weak heart, osteoporosis
Preexisting Conditions:
Allergies: Citrus
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cause of death: sub drawn hematoma with a normal platelet count


VAERS ID: 1454267 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Delaware  
Vaccinated:2020-12-29
Onset:2021-03-02
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes; Lung Cancer; Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough; resulted in death from COVID related symptoms.


VAERS ID: 1454278 (history)  
Form: Version 2.0  
Age: 102.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-01-25
Onset:2021-05-03
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1686 / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   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: Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough death resulted from COVID.


VAERS ID: 1454305 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-04-14
Onset:2021-05-17
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 - / SYR

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

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

Write-up: Breakthrough resulted in COVID death


VAERS ID: 1454319 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-02-20
Onset:2021-06-05
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes; Cholesterol; Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID related death


VAERS ID: 1454364 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-07-04
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Confusional state, Cough, Death, Dyspnoea, Fatigue, SARS-CoV-2 RNA increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 0
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: N/A
Current Illness: N/A
Preexisting Conditions: Dementia, hypertension, Parkinson''s
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: ~5 months following vaccination, COVID-19 infection: Abnormal CXR, fatigue, cough, shortness of breath, confusion, COVID RNA positive; Patient died as result of illness 4 days after admittance to hospital from nursing home.


VAERS ID: 1454388 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-23
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Death, Herpes zoster, Laboratory test, Magnetic resonance imaging, X-ray
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: High Blood Pressure, Cholesterol, Diabetes, anti-depressants medications (known)
Current Illness: none (known)
Preexisting Conditions: high blood pressure, cholesterol, type 2 diabetes
Allergies: unknown
Diagnostic Lab Data: labs, cat scans, MRIs, X-rays.
CDC Split Type:

Write-up: Singles virus broke out within one week of receiving the 2nd COVID-19 vaccination shot. The patient reported to Dr who was then given 400 mg of anti-virals medication. Patient did not improve and was taken to Hospital on 5/17/2021. The Patient was transferred to Hospital on 5/26/2021 and then died on 6/4/2021.


VAERS ID: 1454420 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-03-07
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Brain neoplasm, Condition aggravated, Death
SMQs:, Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Client was receiving chemotherapy
Current Illness: Client has been diagnosed with brain cancer per wife
Preexisting Conditions: Cancer
Allergies: Contrast iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: When pt''s wife came to the clinic for her second dose on 3/11/21 she informed staff that her husband had passed away on 3/7/21 of a brain tumor. Death does not appear to be related to the vaccine - reporting only because death occurred within 30 days of first dose of vaccine. .


VAERS ID: 1454552 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-06-28
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Erythema, General physical health deterioration, SARS-CoV-2 test positive, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel Atorvastatin Lisinopril Nebivolol Aspirin Ferric Citrate Docusate Sodium Lactobacillus Acidophilus Insulin Glargine Insulin Lispro Levothyroxine
Current Illness: Diabetes End Stage renal disease on dialysis peripheral vascular disease Coronary artery disease status post stent placement Non-healing lesion of right heel
Preexisting Conditions: Diabetes End Stage renal disease on dialysis peripheral vascular disease Coronary artery disease status post stent placement Non-healing lesion of right heel
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated with pfizer COVID vaccines 02/26/21 and 03/18/21 Patient presented to ER due to nonhealing lesion of right heel as well as erythema and was admitted on 06/15/21 Patient tested negative for COVID-19 on 06/15/21 Patient deteriorated and tested again for COVID-19 and positive on 06/28/21 Patient expired on 07/01/21


VAERS ID: 1454630 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-05
Onset:2021-04-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Sotolol, xarelto, carvedilol, furosemide, indomethacin, lisinopril
Current Illness: Dyspnea on exertion, atrial fibrillation with palpitations, shortness of breath and tachycardia, gout flare up
Preexisting Conditions: Hypertension Obesity Gout Hyperlipidemia Atrial fibrillation
Allergies: Iodine (anxiety)
Diagnostic Lab Data: Autopsy on April 12, 2021
CDC Split Type:

Write-up: Sudden death 5 days after second vaccination.


VAERS ID: 1454651 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2020-12-21
Onset:2021-07-04
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Private       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: 2021-07-06
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: A-fib, CAD, Chronic anticoagulation, Chronic kidney disease, CHF, COPD, dependence on nocturnal oxygen therapy, dyspnea, HTN, Type 2 diabetes, heart disease
Allergies: Adhesive tape, iodine, Isovue-370, lisinopril, MSG, and shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was admitted to the hospital on 7/4 and tested positive for covid. Pt died 7/6


VAERS ID: 1454655 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-01-28
Onset:2021-01-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute respiratory failure, Aphonia, Death, Dysphagia, Muscle atrophy, Pneumonia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), 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), 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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 Asymptomatic
Preexisting Conditions: Parkinsons
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of voice, difficulty swallowing, rapid muscle mass deterioration, eventual death on 5/21/2021 from acute respiratory failure, and slight pneumonia.


VAERS ID: 1454681 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-16
Onset:2021-06-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio, Anion gap, Aspartate aminotransferase normal, Basophil percentage, Basophil percentage increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood calcium normal, Blood chloride decreased, Blood chloride increased, Blood creatinine increased, Blood glucose normal, Blood magnesium, Blood potassium decreased, Blood potassium normal, Blood sodium decreased, Blood sodium normal, Blood test, Blood thyroid stimulating hormone, Blood urea increased, Carbon dioxide decreased, Chest X-ray, Condition aggravated, Death, Decreased appetite, Dyspnoea, Eosinophil count increased, Eosinophil percentage increased, Full blood count, Globulins decreased, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoxia, Lethargy, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration, Mean cell haemoglobin normal, Mean cell volume increased, Metabolic function test, Monocyte count increased, Monocyte count normal, Monocyte percentage increased, Neutrophil count normal, Neutrophil percentage increased, Platelet count normal, Protein total decreased, Red blood cell count decreased, Red blood cell count normal, Red cell distribution width increased, Thyroxine free, Vitamin B12 normal, Vitamin D, Weight decreased, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 16
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: acetaZOLAMIDE Tablet 250 MG Give 1 tablet by mouth two times a day related to UNSPECIFIED COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50. 40 Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT 2 puff
Current Illness: UNSPECIFIED ATRIAL FIBRILLATION (I48.91) CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH (ACUTE) EXACERBATION (J44.1) CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED (J44.9) ANEMIA, UNSPECIFIED (D64.9) PRESSURE ULCER OF RIGHT BUTTOCK, STAGE 2 (L89.312) PRESSURE ULCER OF SACRAL REGION, STAGE 2 (L89.152) UNSPECIFIED OPEN WOUND OF LEFT BUTTOCK, INITIAL ENCOUNTER (S31.829A) ANOREXIA (R63.0) UNSTEADINESS ON FEET (R26.81) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED (J44.9) DYSPNEA, UNSPECIFIED (R06.00) EDEMA, UNSPECIFIED (R60.9) HYPO-OSMOLALITY AND HYPONATREMIA (E87.1) HYPOMAGNESEMIA (E83.42) HYPOXEMIA (R09.02) IDIOPATHIC HYPOTENSION (I95.0) KLEBSIELLA PNEUMONIAE [K. PNEUMONIAE] AS THE CAUSE OF DISEASES CLASSIFIED ELSEWHERE (B96.1) MODERATE PROTEIN-CALORIE MALNUTRITION (E44.0) MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, UNSPECIFIED SITE (M62.50) MUSCLE WEAKNESS (GENERALIZED) (M62.81) URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) CARDIAC ARREST, CAUSE UNSPECIFIED (I46.9) ESSENTIAL (PRIMARY) HYPERTENSION (I10) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) TOBACCO USE (Z72.0) UNSPECIFIED ATRIAL FIBRILLATION (I48.91) UNSPECIFIED COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50.40) ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPOXIA (J96.21) ALLERGIC RHINITIS, UNSPECIFIED (J30.9) DEPENDENCE ON SUPPLEMENTAL OXYGEN (Z99.81) GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS (K21.9) HYPOKALEMIA (E87.6) HYPOTENSION, UNSPECIFIED (I95.9) LIMITATION OF ACTIVITIES DUE TO DISABILITY (Z73.6) MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED (F33.9) MUSCLE WEAKNESS (GENERALIZED) (M62.81) TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS (E11.9) UNSTEADINESS ON FEET (R26.81)
Preexisting Conditions: UNSPECIFIED ATRIAL FIBRILLATION (I48.91) CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH (ACUTE) EXACERBATION (J44.1) CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED (J44.9) ANEMIA, UNSPECIFIED (D64.9) PRESSURE ULCER OF RIGHT BUTTOCK, STAGE 2 (L89.312) PRESSURE ULCER OF SACRAL REGION, STAGE 2 (L89.152) UNSPECIFIED OPEN WOUND OF LEFT BUTTOCK, INITIAL ENCOUNTER (S31.829A) ANOREXIA (R63.0) UNSTEADINESS ON FEET (R26.81) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED (J44.9) DYSPNEA, UNSPECIFIED (R06.00) EDEMA, UNSPECIFIED (R60.9) HYPO-OSMOLALITY AND HYPONATREMIA (E87.1) HYPOMAGNESEMIA (E83.42) HYPOXEMIA (R09.02) IDIOPATHIC HYPOTENSION (I95.0) KLEBSIELLA PNEUMONIAE [K. PNEUMONIAE] AS THE CAUSE OF DISEASES CLASSIFIED ELSEWHERE (B96.1) MODERATE PROTEIN-CALORIE MALNUTRITION (E44.0) MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, UNSPECIFIED SITE (M62.50) MUSCLE WEAKNESS (GENERALIZED) (M62.81) URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) CARDIAC ARREST, CAUSE UNSPECIFIED (I46.9) ESSENTIAL (PRIMARY) HYPERTENSION (I10) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) TOBACCO USE (Z72.0) UNSPECIFIED ATRIAL FIBRILLATION (I48.91) UNSPECIFIED COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50.40) ACUTE AND CHRONIC RESPIRATORY FAILURE WITH HYPOXIA (J96.21) ALLERGIC RHINITIS, UNSPECIFIED (J30.9) DEPENDENCE ON SUPPLEMENTAL OXYGEN (Z99.81) GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS (K21.9) HYPOKALEMIA (E87.6) HYPOTENSION, UNSPECIFIED (I95.9) LIMITATION OF ACTIVITIES DUE TO DISABILITY (Z73.6) MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED (F33.9) MUSCLE WEAKNESS (GENERALIZED) (M62.81) TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS (E11.9) UNSTEADINESS ON FEET (R26.81)
Allergies: NKA
Diagnostic Lab Data: 6/17/21: Chest X-ray 1 view: "No acute cardiopulmonary processes" 6/18/21: CBC/CMP SODIUM 135 mEq/L Final POTASSIUM 3.3 L GLUCOSE 85 BUN 47 H CREATININE 1.69 H GFR-OTHER 30 L GFR AFRICAN AMERICAN 37 L ALBUMIN 3.2 L ALKALINE PHOSPHATASE 106 TOTAL BILIRUBIN 0.9 CALCIUM 9.2 CARBON DIOXIDE 20 L CHLORIDE 97 L AST (SGOT) 20 ALT (SGPT) 11 TOTAL PROTEIN 5.4 L GLOBULIN 2.2 L A/G RATIO 1.5 WBC 9.2 RBC 4.67 HEMOGLOBIN 14.6 HEMATOCRIT 46.4 H MCV 99 MCHC 31.5 RDW 16.5 H PLATELET COUNT 257 NEUTROPHIL# 6.4 LYMPHOCYTE# 1.2 MONOCYTE# 1.4 H EOSINOPHIL# 0.1 BASOPHIL# 0.1 6/30/21: MAGNESIUM / VITAMIN B12 / CMP COMP METABOLIC / TSH / CBC W/DIFFERENTIAL / VITAMIN D, 25-HYDROXY / T4, FREE MAGNESIUM 2.1 mg/dL VITAMIN B12 512.0 pg/mL SODIUM 140 mEq/L POTASSIUM 4.3 mEq/L CHLORIDE 109 mEq/L CARBON DIOXIDE 20 mEq/L ANION GAP 15.3 mmol/L GLUCOSE 79 mg/dL BUN 55 mg/dL CREATININE 1.37 mg/dL B/C RATIO 40.15 CALCIUM 8.9 mg/dL ALT (SGPT) 7 U/L AST (SGOT) 17 U/L ALKALINE PHOSPHATASE 130 U/L TOTAL BILIRUBIN 0.50 mg/dL TOTAL PROTEIN 5.0 g/dL ALBUMIN 2.95 g/dL GLOBULIN 2.1 A/G RATIO 1.4 GFR CAUCASIAN 39 GFR AFRICAN AMERICAN 47 NULL ********* TSH 2.52 ulU/mL WBC 8.2 10 RBC 3.91 10 HEMOGLOBIN 12.1 g/dL HEMATOCRIT 38.9 % MCV 100 fL MCH 31.0 pg/cell MCHC 31.2 g/dL RDW 16.5 % MPV 8.1 fl PLATELET COUNT 225 10 NEUTROPHIL% 71.9 % LYMPHOCYTE% 14.3 % MONOCYTES% 12.1 % EOSONOPHIL% 0.9 % BASOPHIL% 0.8 % NEUTROPHIL# 5.9 10 LYMPHOCYTE# 1.2 10 MONOCYTE# 1.0 10 EOSINOPHIL# 0.1 10 BASOPHIL# 0.1 10 VITAMIN D, 25-HYDROXY 20.1 ng/mL T4, FREE 0.77 ng/dL
CDC Split Type:

Write-up: 6/18/21: Guest experienced episode of hypoxia. Was able to be corrected with use of )2. Chest X-ray and bloodwork completed. 6/28/21: Seen by NP for weight loss. Ongoing issue prior to vaccine r/t poor appetite 7/1/21: Incident of hypoxia that required increase in 02, SOB, and lethargy. Sent to the hospital. Guest did end up passing at this hospital


VAERS ID: 1454753 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-02-01
Onset:2021-02-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardio-respiratory arrest, Condition aggravated, Death, Failure to thrive, Fall, General physical health deterioration, Hip fracture, Hypoglycaemia, Hypophagia, Respiratory failure, Surgery, Tachypnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (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 (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Neonatal disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg EC tablet atorvastatin 80 mg tablet guaiFENesin 600 mg 12 hr tablet potassium chloride 20 mEq CR tablet tamsulosin 0.4 mg capsule sennosides-docusate sodium 8.6-50 mg tiotropium-olodateroL 2.5-2.5 mcg/actuation mist inhaler p
Current Illness: Patient broke his hip and needed hip surgery on 02/14/2021 and was hospitalized for this reason. He tested positive for COVID-19 on 02/23/2021 and again on 02/25/2021 and subsequently developed COVID-19 associated pneumonia. Discharge summary reports: "Pt had long complicated course spanning almost a month. He was initially admitted for right intertrochanteric hip fracture for which he required surgery. Also had bacterial pneumonia and received Zosyn. He was close to discharge at 1 point and had Covid testing done which came back positive. He gradually worsened from there with acute hypoxic respiratory failure and very poor oral intake. He had multiple episode of hypoglycemia and required D5. He was made comfort care only but improved on his own and was back on medical Mx. It did not last long and he again became very tachypnic in 60s and hypoglycemic. He was made comfort care again."
Preexisting Conditions: Patient has a history of Chronic Obstructive Pulmonary Disease (COPD), hypertension, hyperlipidemia, chronic respiratory failure with hypoxia (on O2 home therapy); acute renal failure superimposed on stage 3b chronic kidney disease,
Allergies: No known allergies
Diagnostic Lab Data: Positive COVID-19 test on 02/23/2021 and 02/25/2021, despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: Pt had long complicated course spanning almost a month. He was initially admitted for right intertrochanteric hip fracture (following a fall at home) for which he required surgery. Also had bacterial pneumonia and received Zosyn. He was close to discharge at 1 point but then had Covid testing done which came back positive. He gradually worsened from there with acute hypoxic respiratory failure and very poor oral intake. He had multiple episode of hypoglycemia and required D5. He was made care only but improved on his own and was back on medical Mx. It did not last long and he again became very tachypnic in 60s and hypoglycemic. He was made care again. Pt passed away peacefully with his daughter at the bedside on 3/11/21 at 11 AM Causes of Death: 1. Cardiopulmonary arrest due to reason #2 2. Failure to thrive due to reason #3 3. Old age and COVID-19 No autopsy performed.


VAERS ID: 1454790 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-26
Onset:2021-03-23
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Multiple organ dysfunction syndrome, Pyrexia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), 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), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient in overall poor health and was in care at time of hospitalization and subsequent death; she was in a facility.
Preexisting Conditions: Patient in care at time of hospitalization and subsequent death; she was in a facility. Patient has history of congestive heart failure, Type 2 diabetes, morbid obesity, diastolic heart failure with preserved ejection fraction, previous Cerebrovascular Accident.
Allergies: HMG-COA-R Inhibitors; adhesives; Morphine Sulfate
Diagnostic Lab Data: Patient tested positive for COVID-19 on 03/29/2021 (both antigen and PCR) despite being fully vaccinated.
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 03/29/2021 via both antigen and PCR despite being fully vaccinated. She was subsequently hospitalized and then died on 03/30/2021. Symptom onset for COVID-19 was 03/23/2021, with symptoms of fever (101.8) and respiratory distress which required an increase in oxygen. Per the death certificate, causes of death are as follows: Part 1: Cause of Death: A. Multi organ failure B. COVID-19 infection Part 2: Other Significant Conditions: Congestive Heart Failure, Diastolic Heart Failure with Preserved Ejection, history of cerebrovascular accident, diabetes mellitus type 2, and morbid obesity


VAERS ID: 1454812 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-02
Onset:2021-04-14
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Death, Delirium, Dyspnoea, General physical health deterioration, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: decadron remdesevir Famotidine 20mg bid melatonin 5mg HS Thiamine 200mg PO BID D/C Zinc, Vit D and C per ID Cefepime Doxycycline
Current Illness:
Preexisting Conditions: Heart murmur due to Aortic stenosis per history. Unable to find documented ECHO Hyperlipidemia Hypertension Diabetes mellitus 2 Depression
Allergies: No known allergies
Diagnostic Lab Data: Patient tested positive for COVID-19 on 4/14/2021 via RNA panel despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: Patient admitted to the hospital with shortness of breath and cough after being diagnosed with pneumonia in the clinic. He was found to have Covid pneumonia and was treated with maximal support but unfortunately became profoundly delirious and developed worsening hypoxia associated with Covid pneumonia. Family was called to the bedside due to progression in his illness and concerns for cardiac dysrhythmias occurring in the setting of worsening hypoxia on maximal support. Decision was made to transition to comfort care and aggressive life-prolonging interventions were discontinued for primary focus on comfort. Patient subsequently expired at 1810 on 04/18/2021. Patient was vaccinated against COVID 19. Death Certificate Information: Part 1: Cause of Death: A. COVID B. SARS COVID 19 Part 2: Other Significant Conditions: Diabetes Mellitus Type 2, Coronary Artery Disease, Hypertension, Hyperlipidemia


VAERS ID: 1454827 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-03-28
Onset:2021-04-18
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cervical vertebral fracture, Death, Fall, Pulse absent, SARS-CoV-2 test positive
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 0
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: Patient was in general poor health due to advanced age, was blind in one eye and required supplemental oxygen 24 hours a day.
Allergies:
Diagnostic Lab Data: Patient tested positive for COVID-19 on 04/18/2021 despite being fully vaccinated.
CDC Split Type:

Write-up: Patient fell down the stairs on 04/18/2021; EMT services found no pulse upon their arrival to the scene. Patient was transported to hospital and found to have several broken bones in neck and ultimately died on 04/18/2021 at the hospital. Patient tested positive for COVID-19 upon admission to hospital, despite being fully vaccinated. Patient did not have any known symptoms of COVID-19; the death is not thought to be related to COVID-19.


VAERS ID: 1454844 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-02-25
Onset:2021-04-15
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 12
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: Revlimid
Current Illness:
Preexisting Conditions: Multiple Myeloma (not having achieved remission); deficiency of B group vitamins; COPD
Allergies: SULFAMETHOXAZOLE W-TRIMETHOPRIM
Diagnostic Lab Data: Patient tested positive for COVID-19 on 04/20/2021 despite being fully vaccinated against it.
CDC Split Type:

Write-up: Patient admitted to hospital on 04/20/2021 for significant shortness of breath; patent tested positive for COVID-19 despite being fully vaccinated against it. Patient died on 04/24/2021. Death Certificate Information: Part I: Cause of Death: A. Repiratory Arrest B. COVID-19 Part II Other Significant Conditions COPD; Multiple Myeloma


VAERS ID: 1454861 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-01-30
Onset:2021-03-17
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death, Dyspnoea, Pulmonary embolism, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), 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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Macular Degeneration
Allergies: No Known Allergies
Diagnostic Lab Data: Patient tested positive for COVID-19 on 03/21/2021 and again on 03/24/2021 despite being fully vaccinated against COVID-19.
CDC Split Type:

Write-up: Patient admitted to hospital on 03/24/2021 for high fever and shortness of breath; these symptoms began in 3/17. Patient tested positive for COVID-19 on 03/21/2021 and again on 03/24/2021 despite being fully vaccinated against COVID-19. Patient died on 04/19/2021. COVID-19 is listed on the death certificate. Death Certificate Information: Part I Cause of Death: A. Acute Hypoxic Respiratory Failure B. Suspected pulmonary embolism Part II: Significant Other Conditions: COVID 19 subacutely


VAERS ID: 1454878 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-01-19
Onset:2021-06-08
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Chills, Continuous positive airway pressure, Death, Dialysis, Endotracheal intubation, Fraction of inspired oxygen, Hypotension, Hypoxia, Intensive care, Lung opacity, Pyrexia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension; Type 2 diabetes, Obesity hypoventilation syndrome; previous history of traumatic brain injury (TBI); end-stage renal disease, chronic congestive heart failure, hemodialysis
Allergies: LEVOFLOXACIN; PIOGLITAZONE
Diagnostic Lab Data: Patient tested positive for COVID-19 on 06/08/2021 despite being fully vaccinated against it.
CDC Split Type:

Write-up: 65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem. Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone. In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house. On the afternoon of June 23 palliative team did meet with patient''s siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation. Patient died of COVID-19 despite being fully vaccinated against it. Death Certificate Information: Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease


VAERS ID: 1454883 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-22
Onset:2021-02-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Decreased appetite, Dyspnoea, Gait inability, Incoherent, Insomnia, Malaise
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 56
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood pressure, vitamins
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy breathing, sick, can?t walk, loss of memory, incoherent, couldn?t sleep, no appetite


VAERS ID: 1455101 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-06-16
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Haemoptysis, Malaise, Migraine, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad)

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: Unknown
Current Illness: High blood pressure Migraine headaches
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Father received vaccine on May 13, 2021. Complained of migraine headaches, feeling tired, and generally unwell. Migraines became more persistent. Father died on June 16, 2021 at home. Coughed up blood and vomited around time of death.


VAERS ID: 1455120 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-23
Onset:2021-03-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6017 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER1742 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Choking, Death, Drug reaction with eosinophilia and systemic symptoms, Dysphagia, Fatigue, General physical health deterioration, Hepatic failure, Hiccups, Multiple organ dysfunction syndrome, Pulmonary haemorrhage, Rash, Renal failure, Vaccination complication
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Co-Diovan, Vitamin D3, Ginkgo Biloba, Collagen, Melatonin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Numerous tests, see attached Continuation Page
CDC Split Type:

Write-up: All events took place: Following first dose, minor rash on left arm; following second dose, first developed severe rash on arm and belly, extreme fatigue, severe hiccups and inability to swallow without choking; ultimately developed liver and kidney failure, was diagnosed with DRESS syndrome resulting from reaction to vaccine, was administered high-dose corticosteroids and antibiotics but continued to decline, developed hemorrhage in lungs and died due to multi-organ failure. PDF Continuation field did not permit entering text, see attached Continuation Page.


VAERS ID: 1456619 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Angiogram pulmonary, Angiogram pulmonary abnormal, Brain injury, Brain oedema, Computerised tomogram head, Computerised tomogram head abnormal, Continuous haemodiafiltration, Death, Deep vein thrombosis, Dyspnoea, Endotracheal intubation, Hepatic steatosis, Hypotension, Hypoxia, Hypoxic-ischaemic encephalopathy, Lung assist device therapy, Mental impairment, Multiple organ dysfunction syndrome, Pain in extremity, Peripheral swelling, Pulmonary embolism, Pulmonary infarction, Right ventricular dysfunction, Thrombectomy, Ultrasound Doppler, Ultrasound Doppler abnormal, Withdrawal of life support
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 14
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: Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Alcohol abuse; Comments: The patient had no known drug allergies. The patient had no known other illness at the time of vaccination. The patient was not pregnant at the time of vaccination. The patient had not taken any prescriptions, over the counter medications, dietary supplements or herbal remedies at the time of vaccination. The patient had no adverse event following any previous vaccine.
Allergies:
Diagnostic Lab Data: Test Date: 20210508; Test Name: Angiogram pulmonary; Result Unstructured Data: Abnormal; Test Date: 20210510; Test Name: Ultrasound Doppler; Result Unstructured Data: Abnormal; Test Date: 20210513; Test Name: Computerised tomogram head; Result Unstructured Data: Abnormal (Findings consistent with a hypoxic anoxic injury)
CDC Split Type: USJNJFOC20210625722

Write-up: DEATH; COMPUTERISED TOMOGRAM HEAD ABNORMAL; MULTIPLE ORGAN DYSFUNCTION SYNDROME; HYPOXIA; HYPOTENSION; CONTINUOUS HAEMODIAFILTRATION; ENDOTRACHEAL INTUBATION; DEEP VEIN THROMBOSIS; ULTRASOUND DOPPLER ABNORMAL; LUNG ASSIST DEVICE THERAPY; DYSPNOEA; PAIN IN EXTREMITY; PERIPHERAL SWELLING; HYPOXIC-ISCHAEMIC ENCEPHALOPATHY; BRAIN INJURY; BRAIN OEDEMA; ACUTE KIDNEY INJURY; MENTAL IMPAIRMENT; HEPATIC STEATOSIS; THROMBECTOMY; PULMONARY EMBOLISM; PULMONARY INFARCTION; RIGHT VENTRICULAR DYSFUNCTION; ANGIOGRAM PULMONARY ABNORMAL; WITHDRAWAL OF LIFE SUPPORT; This spontaneous report received from a health care professional via a Regulatory Authority, VAERS (Vaccine Adverse Event Reporting System), concerned a 55 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included ethyl alcohol abuse, and concurrent conditions included hypertension. The patient had no known drug allergies. The patient had no known other illness at the time of vaccination. The patient was not pregnant at the time of vaccination. The patient had not taken any prescriptions, over the counter medications, dietary supplements or herbal remedies at the time of vaccination. The patient had no adverse event following any previous vaccine. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, 1 total administered on 21-APR-2021 on left arm for prophylactic vaccination. No concomitant medications were reported. On 08-MAY-2021, the patient''s laboratory data included CT (computed tomography) angiography of chest showed severe burden of acute pulmonary embolism (PE) with severe right heart strain, small early infarct posteromedial left lower lobe (LLL), hepatic steatosis and interventional radiology (IR) thrombectomy procedure showed large bilateral pulmonary emboli. On 09-MAY-2021 (approximately 3 weeks after vaccination), the patient was presented to the emergency room due to progressively worsening shortness of breath. The patient also had pain and swelling in the left calf and leg. On the same day, the patient experienced brain injury, brain oedema, acute kidney injury, hypoxic-ischaemic encephalopathy, mental impairment, pain in extremity, peripheral swelling and had lung assist device therapy. The patient was hospitalized on an unspecified date. On 10-MAY-2021, the patient''s ultrasound venous Doppler showed complete thrombosis left femoral, popliteal, posterior tibial, peroneal and anterior tibial veins, partial thrombosis of left common femoral vein. The patient underwent urgent thrombectomy, however, on 11-MAY-2021 (the next morning), she became more hypoxic and hypotensive and was intubated and was urgently placed on extracorporeal membrane oxygenation (ECMO). The patient developed multi-organ failure and was started on continuous veno-venous hemofiltration (CVVH) for oliguric renal failure. On 13-MAY-2021, CT computerised tomogram (CT) scan of the patient''s head showed diffuse cerebral edema, which was most likely a result of hypoxic encephalopathy. With no improvement in her mental status over the course of the next few days, the patient was taken off life support and died on 15-MAY-2021 due to unknown cause. The patient was in hospital for 7 days. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death, multiple organ dysfunction syndrome, hypoxic-ischaemic encephalopathy, brain injury, brain oedema, acute kidney injury, mental impairment, deep vein thrombosis, pulmonary embolism, pulmonary infarction, hypoxia, dyspnoea, pain in extremity, peripheral swelling, hepatic steatosis, hypotension, right ventricular dysfunction, continuous haemodiafiltration, endotracheal intubation, thrombectomy, lung assist device therapy, withdrawal of life support, angiogram pulmonary abnormal, computerised tomogram head abnormal and ultrasound doppler abnormal on 15-MAY-2021. This report was serious (Death, and Hospitalization Caused / Prolonged). This case, involving the same patient is linked to 20210542597. Additional information was received from patient on 01-JUN-2021. The following information was updated and incorporated in to the case narrative: Patient demographics (race, ethnic origin), added patient history, added ethyl alcohol abuse in disease tab, added batch number, added facility type and other identification numbers updated.; Sender''s Comments: V1: This spontaneous report received from a health care professional via Regulatory Authority VAERS (Vaccine Adverse Event Reporting System), concerns a 55 year old female patient, who was noted to experience acute pulmonary embolism (PE), with severe right heart strain, 18 days after receiving the Janssen Covid-19 vaccine. The patient sought consult at the emergency room due to worsening of the shortness of breath. The patient also had pain and swelling in the left calf and leg. Computed Tomography Angiography (CTA) of chest showed acute pulmonary embolism (PE) with severe right heart strain, small early infarct posteromedial left lower lobe (LLL), hepatic steatosis. Venous doppler showed complete thrombosis left femoral, popliteal, posterior tibial, peroneal and anterior tibial veins, partial thrombosis of left common femoral vein. The patient underwent urgent thrombectomy. However, she became more hypoxic and hypotensive, was intubated and was urgently placed on extracorporeal membrane oxygenation (ECMO). Later, she developed multi-organ failure and was started on continuous veno-venous hemofiltration (CVVH) for renal failure. Nineteen (19) days after receiving the vaccine, Computerised tomogram (CT) scan of the patient''s head showed diffuse cerebral edema, which was most likely a result of hypoxic encephalopathy. With no improvement in her mental status, life support was said to be taken off which resulted to death. It was unknown if autopsy was performed. Patient''s height and weight were not reported. The patient''s past medical history included ethyl alcohol abuse and concurrent conditions included hypertension. The patient had no known drug allergies. The patient was not pregnant at the time of vaccination. Information is limited in this case. However, a relationship with Janssen Covid-19 vaccine cannot be ruled out and the relationship is considered indeterminate. Additional information has been requested.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1456637 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: healthy woman dying within 48 h of vaccination; blood coming out of her nose; This spontaneous case was reported by a physician and describes the occurrence of DEATH (healthy woman dying within 48 h of vaccination) and EPISTAXIS (blood coming out of her nose) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (healthy woman dying within 48 h of vaccination) (seriousness criteria death, medically significant and life threatening) and EPISTAXIS (blood coming out of her nose) (seriousness criteria death and life threatening). The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were provided by the reporter. The subject stated that "there are many deaths related to the Covid vaccine and autopsies have been ordered." The subject also stated that many deaths have occurred within 48 hours of the vaccination. He also reported that a healthy young woman was found deceased in her apartment within 48 hours of vaccination. The deceased was found with blood coming out of her nose. No treatment information was provided by the reporter. Very limited information regarding this events has been provided at this time. Details regarding the exact brand of vaccine received, dosing dates, Medical history, concomitant medication, and date/cause of death are required for further evaluation. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Details regarding the exact brand of vaccine received, dosing dates, Medical history, concomitant medication, and date/cause of death are required for further evaluation. Further information has been requested.; Reported Cause(s) of Death: Many deaths related to the COVID vaccine


VAERS ID: 1456646 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hodgkin''s disease (and they took his spleen out so he is a little immunocompromised.)
Allergies:
Diagnostic Lab Data: Test Date: 20210407; Test Name: IG; Test Result: Negative ; Comments: AbIG Quantitative; Test Date: 20210524; Test Name: IG; Test Result: Negative ; Comments: IGg; Test Date: 2021; Test Name: IG; Test Result: Negative ; Comments: IGgAb, ABIGm; Test Date: 20210407; Test Name: COB TEST; Test Result: Negative ; Test Date: 20210524; Test Name: COB TEST; Test Result: Negative ; Test Date: 2021; Test Name: COB TEST; Test Result: Negative ; Test Date: 20210407; Test Name: COVID-19 test; Test Result: Negative ; Test Date: 20210524; Test Name: COVID-19 test; Test Result: Negative ; Test Date: 20210407; Test Name: SARS test; Test Result: Negative ; Test Date: 20210524; Test Name: SARS test; Test Result: Negative ; Test Date: 2021; Test Name: SARS test; Test Result: Negative
CDC Split Type: USPFIZER INC2021640296

Write-up: passed away; The initial case was missing the following minimum criteria: adverse event. Upon receipt of follow-up information on 01Jul2021, this case now contains all required information to be considered valid. This is a spontaneous report from a contactable consumer (patient) and patient''s wife. A 69-years-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: EN6201), via an unspecified route on 10Feb2021 (at the age of 69-years) as dose 1, single and second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: EN6203), via an unspecified route on 03Mar2021 (at the age of 69-years) as dose 2, single for covid-19 immunisation. The patient medical history included Hodgkin''s disease from 1978 (they took his spleen out, so he was a little immunocompromised and they took out his spleen and appendix after diagnosis) and unknown if ongoing. The patient concomitant medications were not reported. On unspecified date, the patient experienced had 3 antibody tests- one that was a 15minutes finger prick and two others that were all 2-3 weeks apart. Patient stated all 3 tests were negative for antibodies and his doctors don''t know why. His doctors said maybe it did not detect antibodies to the vaccine. In 1978, he had Hodgkin''s disease and they took his spleen out, so he was a little immunocompromised. However, the infectious disease doctor said since he got both doses he should still be protected. Reporter was concerned that he didn''t had great immune system when three negative tests came back, he just want to make sure that everybody thinks he was not okay because he was going out over usual instructions because of them. His primary care physician (PCP) said he talked to another doctor and said if he had the vaccine it should be covered but the test came back negative. Reporter stated that the "last test he had was on 24May2021, it was COVID-19 antibody test, SARS test, COB test 2, AbIG Quantitative. This one was done on maybe 10th (unspecified date in 2021) it was rapid test for SARS, COB-2, IGg antibody. That was done on 07Apr201 and stated if Pfizer want, he can give that also, SARS, COVID, COB-2, IGgAb, AbIGm, they all came back negative". Patient''s wife stated her husband passed away and at the time of the vaccination she and her daughter got adverse reactions she would like to fill the form for both her and her daughter. The patient died on unspecified date in 2021 with unknown cause of death and autopsy results was unknown. The outcome of the event was fatal. Follow up needed, further information has been requested.; Reported Cause(s) of Death: passed away


VAERS ID: 1457004 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-11
Onset:2021-03-31
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Dyspepsia, Feeling abnormal, Feeling hot
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: Prostate cancer treatment for 2-3 years, other meds unknown
Current Illness:
Preexisting Conditions: prostate cancer in remission, diabetes since 1990, heart attack with stent placement in 1995. On oxygen nightly since 2008.
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received dose 2 of Moderna vaccine on 3/11/21. Symptoms worse after 2nd dose, and on March 31, 2021 get worse. On April 4 at church, became very hot and weaker and weaker. Came home and put him to bed and slept some. At lunch time, ate a bite of jello and sipped 7 up and said he did not feel very good. Took an Alka Seltzer for heart burn, but it did not help. Went to sleep. Wife unable to waken him later that day. Died 4/4/21.


VAERS ID: 1457198 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-03
Onset:2021-06-14
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Syncope and Collapse, Orthostatic Hypotension, Hypothyroidism, DM II, A-Fib, IBS, CAD, CKD, Adrenocortical Insufficiency, Vitamin D Deficiency
Allergies: NKA/NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Found resident expired in bed, hands gripped on his gown over his sternum at 6:15am on 6/14/21. He had no complaints of discomfort before going to bed or overnight.


VAERS ID: 1457205 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tramadol, Metoclopramide hydrochloride, Clonidine, Famotidine, Lisinopril, Clonazepam, Amlodipine besylate, Solifenacin, Hydrocodone bitartrate and acetaminophen,
Current Illness:
Preexisting Conditions: Hypertension, hyperlipidemia, & diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reportedly "didn''t feel well" after vaccine but didnt want to seek medical treatment.


VAERS ID: 1457207 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-01-14
Onset:2021-06-21
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Public       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: 2021-07-03
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: dementia, coronary artery disease, GERD, hypertension, hyperlipidemia, osteoarthritis
Allergies: Adhesive bandage, amoxicillin, cortisone
Diagnostic Lab Data: Positive COVID-19 PCR test on 6/21/21 and 6/28/21.
CDC Split Type:

Write-up: Patient was fully vaccinated. Doses on 1/14/21 and 2/4/21. Diagnosed with COVID-19 on 6/21/2021 and passed away on 7/3/2021.


VAERS ID: 1457210 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-12
Onset:2021-03-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   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: Caller stated that she can get a list of medication.
Current Illness:
Preexisting Conditions: Hydrotropic Cardio myothia
Allergies: Peaches
Diagnostic Lab Data:
CDC Split Type:

Write-up: Caller stated that she was contacted by Sherriff department that father called 911. When ambulance arrived they did CPR. When they took him to the hospital they perform CPR again. Father was pronounced dead at 1am.


VAERS ID: 1457215 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-06-28
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, albuterol, Prilosec, multi vitamin, Tylenol, Calcium 500, vitamin D3, cyanocobalamin
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 06/28/2021


VAERS ID: 1457253 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-02-18
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M210A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Protonix, Lopressor, Xarelto, Zofran, Demadex, Desyrel, Lantus, Januvia, Nitrostat, magnesium chloride, Cranberry, Tylenol, Milk of Magnesia, Maalox, potassium chloride, miralax, voltaren, multi vitamin
Current Illness:
Preexisting Conditions:
Allergies: HCTZ, Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 02/18/2021.


VAERS ID: 1457452 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-10
Onset:2021-04-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Completed suicide, Suicidal ideation
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tizanidine, hydrocodone/acetaminophen, lisinopril, midodrine, esomeprazole, trazodone, valacyclovir, tramadol, metoprolol, mirtazapine, venlafaxine, gabapentin, baclofen, atorvastatin, mirtazapine, tolterodine, ondansetron, ciprofloxacin,
Current Illness:
Preexisting Conditions: Multiple sclerosis, cardiomyopathy, depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Completed suicide on 04/29/2021. Family reported an increase in suicidal ideations after the vaccination.


VAERS ID: 1457522 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-06-10
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)


VAERS ID: 1457593 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-06-08
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Death, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   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: acetaminophen, acidophillus, xanax, amlodipine, flonase, ferrous sulfate, lisinopril, lasix, ocuvite, morphine sulfate, zoloft, seroquel, rivastigmine
Current Illness: covid illness
Preexisting Conditions: Dementia, PTSD, encephalopathy, hypothryoidism, TIA, breast CA, htn, arthropathy
Allergies: benedryl, sulfa, trimethoprim
Diagnostic Lab Data: covid testing
CDC Split Type:

Write-up: While receiving Hospice care, tested positive for COVID illness, prior fully vaccinated status noted. Remained at baseline w/overall status during covid illness, asymptomatic for covid illness. Following completion of covid illness recovery, continued to decline as observed during extended hospice care. End of life progressed with overall decline and she expired 6/8/21 at facility.


VAERS ID: 1457614 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-15
Onset:2021-06-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal behaviour, Death, Exophthalmos, Motor dysfunction
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Hyperthyroidism (narrow), Ocular infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: states flu vaccine gave him the flu (unknown date of specific vaccine)
Other Medications: Patient wife not good historian. According to other pharmacy where patient filled, he has been on isosorbide, citalopram, quetiapine, risperidone, rosuvastatin, and tamsulosin in past. Patient was nonadherent according to that pharmacist. P
Current Illness: N/A
Preexisting Conditions: Vascular dementia with behaviors, coronary artery disease, hyperlipidemia, history of left hip pain, history of bladder stones, heurogenic bladder, history of coronary artery bypass graft x5
Allergies: Aricept, oxybutinin, terbinafine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s wife states that he was not the same the evening after receiving the vaccine. She stated that he was unable to hold objects and his eyes were bulging from his head. He was going to a nursing facility after vaccination and later died on 7/4/21.


VAERS ID: 1457622 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-04-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest X-ray, Condition aggravated, Death, Dysphagia, Feeding disorder, Hypopnoea, Mental status changes, Multiple sclerosis, Pallor, Pulmonary congestion, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), 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), Optic nerve disorders (broad), Cardiomyopathy (broad), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: baclofen, asa, acetaminophen, levothyroxine, lactulose, gabapentin, vit d3, lipitor, ativan, metformin, miralax, morphine, simethicone, primidone, senna, dicyclomine
Current Illness: no acute
Preexisting Conditions: multiple sclerosis, paraplegia, hypthyroidism, diabetes II, anemia, depression
Allergies: cipro
Diagnostic Lab Data: covid testing and chest xray
CDC Split Type:

Write-up: Vaccine received 4/28/30. During 4/30/21 resident overall status changed to altered mental status, which included unresponsive and inability to take in food or drink. Breathing became shallow. Skin pale. Lungs congested w/Chest xray ordered. Moved to Covid PUI unit. Hospice notified w/comfort care initiated and preparations made for end of life w/family notification. COVID testing negative. Bedside observations continued w/NP noting possibility of adverse effect to vaccine r/t multiple sclerosis dx. Hx of others w/multiple sclerosis observed by NP included returning to baseline within 24-48 hours. IV gently hydration initiated during time of little to no response. Within 12 hours, resident was observed to exhibit returning to her baseline status which included responsiveness, ability to drink, swallow, eat, interact w/communication. She returned to baseline, was seen by MD and cleared to return to her previous living area. After several weeks of baseline, she did decline gradually overall with end of life under hospice care with exacerbation of multiple sclerosis symptoms and expired at facility.


VAERS ID: 1457640 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-05-07
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, General physical health deterioration, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   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: zofran, nitroglycerin, tramadol, acetaminophen, aspirin, pantoprazole, metformin, morphine, potassium chloride, senna, tamsulosin
Current Illness: nausea/emesis
Preexisting Conditions: chf, anemia, copd, afib, pulmonary htn, chronic kidney disease, hx Pulmonary embolism, edema, diabetes II, chronic normocytic anemia, Hx pneumonia
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Was currently w/hospice care. 5/25/2021 exhibited symptoms nausea/emesis. Seen by MD. Treated for symptoms. continued to decline consistent w/ dx. End of life care with nitro prn, oxygen continued and emotional support followed and he expired 5/27/2021 at facility.


VAERS ID: 1457646 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-08
Onset:2021-03-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Arteriosclerosis, Arteriosclerosis coronary artery, Autopsy, Cardiac tamponade, Coronary artery disease, Coronary artery occlusion, Myocardial infarction, Myocardial rupture, Pericardial haemorrhage, Toxicologic test normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Accidents and injuries (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not on file
Current Illness: none
Preexisting Conditions: Pt was a smoker
Allergies: not on file
Diagnostic Lab Data:
CDC Split Type:

Write-up: Confirmed that pt passed away 3/13/21, 5 days after 1st covid vaccine. Per relative who rec''d the autopsy report, pt had no obvious health problems prior to death, was a smoker, but otherwise very fit and active, healthy eater. On day of death, pt had gone hiking for a few hours on a camping trip, they were sitting around eating dinner and pt said he had to go to the bathroom and never came out. Pt''s family feel sure something was triggered by vaccine. Relative I spoke to retrieved the autopsy results during the call and read them on the phone as they were reported on paper. Final dx on autopsy was: I. atherosclerosis, generalized, severe. A. Atherosclerotic coronary artery disease i. atherosclerosis, coronary arteries w/ 75% occlusion of LAD, 90% occlusion of L obtuse marginal and 80% occlusion circumflex coronary artery. a. Ruptured acute myocardial infarction, transmural, posterior left ventricle i. cardiac tamponade ii. hemopericardium 350cc COD listed as: ruptured, acute MI d/t atherosclerotic coronary artery disease, tox report was clear.


VAERS ID: 1458126 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-13
Onset:2021-06-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pulmonary haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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: No medications taken at the time and no medication profile given by patient.
Current Illness: Patient recorded no illnesses or chronic conditions at the time of receiving his vaccination.
Preexisting Conditions: No chronic history or medical condition was documented on his paperwork.
Allergies: No allergies to medication, food or other products.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Father of patient came to store pharmacy to inform us of his son''s passing. He stated patient died 5 days after receiving his Moderna vaccine on 6/13/2021 due to blood in the lungs. He stated the autopsy has not been done yet to confirm his death, however he was curious of the possibility. I contacted Moderna on July 8th at 4:30pm and spoke to a pharmaceutical representative of Moderna regarding possible side effects of the vaccine.


VAERS ID: 1458145 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-30
Onset:2021-07-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac valve rupture, Chest pain, Cough, Death, Headache, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-05
   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: Omeprazole dr 20 mg capsule Lisinopril 10 mg tablet
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Aortic valve rupture 7/8/21
CDC Split Type:

Write-up: Fever, coughing, body ache, head ache, congestion, chest pain, death


VAERS ID: 1458628 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-17
Onset:2021-04-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure, Cerebrovascular accident, Death, Dyspnoea, Intensive care, Laboratory test, Pulmonary thrombosis, SARS-CoV-2 test negative, Thrombosis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), 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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Yes a lot of test and lab were done, but like I said previously they have not given me his medical records so I don''t know all the exact dates to everything yet.
CDC Split Type:

Write-up: My previously healthy brother received the Pfizer vaccine (1st dose) and 4 days after he was hospitalized with shortness of breath, heart failure, blood clots in his arm, lungs and leg along with a stroke and many medical conditions kept arising as he was hospitalized. He was in the CICU for a week and a half. Unfortunately, my brother passed away from the Pfizer vaccine. Until his last day the doctors still "didn''t know" what was wrong with him. A lot happened during his hospital stay, but this is just a brief statement. They have been keeping his medical records from me. They tested him repeatedly there from covid and he wa salways negative. They had no other explanation to what was happening and all along they wanted it to be COVID-19 and were so quick to say it was not the vaccine.


VAERS ID: 1458791 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-03
Onset:2021-03-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Confusional state, Hospice care, Malaise, SARS-CoV-2 test, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 23
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: Blood pressure abnormal
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210313; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: didn''t know anyone around her; very weak; not feeling well; failure to survive complications from COVID-19; Hospice care; This spontaneous case was reported by an other caregiver (subsequently medically confirmed) and describes the occurrence of VACCINATION COMPLICATION (failure to survive complications from COVID-19), MALAISE (not feeling well), CONFUSIONAL STATE (didn''t know anyone around her) and ASTHENIA (very weak) in an 88-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Blood pressure abnormal. On 03-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Mar-2021, the patient experienced MALAISE (not feeling well) (seriousness criteria death and hospitalization). On 06-Mar-2021, the patient experienced CONFUSIONAL STATE (didn''t know anyone around her) (seriousness criteria death and hospitalization) and ASTHENIA (very weak) (seriousness criteria death and hospitalization). On 26-Mar-2021, the patient experienced HOSPICE CARE (Hospice care). On 29-Mar-2021, the patient experienced VACCINATION COMPLICATION (failure to survive complications from COVID-19) (seriousness criterion death). The patient died on 29-Mar-2021. The reported cause of death was failure to survive complications from covid-19 vaccine. It is unknown if an autopsy was performed. At the time of death, HOSPICE CARE (Hospice care) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Mar-2021, SARS-CoV-2 test: negative (Negative) Negative. Patient was concomitantly taking blood pressure medications. Patient received IV fluids as corrective treatment. Company Comment : Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Further information has been requested.; Sender''s Comments: Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: failure to survive complications from COVID-19 vaccine


VAERS ID: 1458799 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: they believe the cause of death was stroke; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (they believe the cause of death was stroke) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: Pneumonia vaccine. Past adverse reactions to the above products included Pneumonia with Pneumonia vaccine. Concurrent medical conditions included Egg allergy and Tuberculosis (Tuberculosis in their kidney.). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (they believe the cause of death was stroke) (seriousness criteria death and medically significant). The reported cause of death was Stroke. It is unknown if an autopsy was performed. This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (they believe the cause of death was stroke) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Previously administered products included for Product used for unknown indication: Pneumonia vaccine. Past adverse reactions to the above products included Pneumonia with Pneumonia vaccine. Concurrent medical conditions included Egg allergy and Tuberculosis (Tuberculosis in their kidney.). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (they believe the cause of death was stroke) (seriousness criteria death and medically significant). The reported cause of death was Stroke. It is unknown if an autopsy was performed. The patient was on blood pressure medications. The reporter reports that two days after a family member died two days after they received their first dose of the Moderna COVID-19 vaccine and they believe the cause of death was a stroke. No laboratory data was provided. No Treatment information was provided. Action taken with mRNA-1273 in response to the event was not applicable. Very limited information regarding this event has been provided at this time. No follow up is possible.; Sender''s Comments: Very limited information regarding this event has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: Stroke


VAERS ID: 1459256 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-09
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 INC2021827105

Write-up: already has 1 acquaintance who passed the msm and died; This is a spontaneous report from a contactable physician. This physician reported for an unknown patient. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunization. The patient medical history and were not reported. The patient experienced already has 1 acquaintance who passed the msm and died on an unspecified date. Reporter stated, First of all, I want to say that I''m going to file an investigation against everything that''s going on. when I chose Pfizer it was because you said the vaccine was good for patients and cancer, chronic diseases. I lived working paying my bills and taking care of my children until the day I got this vaccine. and then all my exams started to change. I know you don''t want to be responsible for anything, because only money matters. already has 1 acquaintance who passed the msm and died. so what does pfizer do to support it? nothing? I''m like 1 vegetable and what are you going to do for me? Somehow I''m going to sue you because a lawyer also finds fault with you for that. very disappointed and living hell and even depression because of my health. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Based on available information and temporal relationship, a possible contributory role of BNT162B2 vaccine cannot be excluded for the reported event of Death. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response,will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Died


VAERS ID: 1459398 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-31
Onset:2021-05-05
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes mellitus
Allergies: Unknown
Diagnostic Lab Data: Positive COVID -19 test on 4/19/2021
CDC Split Type: 12178550

Write-up: Died of COVID-19 illness on 05/05/2021


VAERS ID: 1459403 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-04-11
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Dementia
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 3/3/2021
CDC Split Type: 538725

Write-up: Died of COVID-19 illness on 04/11/2021


VAERS ID: 1459409 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-05-26
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Chronic kidney disease
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 05/17/2021
CDC Split Type:

Write-up: Died of COVID-19 on 05/26/2021 Symptoms: Dyspnea (shortness of breath), Fatigue


VAERS ID: 1459429 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Died with a blood clot in her brain; This spontaneous case was reported by a consumer and describes the occurrence of CEREBRAL THROMBOSIS (Died with a blood clot in her brain) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBRAL THROMBOSIS (Died with a blood clot in her brain) (seriousness criteria death and medically significant). The reported cause of death was died with a blood clot in her brain. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. Company Comment: Very limited information on this fatal case. However, based on the current available information and assumed temporal association between the use of the unspecified Moderna Vaccine product and the start date of the event, a causal relationship cannot be excluded. Reporter did not allow further contact; Sender''s Comments: Very limited information on this fatal case. However, based on the current available information and assumed temporal association between the use of the unspecified Moderna Vaccine product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Died with a blood clot in her brain


VAERS ID: 1459439 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-06
Onset:2021-05-20
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Chest X-ray normal, Computerised tomogram thorax abnormal, Cough, Death, Decreased appetite, Differential white blood cell count normal, Full blood count normal, Haemoptysis, Mediastinal mass, Metabolic function test normal, Pulmonary mass, Respiratory failure, Weight decreased
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xanax 0.25mg prn, depakote 250mg daily, aricept 10mg daily, protonix 40mg daily, effexor 75mg daily
Current Illness: NONE
Preexisting Conditions: MILD ALZHEIMERS DEMENTIA, GERD, ANXIETY, OSTEOPOROSIS, MILD COPD/NON O2/NON STEROID DEPENDENT
Allergies: SULFA, SERTRALINE, CIPRO, PCN, DOXYCYCLINE, PREDNISONE, MACROBID
Diagnostic Lab Data: CT chest 6/15 IMPRESSION: IMPRESSION: Large neoplastic mass in the mediastinum measuring 6.6 x 7.6 x 13 cm approximately with mass effect on the right main pulmonary, brachiocephalic, common carotid and subclavian arteries which remain patent. Mass effect on the trachea and right mainstem bronchus. The mass extends into the right supraclavicular region. Spiculated small mass in the right upper lobe measuring 1.3 x 1.2 cm, previously 7 x 7 mm with extension into one of the peripheral bronchus. Tissue diagnosis is recommended. cbc with differential and cmp were normal
CDC Split Type:

Write-up: Pt received Moderna covid 19 vaccines on Feb 6th 2021 and March 6th 2021. She was diagnosed with new aggressive possible lymphoma or lung cancer for which she ultimately died from on 7/2/21 . Daughters reported symptoms started suddenly 5 1/2 weeks ago around 5/20/21. PCP notes confirm this. She saw her PCP on 5/25 for the cough and a cxr done that day was normal. She was prescribed tesselon perles and azithromycin. She presented back on 6/8 with persistent cough with new hemoptysis, decreased appetite and weight loss and ct scan done 6/15 showed a large heterogenous mass of the mediastinum 6.6 x 7.6 x 13cm encasing the r main pulmonary artery the r brachicephalic, r subclavian and common carotids. There was mass effect on the trachea and r main stem bronchus. The 6mm nodule seen in the posterior left upper lobe was stable and unchanged from previous ct chest from 9/20. This rapidly progressed in a very short time resulting in her admission to the hospital for respiratory failure on 6/28 and she was so unstable we were unable to transfer her for a biopsy and start of treatment as recommended by oncology. She passed away on 7/2/21. The family decided they wanted to pursue a limited autopsy to have the mass biopsied to determine what the cancer was which was so rapidly progressive. They describe her as prior to the start of the cough and hemoptysis on 5/20 that she was living alone, used no assistive devices and other than her dementia was generally healthy and was very interactive and involved with her family


VAERS ID: 1459444 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-02
Onset:2021-06-02
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E11284 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 5/21/2021
CDC Split Type: 12100587

Write-up: Died of COVID-19 illness on 06/02/2021 Symptoms: low oxygen levels


VAERS ID: 1459461 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-17
Onset:2021-06-13
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac arrest, Condition aggravated, Coronary artery disease, Death, Dementia, Hypoxic-ischaemic encephalopathy, Pneumonia aspiration, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (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: 2021-06-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic heart disease High blood pressure parkinsonian dementia
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 6/1/2021
CDC Split Type:

Write-up: From EMR: Immediate cause of death: acute hypoxemic respiratory failure (2 days from onset to death) Secondary conditions leading to death: pneumonia (2 days from onset to death) COVID-19 (2 weeks) Other conditions present at time of death: coronary artery disease, Parkinson dementia, pulmonary embolism Was smoking a factor: no COD listed as COD listed as CARDIAC ARREST, COVID-19 PNEUMONIA, HYPOXIC ISCHEMIC ENCEPHALOPATHY, ASPIRATION PNEUMONIA Died of COVID-19 illness on 06/13/2021


VAERS ID: 1459478 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-16
Onset:2021-06-14
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Death, Respiratory failure, 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 (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic heart disease High blood pressure History of Lymphoma
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 06/08/2021
CDC Split Type: 4312658

Write-up: Died of COVID-19 illness on 06/14/2021 Immediate Cause of Death: Acute respiratory distress syndrome with respiratory failure Due To or as a Consequence Of: COVID-19 infection Interval between Onset & Death: 4 days COD listed as ACUTE RESPIRATORY DISTRESS SYNDROME WITH RESPIRATORY FAILURE INTERVAL BETWEEN ONSET & DEATH and COVID-19 INFECTION INTERVAL BETWEEN ONSET & DEATH


VAERS ID: 1459756 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-10
Onset:2021-04-21
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Histology, Pericarditis, Vasculitis
SMQs:, Systemic lupus erythematosus (broad), Vasculitis (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   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: Unknown
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Unknown
Diagnostic Lab Data: Autopsy and histology as above
CDC Split Type:

Write-up: Pericarditis, large vessel vasculitis, death


VAERS ID: 1459791 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Nodule, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: breathing problems, bone pains, COPD
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few days after taken the vaccine are became swollen with a big knot under it and turning red


VAERS ID: 1459796 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-27
Onset:2021-06-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Death, Heart rate irregular, Memory impairment, Sleep apnoea syndrome
SMQs:, Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiac arrhythmia terms, nonspecific (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Neurontin800 mg, Fabosin, losartin,
Current Illness:
Preexisting Conditions: COPD
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: three days before the patent died he started having sloop apnea and for several days before the event he started having memory problems and the day before the event he started having a issue with his heart where he just said his heart felt irregular.


VAERS ID: 1459912 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-23
Onset:2021-06-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Death, No adverse event
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: med Plus supplement, asa 81mg 1 x day, amlodipine 10mg 1 x day, cholecalciferol 1000units/day,
Current Illness: n/a
Preexisting Conditions: hyperlipidemia, recurrent hyponatremia r/t decreased oral intake, adult failure to thrive, muscle wasting, dysphagia, delusions, seizures, dementia
Allergies: NKDA
Diagnostic Lab Data: This resident has had a decline in health status in months prior to the Janssen vaccine. The residents fever resolved but he did end up passing away on 6/28/2021. no adverse effects from the Janssen vaccine noted during assessments. Patient passing not related to the Janssen vaccination.
CDC Split Type:

Write-up: temp on 101.7 6/25/2021


VAERS ID: 1459938 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-05-24
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Blood test, Death, Hypophagia, Urine analysis, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, vit D3, vit B12, glimepiride, folic acid, ferrous sulfate, eliquis, Norco, Hyoscyamine sulfate, lasix, potassium chloride, oxybutynin, morphine, meropenem, vancomycin, mirapex, ativan, simvastatin
Current Illness: UTI
Preexisting Conditions: cellulitis RLE w/MRSA, Dysphagia, altered mental status, heart failure, lymphedema, chronic diarrhea, bladder CA, DVT RLE, leukemia, diabetes, hypertensive chronic kidney disease, parkinson''s, arthropathy, sleep apnea, restless legs symptoms
Allergies: lidocain/lidoderm
Diagnostic Lab Data: labs: urine, blood tests for WBCs
CDC Split Type:

Write-up: Participated in skilled therapy, continued visits w/oncologist, vaccine requested and administered, continued skilled therapy w/decrease in strength as what brought resident to SNF w/RLE cellulits w/MRSA, Vaccine series completed, continued skilled therapy, WBCs chronically elevated per oncologist as expected may occur w/cancer tx med for active leukemia. Continued decline overall w/decline in intake of food and fluids, hospice care initiated. Over the course of months, resident declined to bedrest w/expiration 5/24/21.


VAERS ID: 1459979 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-07
Onset:2021-07-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-08
   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: Flomax Capsule 0.4 MG (Tamsulosin HCl) Vitamin D3 Tablet (Cholecalciferol) Aspirin Tablet Delayed Release 81 MG LaMICtal Tablet 100 MG (lamoTRIgine) Losartan Potassium Tablet 50 MG Ativan Tablet 0.5 MG (LORazepam) PROzac Capsule 40 MG
Current Illness: No acute illnesses at time of vaccination
Preexisting Conditions: PARKINSON''S DISEASE POSTHERPETIC GENICULATE GANGLIONITIS BIPOLAR DISORDER, UNSPECIFIED TRANSIENT CEREBRAL ISCHEMIC ATTACK, UNSPECIFIED ANXIETY DISORDER, UNSPECIFIED MAJOR DEPRESSIVE DISORDER, RECURRENT, SEVERE WITH PSYCHOTIC SYMPTOMS UNSPECIFIED MOOD [AFFECTIVE] DISORDER ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS INSOMNIA, UNSPECIFIED OTHER ABNORMALITIES OF GAIT AND MOBILITY UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE SENSORINEURAL HEARING LOSS, BILATERAL COGNITIVE COMMUNICATION DEFICIT DYSPHAGIA, OROPHARYNGEAL PHASE AGE-RELATED PHYSICAL DEBILITY RETENTION OF URINE, UNSPECIFIED DIZZINESS AND GIDDINESS BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS SOLITARY PULMONARY NODULE
Allergies: Sinemet
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident was given Moderna COVID vaccine dose #1 on 7/7/2021 around 10:40 am and was found deceased on 7/8/2021 at 4:10 pm. Member had no acute illnesses/adverse reactions identified prior to death.


VAERS ID: 1460019 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-04-23
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac failure chronic, Condition aggravated, Death, General physical health deterioration, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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: acetaminophen, acidophilus, atorvastatin, ativan, adedronate, albuterol sulfate, Bactrim, doxycline, dilauded, colace, cardizem, benedryl
Current Illness: UTI, CHF
Preexisting Conditions: CHF, chronic pulmonary edema, MRSA, dysphagia, bradycardia, dementia, osteoporosis, rheumatoid arthritis, afib, osteoarthritis, hyperlipidemia
Allergies: allergenic extract-food-shrimp, morphine, Shellfish, Shrimp
Diagnostic Lab Data: during hospice care, labs discontinued.
CDC Split Type:

Write-up: Decline noted w/increased hospitalizations over months, including during time of vaccination. CHF and pulmonary edema. Hospice care initiated, end of life care, expired at facility.


VAERS ID: 1460035 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-16
Onset:2021-06-24
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C039B21A / 2 RA / IM

Administered by: Public       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: 2021-06-24
   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: Simvastatin 5mg qd HCTZ 12.5mg qd Allopurinol 100mg qd
Current Illness:
Preexisting Conditions: HTN, HLD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: According to family and certificate of death, patient suffered from an acute mid-brain cerebrovascular accident and died on 6/24/2021.


VAERS ID: 1460241 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-30
Onset:2021-07-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriosclerosis, Autopsy, Resuscitation, 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: 2021-07-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data: Autopsy found high levels of atherosclerotic plaque
CDC Split Type:

Write-up: Sudden death 17 hours after vaccine shot. Ambulance to Hospital. Unable to resuscitate.


VAERS ID: 1460255 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-30
Onset:2021-07-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood alkaline phosphatase increased, Condition aggravated, Death, Dyspnoea, Glycosylated haemoglobin, Haemoglobin normal, Loss of consciousness, Metabolic function test normal, Nausea, Oedema peripheral, Platelet count normal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline ProAir inhaler Oxycodone/acetaminophen Omeprazole Hydroxyzine Gabapentin
Current Illness: Lower extremity edema, increasing shortness of breath prior to vaccination
Preexisting Conditions: COPD fibromyalgia deconditioning tobacco use
Allergies: Azithromycin Bee allergy (anaphylaxis) Zolpidem
Diagnostic Lab Data: Labs obtained 7/6/21 with elevated WBC 16,000. Hgb 16.0. Platelets normal. Complete metabolic panel normal aside from elevated alkaline phosphatase of 205. Hemoglobin A1c 6.5.
CDC Split Type:

Write-up: Patient received COVID vaccine on 6/30/21. She had been experiencing chronic dyspnea, lower extremity edema. On 7/7 had some nausea, vomiting at home. Found unconscious by her spouse a few hours later and subsequently died.


VAERS ID: 1460257 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-07-03
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Confusional state, Culture urine negative, Death, Fall, Full blood count, Metabolic function test, Oxygen saturation decreased, Respiratory failure, Urine analysis, Vitamin D
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), 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 (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 0
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: acetaminophen, atenolol, calcium, cozaar, crestor, lasix, potassium, multivitamin, pepcid, vibramycin
Current Illness: pneumonia, covid illness, hyponatremia, respiratory failure
Preexisting Conditions: gerd, occiptal neuralgia, osteoporosis, htn, diabetes II
Allergies: ciprofloxacin, codeine sulfate, Penicillins, sulfonamide antibiotics
Diagnostic Lab Data: urine w/C&S, CBC, CMP, VITAMIN D, TSH
CDC Split Type:

Write-up: Admitted 6/10/21 w/current covid illness. Partial vaccination noted. 6/17/21 urine culture w/no growth. Progressed to release from Covid unit to general population in recovery status on 6/22/21. Seen/Assessed by NP/MD /IDNP during stay. 6/26/21 urine culture w/no growth. 6/27/21 seen by MD d/t increased falls and confusion. Fall on 6/29/21 w/increased confusion and immediate transport to ER for increased confusion, decreased oxygen saturation and fall w/possible head injury r/t unwitnessed fall and increased confusion. She expired at the hospital 7/3/21 w/respiratory failure.


VAERS ID: 1460326 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-29
Onset:2021-06-30
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-30
   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:
Current Illness:
Preexisting Conditions: Other significant conditions: Chronic A-Fib, HTN, Chronic systolic heart failure, COPD
Allergies:
Diagnostic Lab Data: Covid testing 06/30/2021 08:30 Nasal swab- reported SARS-CoV-2 RNA detected
CDC Split Type:

Write-up: Medical Examiner at time of autopsy ordered Covid testing 06/30/2021 08:30 Nasal swab- reported SARS-CoV-2 RNA detected and confirmed at lab. Cause of death: Complication of Covid-19 Other significant conditions: Chronic A-Fib, HTN, Chronic systolic heart failure, COPD


VAERS ID: 1461692 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-17
Onset:2021-06-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO183 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Cardiac arrest, Death, Fatigue, Resuscitation, Secretion discharge, Somnolence, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: COPD
Preexisting Conditions: COPD, severe Arthritis, Hypertension, Chronic kidney disease stage 111
Allergies: none known
Diagnostic Lab Data: 911 came at 2 AM on 06-19-2021. Asked if this could be vaccine related and was told it could be. Even with the stomach pain and mucus, all vital signs were normal. Since she just had her shot & was not yet fully protected, we all thought it best to wait til 8 AM & call Dispatch & not risk going to emergency risking Covid.
CDC Split Type:

Write-up: Fine in Am. Started complaining of stomach pain in afternoon. Had dinner around 6 pm & threw up part of it along with clear mucus and all the water she drank. After that it was all clear mucus off & on through the night. Has had this episode before but only lasting a few minutes never this long! Tried to give water but kept coming back up. Meanwhile pain in stomach (pelvic area) was getting worse. Called 911 at 2 AM (see line 19). Sometime after 911 left, the clear mucus started coming at a faster rate. Had bowel movement around 6 AM but said no relief in stomach pain. Called at 8Am. Could not come til between 12-1 PM. Seemed weak and very tired so let sleep. Around 10-10:30 AM could not wake her up. Called 911 again. This time it was cardiac arrest and they could not revive her.


VAERS ID: 1461721 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-16
Onset:2021-04-22
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Haemorrhage intracranial, Magnetic resonance imaging head abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   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: None
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: I believe MRI confirmed
CDC Split Type:

Write-up: Onset occured 5-7 days post 2nd dose of vaccine. Developed intracranial hemorrhage / hemorrhagic brain bleed causing death.


VAERS ID: 1461745 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-16
Onset:2021-05-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ? / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: I can send you all20 of her medical list in an email if needed! My mom had Almost every heath issue there could be!
Current Illness: MS, diabetes, high blood pressure, neuropathy, tremors
Preexisting Conditions: MS,high blood pressure, neuropathy, tremors slipped discs, diabetes
Allergies: None
Diagnostic Lab Data: I can have a letter from her dr
CDC Split Type:

Write-up: Developed pneumonia 5 days was hospitalized 2 days later and tested positive for covid pneumonia


VAERS ID: 1461758 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-19
Onset:2021-02-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Anal incontinence, Death, Diarrhoea, Gastrointestinal injury, Intensive care, Refusal of treatment by patient, Sepsis, Vaccination complication
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 31
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: Kidney Failure, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe diarrhea and destruction of part of her intestine and subsequent sepsis. ER doctors "could not rule out the vaccine as a contributing factor." It was suggested she have a portion of her intestines removed. She refused and went on a high dose of antibiotics. She was hospitalized in the ICU and eventually released to a nursing home when stabilized. She never regained control of her bowels or had a solid bowel movement. Her antibiotics were reduced and she again suffered severe abdominal pain and a distended abdomen and return of sepsis. She went back to ER and was told this would keep happening if she did not have the damaged portion of her intestine removed. She elected to go home on hospice, where she died. Her kidney doctor also relayed to her family that this reaction was a direct result of the vaccine. When the family questioned reporting this event, every healthcare provider backed off from admitting it was a result of the vaccine or stated they were not the primary physician and thus was not for them to report.


VAERS ID: 1461829 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dead


VAERS ID: 1461866 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-01
Onset:2021-06-27
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Fatigue
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She wasn''t sick. She just said that she was tired and needed to go home to get some rest and she died that afternoon.


VAERS ID: 1461898 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Had 2nd vaccine a few days earlier and died of cardiac arrest. Was healthy and active prior to vaccine with no known health problems.


VAERS ID: 1462011 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-24
Onset:2021-03-25
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Laboratory test
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, neurontin, ibuprofen, bayer aspirin
Current Illness: None
Preexisting Conditions: osteoarthritis
Allergies: None
Diagnostic Lab Data: Pre-op physical and labs
CDC Split Type:

Write-up: Death; my question is, why wouldn''t the CDC want to investigate/autopsy any individual who has an adverse event??? The body was sent to mortuary without autopsy, as the family wouldn''t want one done at their expense. However, it would seem feasible that the CDC would see this as an opportunity to add to the available statistics on vaccine recipients. Its unknown whether the vaccine contributed to the adverse outcome, but given that this person had the vaccine recently, it should have been investigated. It seems there should be a protocol for Drs and medical examiners to note ALL conditions in the patient not just cause of death, if vaccinated within a few months to a year. It just seems like good research opportunities to me, and I have to wonder why it isn''t being done.


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