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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 55 out of 150

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VAERS ID: 1462036 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-14
Onset:2021-04-17
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Chest pain, Death, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ProAir inhaler pen Prednisone 10mg Rosuvastatin 10mg Citalopram 30mg Metoprolol 25mg Cyanocobalamin
Current Illness: Arthritis Asthma
Preexisting Conditions: Asthma HTN POLYMYALGIA Rhumatica
Allergies: PCN IVP DYE CODEINE Depression Cholesterol B12 deficient
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother had chest and abdominal pain and the passed out and died


VAERS ID: 1462975 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-06-05
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adenocarcinoma of colon, Chest pain, Colonoscopy, Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Plastic surgery; Stoma closure (surgery); Surgery
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: colonoscopy; Result Unstructured Data: Abnormal had a colonoscopy performed through his colostomy which revealed the patient to have a right colonic mass, mass was an adenocarcinoma.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Death; Adenocarcinoma of colon; Chest pain; Myocardial infarction; This case was received via Regulatory Authority on 29-Jun-2021 and was forwarded to Moderna on 29-Jun-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DEATH (Death), ADENOCARCINOMA OF COLON (Adenocarcinoma of colon), CHEST PAIN (Chest pain) and MYOCARDIAL INFARCTION (Myocardial infarction) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 047A21A and 045B21A) for COVID-19 vaccination. The patient''s past medical history included COVID-19, Plastic surgery in December 2020, Surgery in January 2021 and Stoma closure (surgery). On 15-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Jun-2021, the patient experienced DEATH (Death) (seriousness criteria death and hospitalization), ADENOCARCINOMA OF COLON (Adenocarcinoma of colon) (seriousness criteria death and hospitalization), CHEST PAIN (Chest pain) (seriousness criteria death and hospitalization) and MYOCARDIAL INFARCTION (Myocardial infarction) (seriousness criteria death and hospitalization). The patient was treated with Surgery (Colectomy) for Death and Surgery (Colectomy) for Adenocarcinoma of colon. The patient died on 05-Jun-2021. The reported cause of death was Myocardial infarction. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 05-Jun-2021, Colonoscopy: abnormal (abnormal) Abnormal had a colonoscopy performed through his colostomy which revealed the patient to have a right colonic mass, mass was an adenocarcinoma.. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication were not reported Treatment medication were not reported. Action taken with mRNA-1273 in response to the drug was not applicable. Additional information included the patient had decubitus ulcer which failed to heal multiple times and also had plastic and flap surgeries and finally healed . Patient had underwent Stoma closure surgery .Colostomy started functioning, patient was recovering, suddenly started having chest pain and had a massive myocardial infarction. Endoscopy large bowel was performed. Complicated 1 year, started with COVID 19 - patient was admitted prolonged amount of time due to complications of COVID 19 , developed a large decubitus ulcer which was not healing. Was being followed by Dr wound care center. Multiple debridements.Failure to heal. Referred to me for a diverting colostomy to facilitate healing of the large decubitus ulcer. Diverting colostomy was performed September 2nd 2020. Patient had plastic surgery, flap surgeries, in December 2020 and January 2021. finally healed. Brought for a ostomy reversal, found large mass in the cecum attempted endoscopic removal, with micro perforation, taken to the operating room immediately from endoscopy suite had a right colectomy. Colostomy started functioning, patient was recovering, suddenly started having chest pain and had a massive myocardial infarction. Company Comment : This case concerns a 77-year-old male patient who experienced adenocarcinoma of colon, myocardial infarction and chest pain and died 51 day following the first dose of mRNA-1273. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: This case concerns a 77-year-old male patient who experienced adenocarcinoma of colon, myocardial infarction and chest pain and died 51 day following the first dose of mRNA-1273. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: myocardial infarction


VAERS ID: 1463008 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-05-21
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Blood pressure measurement, Brain death, Fall, Incorrect dose administered, Intracranial aneurysm, Needle issue, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 4
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Blind; Cancer; Congestive heart failure; Diabetes; Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Glucose; Result Unstructured Data: glucose 112; Test Name: Blood pressure; Result Unstructured Data: BP 120/75
CDC Split Type: USJNJFOC20210708201

Write-up: BRAIN ANEURYSM; BRAIN DEAD; BLOOD CLOT; FALL; NEEDLE BROKE OFF THE SYRINGE; NEEDLE BROKE OFF THE SYRINGE UNSURE OF THE FULL VOLUME THAT WAS INJECTED; This spontaneous report received from a consumer concerned a 57 year old White Hispanic/Latino male.. The patient''s height, and weight were not reported. The patient''s concurrent conditions included blind, diabetes, cancer, congestive heart failure, and penicillin allergy. Nurse came to patients house to administer the vaccine due to patient disability, patient usually does have a home aid. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. Upon administering the vaccine, the needle broke off the syringe, unsure of the full volume that was injected. On 21-MAY-2021 patient experienced dizziness, vomiting, and fall. Blood pressure and sugar was fine after the wife had checked it (BP 120/75, glucose 112). They called the ambulance because the symptoms were unrelenting and a headache began on 21-MAY-2021. Patient required and emergency surgery to relieve pressure on the brain, drilling of the skull where ultimately patient was pronounced brain dead. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of brain aneurysm due to blood clot and brain dead on 25-MAY-2021, and the outcome of fall, blood clot, needle broke off the syringe, needle broke off the syringe unsure of the full volume that was injected was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, Other Medically Important Condition, and Disability Or Permanent Damage).; Sender''s Comments: V0: 20210708201-COVID-19 VACCINE AD26.COV2.S-Brain Aneurysm, Brain Dead, Blood Clot, Fall. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BRAIN ANEURYSM DUE TO BLOOD CLOT


VAERS ID: 1463018 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210713544

Write-up: PERISHED APPROX 9 WEEKS POST INJECTION OF YOUR PRODUCT; This spontaneous report received from a company representative via social media and concerned a male patient of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number not reported, expiry not reported frequency one total, dose, therapy start date were not reported administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient perished approximately 9 weeks (2021) post injection and cause of death was unknown. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210713544-covid-19 vaccine ad26.cov2.s -Perished approx. 9 weeks post injection of your product. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1463050 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Death, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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: BABY ASPIRIN; COQ10 [UBIDECARENONE]; LISINOPRIL; METOPROLOL TARTRATE; OMEPRAZOLE
Current Illness:
Preexisting Conditions: Comments: Medical history was not provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: passed away; dry, persistent cough; Body aches; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Medical history was not provided. Concomitant products included ACETYLSALICYLIC ACID (BABY ASPIRIN), UBIDECARENONE (COQ10 [UBIDECARENONE]), LISINOPRIL, METOPROLOL TARTRATE and OMEPRAZOLE for an unknown indication. On 03-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Feb-2021, the patient experienced COUGH (dry, persistent cough) and MYALGIA (Body aches). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. 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, COUGH (dry, persistent cough) and MYALGIA (Body aches) had not resolved. This a case of death in 81-year-old male patient who received mRNA-1273. Very limited information regarding death (cause unknown) has been provided at this time. Further information has been requested. Based on the current available information and temporal association between the use of the product and the start date of the events cough and myalgia, a causal relationship cannot be excluded. The event myalgia is consistent with the safety profile of the product. This case was linked to MOD-2021-060909 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 01-Jul-2021: Contains patient death information. Case upgraded to serious.; Sender''s Comments: This a case of death in 81-year-old male patient who received mRNA-1273. Very limited information regarding death (cause unknown) has been provided at this time. Further information has been requested. Based on the current available information and temporal association between the use of the product and the start date of the events cough and myalgia, a causal relationship cannot be excluded. The event myalgia is consistent with the safety profile of the product.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1463061 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Product administered to patient of inappropriate age
SMQs:, Medication errors (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 three days after vaccine; 13 year old boy dies three days after the Moderna vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died three days after vaccine) in a 13-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 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 PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (13 year old boy dies three days after the Moderna vaccine). 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, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (13 year old boy dies three days after the Moderna vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product was not provided by the reporter. Treatment information was unknown. Company comment: This is a case of death in a 13-year-old male subject with unknown medical history, who died one day after receiving the vaccine. Very limited information has been provided at this time. Further information has been requested.; Sender''s Comments: This is a case of death in a 13-year-old male subject with unknown medical history, who died one day after receiving the vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1463262 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: PCR Test; Test Result: Negative ; Test Name: PCR Test; Test Result: Negative
CDC Split Type: USPFIZER INC2021785213

Write-up: suspected covid 19; drug ineffective; This is a spontaneous report from a non-contactable consumer (patient daughter) through a Pfizer sponsored program. A male patient of an unspecified age received bnt162b2 (Pfizer-BioNTech Covid-19 Vaccine), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. As per the reporter, her father (orthopedic surgeon) died of covid-19 vaccine on an unspecified date. The patient underwent lab tests and procedures which included had 2 negative PCR test 14 days later. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; batch/lot number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: suspected covid


VAERS ID: 1463403 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-16
Onset:2021-01-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Death, Dehydration, Laboratory test, Renal failure, Renal impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 7
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: Not sure
Current Illness: Kidney issues
Preexisting Conditions: Kidney issues
Allergies: Not sure
Diagnostic Lab Data: Was admitted to hospital on 1 /20/21. They did 1000 tests of every kind.
CDC Split Type:

Write-up: Caused extreme dehydration. 3 days after shot her Kinsey?s went into failure and she never recovered despite all the efforts of the doctors / staff. She was never advised not to get shot if she had kidney issues. She diesels eight days after getting shot


VAERS ID: 1463406 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-19
Onset:2021-04-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

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

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

Write-up: Death. My mother died 4 days after receiving the first round of Moderna vaccine.


VAERS ID: 1463962 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-23
Onset:2021-03-31
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Connective tissue disorder, Death, Disseminated intravascular coagulation, Haemorrhagic disorder, Histology, Myocarditis, SARS-CoV-2 test negative, Systemic inflammatory response syndrome, Toxicologic test, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   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: Butalbital Omeprazole Prednisone
Current Illness: None
Preexisting Conditions: Well controlled rheumatoid arthritis
Allergies: Sulfa antibiotics
Diagnostic Lab Data: Full autopsy with histology, toxicology, and SARS-CoV-2 testing (negative) The autopsy demonstrated systemic inflammatory reaction, which affected primarily the small blood vessels of the brain with leptomeninges (soft coverings of the brain), heart, lungs, and liver. Generalized systemic tissue inflammation has caused diffuse intravascular inflammatory microthrombi and hemorrhagic myocarditis.
CDC Split Type:

Write-up: Found unresponsive on the floor of her residence; DOA in the ER


VAERS ID: 1464151 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-01-27
Onset:2021-05-19
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain, Discoloured vomit, Small intestinal obstruction
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer COVID19 Vaccine EUA Hospitalized after presenting with dark brown emesis and abdominal pain-$g small bowel obstruction.


VAERS ID: 1464157 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-24
Onset:2021-05-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Condition aggravated, Death, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-31
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levemir 46 units twice daily Novolog 10 units three times daily before meals Ozempic 1 mg weekly Lisinopril 5 mg daily simvastatin 40 mg daily Tums 500 mg daily in the morning Omeprazole 20 mg daily Docusate 100 mg twice daily Albut
Current Illness: uncontrolled Type 2 diabetes acute hyponatremia
Preexisting Conditions: Hypertension CKD stage 3 Hyperlipidemia GERD History of small bowel obstruction Constipation Chronic Hepatitis C Bipolar affective disorder Fragile X syndrome ADHD Tardive dyskinesia generalized anxiety disorder tobacco abuse Seizure disorder COPD Neuropathy/pain Allergic Rhinitis Hypothyroidism Vitamin D deficiency
Allergies: copper (dermatitis) Nickel Olanzapine (nausea and vomiting) staples zinc Zyprexa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest, followed by seizure and death. Pt was hospitalized, undetermined cause of death, case send to a medical examiner. Case was noted upon chart review by reporter.


VAERS ID: 1464197 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-12
Onset:2021-07-08
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: 2021-07-11
   Days after onset: 3
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:
Current Illness: unknown
Preexisting Conditions: Chronic kidney disease, HTN, DM
Allergies: No
Diagnostic Lab Data: Positive COVID test
CDC Split Type:

Write-up: Patient Expired


VAERS ID: 1464255 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-14
Onset:2021-06-12
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dementia, Endotracheal intubation
SMQs:, Angioedema (broad), Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute onset of dementia, intubated est 1 mo after vaccination Deceased 7/3/21 at Hospital


VAERS ID: 1464271 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-06-22
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 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: 2021-07-04
   Days after onset: 12
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: 1464276 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-18
Onset:2021-05-10
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, Chills, Death, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Possibly covid19. The PCR test was negative. No antibodies were tested prior to the vaccine.
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: Death confirmed by a physician and the County Coroner''s Office. Autopsy report still underway: awaiting toxicology.
CDC Split Type:

Write-up: Death caused by probable cardiac arrhythmia on May 10, 2021. No previous heart symptoms. Had the normal reaction to the second dose (body aches, chills, low grade fever), but was recovering as of April 19. First dose was administered 3/21/21. Second dose was administered 4/18/2021.


VAERS ID: 1464398 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-09
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3EN5318 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 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: 2021-07-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute renal failure (ARF)


VAERS ID: 1464403 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   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: Low dose blood pressure pill Name unknow by family Oral Diabetes med Pill form Name unknown by family
Current Illness: None known
Preexisting Conditions: Polio as a child Post polio Syndrome
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: As per patients family, approx 2 days after receiving Moderna Dose #2 Immunization( was received 5/13/21) patient developed soreness of Rt Arm, body ache, shortness of breath. Was sleeping upright in wheelchair.in order to breath easier. Family stated due to pt having polio as a child, he was fearful of hospitals and refused to have family call 911 These symptoms continued until 6/1/2021 when pt was found dead in wheelchair.by family.


VAERS ID: 1464404 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-16
Onset:2021-03-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044921A / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 49
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 50 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: HTN
Allergies: none
Diagnostic Lab Data: she died may 8,2021
CDC Split Type:

Write-up: She had a brain aneurysm. We question if this was related to the covid 19 vaccine


VAERS ID: 1464424 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-06-28
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 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: 2021-07-06
   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: Death N17.9 - Acute kidney failure, unspecified


VAERS ID: 1464551 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-06
Onset:2021-07-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   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: None reported
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discovered dead in residence three days after vaccination. Last seen alive on day of vaccination


VAERS ID: 1464628 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-03
Onset:2021-06-20
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   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: - some medications to address Dementia and conditions resulting from stroke in 2002, also on conditions diagnosed with Lung Cancer on May 10, 2021
Current Illness: see Item 9
Preexisting Conditions: - Dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ? June 20 ? struggling to breathe; morphine administered ? June 21 ? passed away


VAERS ID: 1464651 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-26
Onset:2021-05-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203AZIA / UNK UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: antibiotics
Current Illness: dry socket from tooth removal
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: autopsy pending
CDC Split Type:

Write-up: This was a J&J vaccine but I didn''t see that as a choice in the drop down. My son passed away on June 5 2021. He had severe nausea


VAERS ID: 1464745 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-24
Onset:2021-05-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Central nervous system inflammation, Death, Diarrhoea, Fatigue, Headache, Malaise, Nausea, SARS-CoV-2 test positive, Spinal pain
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was taking medication. Sister could not provide list.
Current Illness:
Preexisting Conditions: Diabetic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Reporter stated that patient got real ill and new symptoms arrived everyday from the day she reviewed the vaccine.. loose stool, fatigue nausea and pain in her spine and headaches. . A few days after the vaccine patient went to the hospital and tested positive for COVID. Patient went to the Hospital on June3rd around 5pm. Test was perform and said she was filled with inflammation of the spine. Patient was release from hospital on June 4th with pain killers and steroids. Patient was pronounced dead on June 6th.


VAERS ID: 1464775 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008 B 2I-2H / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   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 oxybutynin
Current Illness:
Preexisting Conditions: hypertension
Allergies: none
Diagnostic Lab Data: Ask medical examiner who took possession of his body for an autopsy, but hasn''t provided an autopsy report.
CDC Split Type:

Write-up: Death. It''s not known if pt. died on March 31 or soon thereafter. His body was found on April 7, but he was incommunicado before that when I tried to contact him over the Easter weekend. He was found on the floor of his bedroom as if he were getting ready for bed and keeled over.


VAERS ID: 1465112 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-03-27
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Biopsy heart, Death, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension cardiac
Allergies: ceolor
Diagnostic Lab Data: autopsy performed by local Medical Examiner
CDC Split Type:

Write-up: Patient died we think on March 27th although he wasn''t found until March 28th. We are waiting for the histology report on his cardiac tissue samples. We are suspecting myocarditis.


VAERS ID: 1465600 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-12
Onset:2021-04-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Anti-neutrophil cytoplasmic antibody positive vasculitis, Blood disorder, Death, Fatigue, Hypophagia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (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), Vasculitis (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   Days after onset: 71
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 60 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cipro antibiotics
Current Illness: Right ear pain
Preexisting Conditions: None
Allergies: Sulfa medications
Diagnostic Lab Data: Hospital has records
CDC Split Type:

Write-up: Tried all the time, not eating, anemia, stopped making blood, hospitalized from may 21, 2021 to dying on June 29, 2021with ANCA vasculitis renal failure. My mother was never sick with this until She got the vaccine moderna


VAERS ID: 1465684 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Blood pressure measurement
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   Days after onset: 66
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bone cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210408; Test Name: Blood pressure; Result Unstructured Data: Elevated blood pressure
CDC Split Type: MOD2021109503

Write-up: Elevated blood pressure since receiving first dose.; This spontaneous case was reported by a consumer and describes the occurrence of BLOOD PRESSURE INCREASED (Elevated blood pressure since receiving first dose.) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017B21A) for COVID-19 vaccination. Concurrent medical conditions included Bone cancer. On 08-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Apr-2021, the patient experienced BLOOD PRESSURE INCREASED (Elevated blood pressure since receiving first dose.) (seriousness criterion death). The patient died on 13-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Apr-2021, Blood pressure measurement: high (High) Elevated blood pressure. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. Treatment information was not provided. Company Comment: Very limited information regarding the event has been provided at this time. Further information is not expected. Most recent FOLLOW-UP information incorporated above includes: On 07-Jul-2021: Follow up received on 07 Jul 2021 included relevant history detail (bone cancer), seriousness (death) and outcome of the event (fatal).; Sender''s Comments: Very limited information regarding the event has been provided at this time. Further information is not expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1465762 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-28
Onset:2021-03-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Chills, Dyspnoea, Histology, Laboratory test, Malaise, Pyrexia, SARS-CoV-2 test negative, Syncope, Toxicologic test
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   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: None
Current Illness: None
Preexisting Conditions: Hypertension and obesity
Allergies: Not known
Diagnostic Lab Data: Autopsy findings along with histology, toxicology and other ancillary tests; SARS-CoV-2 negative in the nasopharyngeal and pulmonary swabs.
CDC Split Type:

Write-up: Fever, chills, malaise, progressive shortness of breath and sudden collapse


VAERS ID: 1466009 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-03
Onset:2021-04-30
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: He had no previous symptoms. I was with him one hour before and my assistant saw him 20 minutes prior and he did not show any irregularities.
CDC Split Type:

Write-up: My son died, while taking his math class on Zoom. We are waiting for the autopsy because the doctors did not find anything. He was a healthy boy, he had a good academic index, he wanted to be a civil engineer. He was the best thing in my life.


VAERS ID: 1466124 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021807766

Write-up: blood clots; This is a spontaneous report from a contactable physician via a sales representative. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Patient died one week after receiving Pfizer COVID vaccine, autopsy confirmed blood clots. Event took place after use of product. Information on the lot/batch number has been requested.; Sender''s Comments: A possible contributory role of the suspect drug to the reported event "blood clots" cannot be completely excluded based on temporal association. This case will be re-assessed when additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identifies as part of this review, as well as any appropriate action in response, will be promptly notifies to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: blood clots


VAERS ID: 1466254 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: None..patient got vaccine and died 5 days later
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient receive vaccine, was very sick the first 3 days after getting it started to feel better for two more days and then died suddenly around 3 p.m.


VAERS ID: 1466464 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-03-01
Onset:2021-07-02
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Respiration abnormal
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Prinivil, Allopurinol, prilosec, euflexxa
Current Illness:
Preexisting Conditions: history of prostate cancer, A fib, renal insufficiency, hypercholesteremia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/3/2021 7:23:41 AM $g phone call from Officer pt deceased. discussed with wife. she heard him make a loud breathing noise at 3am and then could not wake him. had been feeling well with no complaints. planned to run a road race this Sunday. offered support. pls mark chart and then FYI to Dr.


VAERS ID: 1466685 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-23
Onset:2021-06-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Cold sweat, Cough, Lethargy, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ELIQUIS 5MG CARVEDILOL 3.125 MG BENZONATATE 200MG
Current Illness: SUPRAVENTRICULAR TACHYCARDIA
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: ARM PAIN, COUGHING, LETHARGIC, CHEST PAIN, CLAMMY,


VAERS ID: 1466773 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-04-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   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: N/A
Current Illness: Lupus
Preexisting Conditions: Lupus
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Convulsions, loss of brain function, then death.


VAERS ID: 1466862 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-09
Onset:2021-02-28
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045AX119 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Aggression, Chest X-ray, Computerised tomogram, Confusional state, Dyspnoea exertional, Insomnia, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-05
   Days after onset: 126
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: Hytrin, Losartan,
Current Illness: none
Preexisting Conditions: chronic back ache, htn, prediabetes, BPH
Allergies: NKA
Diagnostic Lab Data: CT, Chest xray
CDC Split Type: NHTP

Write-up: Progressively worse muscle and body aches, shortness of breath upon exertion, aggressive behavior, insomnia, confusion,


VAERS ID: 1466883 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-06
Onset:2021-04-26
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Death, Dyspepsia, Pain, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Chills and aches" the day and evening of the shot. After a couple of weeks, Pt began to experience various pains at different points of his body. He developed severe indigestion resulting in him visiting his physician on April 19th where he was put on a 7-day steroid regimen. One week later, early on Monday morning, April 26, 2021, Pt collapsed in his bathroom at home, was unresponsive, and pronounced dead by the paramedics who responded.


VAERS ID: 1466971 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-25
Onset:2021-06-16
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-05
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 5 mg tablet once a day with benazepril; omeprazole 20 mg tablet once a day in the morning; Synthroid 75 ?g tab, 1 every day; atorvastatin 40 mg tablet, 1 every evening; doxazosin 2 mg tablets 1 every day; clopidogrel 75 mg tablet
Current Illness:
Preexisting Conditions: type 2 diabetes hypertension Hyperlipidemia anemia Kidney disease Hypothyroidism Peripheral artery disease
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath, endotracheal intubation, ventilator, death


VAERS ID: 1467970 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-30
Onset:2021-04-12
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death due to brain bleed, per wife''s message left with agency. Obituary located at:


VAERS ID: 1469612 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-14
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 61
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: USJNJFOC20210710773

Write-up: DIED AFTER RECEIVING YOUR VACCINE; This spontaneous report received from a consumer via a company representative concerned a female of unspecified age, race and ethnicity. The patient''s height and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown and expiry: unknown) 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On 14-APR-2021, the patient died after receiving vaccine and cause of death was unknown. It was unspecified if autopsy performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210710773-covid-19 vaccine ad26.cov2.s - DIED AFTER RECEIVING YOUR VACCINE. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1469661 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-11
Onset:2021-01-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K0A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Erythema, Feeling hot, Illness, Loss of personal independence in daily activities, Mobility decreased, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 142
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: Medical History/Concurrent Conditions: Lyme''s disease (4 years ago); Paralysis (Both legs and one arm)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Crticial illness; He couldn''t dress himself; The elbow on his left arm was killing him; he had a lot of pain in his left arm; Warmth of hands; swelling, pain, and the heat in his hands; Couldn''t move his right arm; Both of his hands and fingers swelled; Pain in elbow; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of ILLNESS (Crticial illness), MOBILITY DECREASED (Couldn''t move his right arm), PERIPHERAL SWELLING (Both of his hands and fingers swelled), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (He couldn''t dress himself), PAIN IN EXTREMITY (The elbow on his left arm was killing him; he had a lot of pain in his left arm), ERYTHEMA (swelling, pain, and the heat in his hands), FEELING HOT (Warmth of hands) and ARTHRALGIA (Pain in elbow) in an 89-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K0A) for COVID-19 vaccination. The patient''s past medical history included Lyme''s disease (4 years ago) and Paralysis (Both legs and one arm). On 11-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Jan-2021, the patient experienced MOBILITY DECREASED (Couldn''t move his right arm) (seriousness criterion medically significant), PERIPHERAL SWELLING (Both of his hands and fingers swelled) (seriousness criterion medically significant) and ARTHRALGIA (Pain in elbow) (seriousness criterion medically significant). On 17-Jan-2021, the patient experienced ERYTHEMA (swelling, pain, and the heat in his hands) (seriousness criterion medically significant). On 04-Jun-2021, the patient experienced ILLNESS (Crticial illness) (seriousness criteria death and hospitalization). On an unknown date, the patient experienced LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (He couldn''t dress himself) (seriousness criterion medically significant), PAIN IN EXTREMITY (The elbow on his left arm was killing him; he had a lot of pain in his left arm) (seriousness criterion medically significant) and FEELING HOT (Warmth of hands) (seriousness criterion medically significant). The patient was hospitalized on sometime in 2021 due to ILLNESS. The patient died on 04-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, MOBILITY DECREASED (Couldn''t move his right arm), PERIPHERAL SWELLING (Both of his hands and fingers swelled), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (He couldn''t dress himself), PAIN IN EXTREMITY (The elbow on his left arm was killing him; he had a lot of pain in his left arm), ERYTHEMA (swelling, pain, and the heat in his hands), FEELING HOT (Warmth of hands) and ARTHRALGIA (Pain in elbow) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. on 17-Jan-2021. There the patient underwent bloodwork, ultrasound, and x-rays to rule out blood clots or anything else. Treatment included a steroid shot, antibiotic shot, and medication, steroids and antibiotics and 4 pain pills on 17Jan2021. No concomitant medications was provided by the reporter. Company Comment: Very limited information regarding this events has been provided at this time. Further information has been requested. Most recent FOLLOW-UP information incorporated above includes: On 26-Apr-2021: Added reporter''s email address. On 06-Jul-2021: F/U-1 : Case upgraded to serious: Patient has died on 04-Jun-2021.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1469672 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-14
Onset:2021-04-11
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac failure congestive, Chills, Confusional state, Cyanosis, Death, Dyspnoea, Erythema, Feeling abnormal, Gait disturbance, General physical health deterioration, Illness, Insomnia, Nausea, Pallor, Paradoxical drug reaction, Peripheral coldness, Peripheral swelling, Renal function test, Renal impairment, Restlessness, Suicidal ideation, Vasodilatation, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Suicide/self-injury (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Renal function test; Result Unstructured Data: Kidney levels were also not where they needed to be
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Congestive heart failure, he had 32% of his heart; Patient asked caller to "help him with suicide"; escape from house, Confused; Super sick; medication having opposite effect on him; his kidney levels were also not where they needed to be; died after receiving the Moderna vaccine; Nails were blue; Very cold; Fidgety; Vomiting; Wasn''t breathing right/abdomen breathing; Continued to deteriorate; Went outside and could barely make it up the steps; Neck veins distended; Had not slept the night before; Didn''t feel good; right arm was swelling; Pale in the face; Right arm red; Chills; Nausea; This spontaneous case was reported by an other caregiver and describes the occurrence of DEATH (died after receiving the Moderna vaccine), CARDIAC FAILURE CONGESTIVE (Congestive heart failure, he had 32% of his heart) and SUICIDAL IDEATION (Patient asked caller to "help him with suicide") in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 036B21A and 044A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 14-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 11-Apr-2021, the patient experienced PALLOR (Pale in the face), ERYTHEMA (Right arm red), PERIPHERAL SWELLING (right arm was swelling), CHILLS (Chills) and NAUSEA (Nausea). On 12-Apr-2021, the patient experienced INSOMNIA (Had not slept the night before) and FEELING ABNORMAL (Didn''t feel good). On 13-Apr-2021, the patient experienced CARDIAC FAILURE CONGESTIVE (Congestive heart failure, he had 32% of his heart) (seriousness criteria hospitalization and medically significant), DYSPNOEA (Wasn''t breathing right/abdomen breathing), GENERAL PHYSICAL HEALTH DETERIORATION (Continued to deteriorate), GAIT DISTURBANCE (Went outside and could barely make it up the steps) and VASODILATATION (Neck veins distended). On 25-May-2021, the patient experienced VOMITING (Vomiting). On 26-May-2021, the patient experienced DEATH (died after receiving the Moderna vaccine) (seriousness criteria death and medically significant), CYANOSIS (Nails were blue), PERIPHERAL COLDNESS (Very cold) and RESTLESSNESS (Fidgety). On an unknown date, the patient experienced SUICIDAL IDEATION (Patient asked caller to "help him with suicide") (seriousness criterion medically significant), CONFUSIONAL STATE (escape from house, Confused), ILLNESS (Super sick), PARADOXICAL DRUG REACTION (medication having opposite effect on him) and RENAL IMPAIRMENT (his kidney levels were also not where they needed to be). The patient was treated with HALOPERIDOL (HALDOL [HALOPERIDOL]) at a dose of 1 dosage form and DIAZEPAM at a dose of 1 dosage form. The patient died on 26-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, CARDIAC FAILURE CONGESTIVE (Congestive heart failure, he had 32% of his heart), SUICIDAL IDEATION (Patient asked caller to "help him with suicide"), PALLOR (Pale in the face), ERYTHEMA (Right arm red), INSOMNIA (Had not slept the night before), FEELING ABNORMAL (Didn''t feel good), DYSPNOEA (Wasn''t breathing right/abdomen breathing), GENERAL PHYSICAL HEALTH DETERIORATION (Continued to deteriorate), GAIT DISTURBANCE (Went outside and could barely make it up the steps), VASODILATATION (Neck veins distended), CONFUSIONAL STATE (escape from house, Confused), CYANOSIS (Nails were blue), PERIPHERAL COLDNESS (Very cold), RESTLESSNESS (Fidgety), ILLNESS (Super sick), PARADOXICAL DRUG REACTION (medication having opposite effect on him), PERIPHERAL SWELLING (right arm was swelling), RENAL IMPAIRMENT (his kidney levels were also not where they needed to be), CHILLS (Chills), NAUSEA (Nausea) and VOMITING (Vomiting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Renal function test: abnormal (abnormal) Kidney levels were also not where they needed to be. No concomitant product information was provided. Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded. However, no information is available regarding medical history/medications that could be confounders/co-suspects for the events. Further information has been request. This case was linked to MOD-2021-248336 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 06-Jul-2021: Additional information added in laboratory data, treatment drug and events.; Sender''s Comments: Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded. However, no information is available regarding medical history/medications that could be confounders/co-suspects for the events. Further information has been request.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1469692 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT PROVIDED / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocardial infarction, Rheumatoid arthritis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Arthritis (narrow), Immune-mediated/autoimmune disorders (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: HUMIRA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: massive heart attack; Death; rheumatoid arthritis; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (massive heart attack), DEATH (Death) and RHEUMATOID ARTHRITIS (rheumatoid arthritis) in a 55-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Not provided) for COVID-19 vaccination. Concomitant products included ADALIMUMAB (HUMIRA) for Rheumatoid arthritis. 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 MYOCARDIAL INFARCTION (massive heart attack) (seriousness criteria death and medically significant), DEATH (Death) (seriousness criteria death and medically significant) and RHEUMATOID ARTHRITIS (rheumatoid arthritis) (seriousness criteria death and medically significant). The reported cause of death was massive heart attack. It is unknown if an autopsy was performed. No laboratory was not given. No treatment information was provided by reporter. According to, "The caller stated that she does not know if her brother?s friend received a Moderna, Pfizer or J&J vaccine." This a report of dead one day after the second dose of the product in a 55-year-old patient with concomitant Rheumatoid arthritis. Very limited information regarding the event has been provided for inferring causality. Further information has been request. Most recent FOLLOW-UP information incorporated above includes: On 08-Jul-2021: Follow Up information was received 08-JUL-2021 and added concomitant product and event verbatim; Sender''s Comments: This a report of dead one day after the second dose of the product in a 55-year-old patient with concomitant Rheumatoid arthritis. Very limited information regarding the event has been provided for inferring causality. Further information has been request.; Reported Cause(s) of Death: massive heart attack


VAERS ID: 1470106 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-12
Onset:2021-06-25
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-08
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: INFLAMMATORY BOWEL DISEASE, HTN,
Allergies:
Diagnostic Lab Data: 6/25/201 AND 6/26/2021 COVID TESTING = DETECTED.
CDC Split Type:

Write-up: PATIENT ADMITTED TO HOSPITAL ON 6/25/21 DUE TO RESP DISTRESS. COVID TESTING POSITIVE. DIAGNOSED WITH COVID PNEUMONIA. ON 6/25/21 NAD 6/26/21. PATIENT DIED ON 7/8/2021.


VAERS ID: 1470120 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-10
Onset:2021-05-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cardiac hypertrophy, Deep vein thrombosis, Electrocardiogram ST-T segment abnormal, Fatigue, Influenza virus test negative, Malaise, Myocardial strain, Nucleic acid test, Prostate cancer, Pulmonary embolism, SARS-CoV-2 test negative, Sudden death, Syncope, Toxicologic test normal
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (broad), Prostate malignant tumours (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), COVID-19 (broad)

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: None known
Current Illness: None known
Preexisting Conditions: None reported
Allergies: None known
Diagnostic Lab Data: Autopsy revealed: Noncontributory toxicologic testing. Negative COVID-19 and influenza NAA testing. Obstructive pulmonary thromboemboli, recent and organizing, with right lower extremity organizing DVT. Cardiac hypertrophy with slight left ventricular and right heart strain pattern (no evidence of myocarditis). Probable small focus of prostatic adenocarcinoma.
CDC Split Type:

Write-up: Patient had 1st dose of Moderna COVID-19 vaccine on 5/10/2021. Several days after he complained of "not feeling well" and fatigue, but did not give more specific symptomatology. On 5/17/2021 he had a sudden collapse at home and was transported to local hospital, where he was pronounced dead. Case accepted as medical examiner jurisdiction due to no apparent medical history and sudden death after vaccine administration. Full autopsy completed on 5/19/21 revealed obstructive pulmonary thromboemboli as cause of death, with lower extremity DVT. Both portions of the pulmonary thromboembolus and the DVT show organization, thus raising question of whether this process started before or after the vaccination. No known history of thrombophilic disorder, recent injury, or prolonged stasis/immobility. Not known to be current smoker. See below for additional autopsy information.


VAERS ID: 1470235 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-25
Onset:2021-07-09
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Catastrophic reaction, 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: 2021-07-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medication List As of 7/8/2021 10:18 AM Diclofenac Sodium 0.1 % No dose, route, or frequency recorded. Furosemide 40 mg Oral DAILY Patient taking differently: Take 20 mg by mouth daily Lisinopril 5 mg Oral DAILY metFORMIN HCl 500 mg
Current Illness:
Preexisting Conditions: Problem List As of 7/8/2021 9:39 AM Chronic atrial fibrillation Hypovitaminosis D Type 2 diabetes mellitus without complication, without long-term current use of insulin Essential hypertension Chronic systolic heart failure Chronic kidney disease, stage III (moderate) Acquired hypothyroidism Mixed hyperlipidemia Neuropathy Anemia Elevated LFTs Acute thrombus of left ventricle NSVT (nonsustained ventricular tachycardia) Hypomagnesemia Hypokalemia PVD (peripheral vascular disease) Azotemia Chronic anticoagulation Fissure in skin of both feet Ulcer of heel and midfoot, left, limited to breakdown of skin Ulcer of heel and midfoot, limited to breakdown of skin, right Onychomycosis Pain in toes of both feet Ischemic cardiomyopathy Cataract of left eye Cataract extraction status of eye, right
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: catastrophic stroke on 7/9/21, death on 7/10/21


VAERS ID: 1470249 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-27
Onset:2021-05-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Feeding disorder, Feeling abnormal, Feeling of body temperature change, Headache, Illness, Vomiting
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   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: Zoloft
Current Illness: None
Preexisting Conditions: Diabetes, Hypoglycemia
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The first dose of vaccine (lot number EW0176) was taken on 05/06/2021, and the second dose of vaccine (lot number EW0186) was taken on 05/27/2021. within 12 hours of second does she had gotten severe headache, she couldn''t eat for severe vomiting, she said she felt like she was hit by a truck, and had the chills. she would go from really cold to really hot. She couldn''t keep anything down even water. On the third day after the vaccine she was very sick and we ( the family) thought she was sleeping but when we went to try and wake her up we discovered her dead.


VAERS ID: 1470347 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-09
Onset:2021-07-03
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-11
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SIMVASTATIN,COLCHICINE,PROTONIX,ASA,LISINOPRIL,METOPROLOL,MELOXICAM, PLAVIX,NORVASC,CLONIDINE,POTASSIUM,LASIX,FLONASE,MYSOLINE,AZWLASTINE,VOLTAREN,DUONEB,NORCO,APRECREME
Current Illness:
Preexisting Conditions: CHF, HTN, CHRONIC RESP FAILURE
Allergies: CODEINE
Diagnostic Lab Data: 7/6/2021 SARS COV 2 PCR POSITIVE
CDC Split Type:

Write-up: PATIENT DEVELOPED ACUTE RESPIRATORY AND RENAL FAILURE AND EXPIRED 7/11/2021


VAERS ID: 1470463 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-03-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Biopsy, Renal failure, Renal tubular necrosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Renovascular disorders (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 67
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COPD
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Biopsy performed at Hospital in May of 2021
CDC Split Type:

Write-up: Patient suffered complete kidney failure despite no history of kidney disease. Acute tubular necrosis.


VAERS ID: 1470499 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-17
Onset:2021-03-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6027 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute myeloid leukaemia, Biopsy bone marrow abnormal, COVID-19, Chemotherapy, Chest X-ray abnormal, Contusion, Death, Granulocytes abnormal, Haemoglobin decreased, Mechanical ventilation, Myeloblast percentage increased, Packed red blood cell transfusion, Platelet count decreased, Platelet transfusion, Pneumonia, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Malignant lymphomas (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 51
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: flexeril, topamax, maxide, centrum silver, gingko biloba, Norco
Current Illness: UTI
Preexisting Conditions: Back pain from accident in 2011, hypertension, rectocele, migraine, diverticulitis
Allergies: None
Diagnostic Lab Data: April 8, 2021 Bone marrow biopsy completed with report of 29% blasts, hypercellular bone marrow (60-70%) with significant granulocytic dysplasia and occasional diserythropoiesis. April 25, 2021 Hospital admission and positive covid test: Labs were remarkable for Hgb 4.3, WBC 1.3, and PLT< 10. Transfusion of 3 units pRBCs and 2 units PLT was ordered. After 2 units pRBC, Hgb up-trended from 4.3 to 6.0. Plan was for admission to P2, but the patient tested positive for COVID-19. Chest x ray was obtained and showed evidence of early multilobar pneumonia.
CDC Split Type:

Write-up: The patient received her COVID vaccine on March 17, 2021 at a local clinic. She developed bruises within days after the shot. She pursued care and diagnosis and reporting with the vaccine administrator, but finally had to see PCP. After multiple visits, the patient was sent to Hospital. She was diagnosed with AML (hospitalized 5 days: April 6-10) and started chemotherapy (outpatient on April 19). She returned to hospital on April 25 in distress and diagnosed with COVID. The patient was put on a ventilator with pressor support on May 1 and passed away on May 10, 2021.


VAERS ID: 1470622 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-01
Onset:2021-04-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   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: Losartan hydrochlorothiazide (Hyzaar) 50mg tablets once a day Morphine (MS IR) 30 mg tablet every 4 hours when needed during Sickle Cell pain crisis Amlodipine 5mg once a day Lipitor 40mg at night Sertraline 25mg at night Apixaban 2.5 mg t
Current Illness: Pneumonia resolved 2 weeks prior to death on 4/5/2021
Preexisting Conditions: Sickle Cell Anemia Congestive Heart Failure Controlled hypertension
Allergies: Latex allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute heart attack on 4/5/2021 that lead to death on 4/5/2021 at 9:58am.


VAERS ID: 1470647 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-02-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Death, Electrocauterisation, Exsanguination, Haemorrhage, Penile haemorrhage, Platelet count decreased, Skin laceration
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 78
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: PER SPOUSE, HE HAD A CUT ON HIS LEG THAT DID NOT STOP BLEEDING. THEY WENT TO CLINIC TO GET IT CAUTERIZED. DAY LATER HIS BODY HAD MULTIPLE BRUISES, THEN HE WAS EVEN BLEEDING FROM HIS PENIS. AT HOSPITAL THEY TOLD HIM HE HAD LOW PLATELETS AND WAS BLEEDING OUT. HE WENT INTO HOSPICE AND PASSED AWAY ON 5/8/2021


VAERS ID: 1471305 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Blindness, Death, Pain, Plasma cell myeloma
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 55
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, pravastatin, multivitamin, aspirin
Current Illness: glaucoma
Preexisting Conditions: high blood pressure , high cholesterol
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 days after the vaccine pt developed a stomach ache radiating to the back ,after several tests and seven weeks later pt. was diagnosis with multiple myeloma went blind and passed away,


VAERS ID: 1474054 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-01
Onset:2021-06-09
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Heart attack 06/10/2020 widow maker stints put in and at age of 21 had a brain aneurysm. He died 6/9/2021. They didn?t ask if he had the vaccine. So how are they to know the correct numbers if they aren?t asking if he had the vaccine or not. He had the Johnson and Johnson vaccine in March and then died 3 months later. People with underlying health issues shouldn?t be getting them!
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1474062 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-06-08
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   Days after onset: 34
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization within 6 weeks of receiving COVID vaccination. Patient deceased.


VAERS ID: 1474154 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-06
Onset:2021-05-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 52
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ED/Hospitalization within 6 weeks of receiving COVID vaccination. Patient Deceased.


VAERS ID: 1474305 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-05-27
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died 05/27/2021- not a covid related death Vaccine #2 Moderna 03/05/2021 Lot # 032M20A


VAERS ID: 1474311 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-16
Onset:2021-04-06
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / UNK - / -

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

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

Write-up: Patient died 04/06/2021 Covid vaccine #1 Pfizer 03/16/2021 Lot #EN6207 Covid Vaccine #2 Pfizer 03/19/2021 Lot # N/A


VAERS ID: 1474326 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-25
Onset:2021-06-20
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Disseminated intravascular coagulation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prescriptions: Enalapril Maleate, Citalopram, Folbic Tab, Gemfibrozil Tab USP, Glipizide XL Tab, Januvia (Sitagliptin) tab, Lovastatin, Tab, Metformin ER, Omeprazole Dr, Vitamine D2, Over the Counter: Vitmine E, Align Probiotic, Niacin
Current Illness: None
Preexisting Conditions: Type 2 Diabetic
Allergies: None
Diagnostic Lab Data: Do not know
CDC Split Type:

Write-up: Disseminated Intravascular Coagulation


VAERS ID: 1474379 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-06-11
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO0158 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO0179 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Aspiration pleural cavity, Autopsy, Biopsy bone marrow, Blood test abnormal, Catheterisation cardiac, Computerised tomogram, Death, Decreased appetite, Eosinophil count increased, Inflammation, Myocarditis, Nausea, Night sweats, Paraesthesia, Pericardial effusion, Pleural effusion, Pyrexia, White blood cell count increased, X-ray
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 29
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: Dulera, Albuterol, Multi-Vitamin, Ubiquinol, Vitamin D
Current Illness: None
Preexisting Conditions: Asthma
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No immediate adverse reaction, however, began developing nightly fevers/profuse sweating on June 11. This continued for two weeks with increasing symptoms of loss of appetite, nausea, abdominal pain, tingling sensation on scalp before going to ER. Visited urgent care on June 16 and bloodwork results indicated elevated white blood cell count and eosinophil count. There was a question as to whether patient had been subjected to a tick bite, so doxycycline was prescribed. After several days, patient returned to urgent care for follow-up bloodwork (June 20th). Results showed WBC and eosinophil count continued to escalate. He went to ER on June 25th and was admitted to the hospital for 5 days. During his visit at Hospital, he was seen by a team of specialists: cardiologist, pulmonologist, hematologist, infectious disease doctor. Multiple tests were run, as the doctors started broad to eliminate certain diagnoses - i.e., bone marrow biopsy, heart cath, CT scans, x-rays, thoracentesis, etc. Patient had fluid around his heart and lungs and was diagnosed with myocarditis. He had no previous heart issues nor family history of heart issues. Test results indicated no abnormal blockage or other issues, other than inflammation and his heart strength was at 27%. I am unable to access his account, as it was disabled after his death. An autopsy is being performed and results are pending; however, the question(s) at large: what was the condition of his heart at the time of his death and was this vaccine-related? Did his myocarditis get worse? Did his heart muscle weaken further and rupture? Please let me know if the autopsy results are needed and where to send them.


VAERS ID: 1474425 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESP. DISTRESS AND DEATH


VAERS ID: 1474430 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-02-02
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Death, Pulmonary embolism, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), 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: 2021-07-14
   Days after onset: 161
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 NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) Pulmonary emboli (CMS/HCC) Acute kidney failure, unspecified Thrombocytopenia, unspecified


VAERS ID: 1474596 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-09
Onset:2021-06-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Cardiac arrest, Chest pain, Death, Electrocardiogram
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasitapril, (Diabetic Medication)
Current Illness: Exposed to Covid-19, Positive in January
Preexisting Conditions: Diabetes
Allergies: Penicillin
Diagnostic Lab Data: EKG 06/11/2021 Blood Test 06/11/2021
CDC Split Type:

Write-up: Pt.''s daughter states after receiving the 2nd Phizer dose 06/09/2021, shortly after 06/11/2021 started experiencing chest pain, went into Cardiac Arrest and Passed away 06/19/2021.


VAERS ID: 1474730 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Death, Dyspnoea, Gait inability
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 91
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 1. Carbidopa/Levodopa 25-250mg, 4x daily (continued on other p #2 Entacapone 200 mg, 3x daily; #3 Levothyroxine 0.025mg, 1x daily; #4 Combigan eye drops 0.2%/0.5%.
Current Illness: None
Preexisting Conditions: Parkinsons disease
Allergies: Hay fever
Diagnostic Lab Data: Patient was under palliative care at the time. They gave us a nebulizer to help with his breathing.
CDC Split Type:

Write-up: Within two hours of the vaccine, my father was unable to walk, suffered severe weakness, and had severe shortness of breath. The weakness, inability to walk, and shortness of breath lasted in a severe state for 48 hours. After that, he continued to be unable to walk, suffered weakness and had shortness of breath until he died. He never recovered the strength and vitality he had prior to the 2nd vaccine. That 2nd shot shortened his life and killed him.


VAERS ID: 1475006 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-27
Onset:2021-06-22
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal behaviour, Abscess drainage, Blood test, Computerised tomogram thorax abnormal, Cough, Death, Increased appetite, Lung abscess, Pneumonia, Skin warm, Somnolence, X-ray
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-30
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Divalproex, Vyvanse, Risperidone, multivitamin, vitamin D3
Current Illness: None
Preexisting Conditions: ADHD, Epilepsy, Anxiety, Microcephalus, Autism, urinary incontinence, incontinence of feces
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. started coughing Tuesday, June 22, 2021, in the afternoon and it worsened through the rest of day. She also was beginning to be drowsy. Wednesday, June 23, 2021, coughing continued, she became drowsier, she felt warm to the touch (forehead, face, arms, back) and was not acting like herself. Thursday, June 24, 2021, 9am she was at the clinic. The doctor ordered an x-ray and blood work. After results arrived, we were advised to go to the emergency room. There the doctor ordered CT scan. The results showed an abscess and fluid in her left lung and pneumonia. Her lung was drained, was not able to get all of it out. They discussed surgery but needed to send pt. to ER. The discussion for surgery was a daily thing but never happened. They tried multiple procedures, CT scans, etc. On Tuesday, June 29, 2021 there was a meeting called with her doctor to discuss palliative care. The risk of surgery and all the complications following were high risk. Pt. did not understand that she needed to leave the IV and drainage tube in as well as leaving the oxygen on. Based on the complications and pts. quality of life after surgery and the fact that the fluid and pneumonia spread quickly throughout her body - the doctors were leaning towards end-of-life comfort. It all happened so fast! The evening of the 29th, pt. was transported home to end her life on hospice. On Wednesday, June 30, 2021 pt. passed away in the afternoon. Pt. was rarely ever sick. Once in a great while she would get a runny nose or little cough. Everyone around her would catch a virus and she simply would not. We had a member of our family test positive for COVID-19 in November 2020, and pt. never showed any symptoms of being ill. This was all before she received the COVID-19 Vaccine. About a week or two after she received the second vaccine, on May 27,2021. she had increased behaviors with eating and daily ADLs. But the behaviors were her ?normal? behaviors that would occasionally come and go. Nothing was ever persistent. Then on Tuesday June 22, 2021 when sick like symptoms started to appear it was less then four weeks after the second vaccine.


VAERS ID: 1475167 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-12
Onset:2021-03-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0261721A / 2 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Blood glucose increased, Cardiac arrest, Death, Discomfort, Dysarthria, Endotracheal intubation, Fatigue, Feeling of body temperature change, Hallucination, Headache, Illness, Insomnia, Laboratory test, Nausea, Resuscitation, Vomiting, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), 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), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 2
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: Levothyroxine, meloxicam, prednisone, sulfasalezine, citalopram, gabapentine, lisinopril, atenolol, metformin, percocet, oxybutyn, zyrtec, methacarbamol, omeprazole, novilin insulin, B12, orencia infusion
Current Illness: Rhumetoid arthritis, steriod induced diabetes, neuropathy osteopena
Preexisting Conditions: Rhematoid arthritis
Allergies: none
Diagnostic Lab Data: ER did lab work and x-rays to try to find source of problem - they were unsuccessful
CDC Split Type:

Write-up: Early in the morning Saturday, the day after the injection, patient became very nauseaus with a bad headache. She was sick all day on Saturday with nausea and headache. She could not sleep. On Sunday, she felt worse and called ambulance. They came and checked her out. Said Oxygen level was normal and all her symptoms were normal side effects. They did not take her to the hospital. All day Sunday, she continued to be agitated and not able to get comfortable. She was hot and cold, back and forth. Her headache was very bad and she felt like she would throw up, but only threw up a little that day. By Monday, she started not making sense and slurred her words. We thought this was due to lack of sleep (exhaustion). Her sugar was high, so we gave her an insulin shot. She continued to make less and less sense so we called 911 approximately 7 PM on Monday night. She was hallucinating. At the hospital, they looked for infection, but could not find any source of infection. They intubated her and soon after this, her heart stopped breathing. They performed CPR 3 times, but not successful. She died at 5 AM Tuesday morning.


VAERS ID: 1475432 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-09
Onset:2021-06-13
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown patient is noted to be on hospice in report
Allergies: unknown
Diagnostic Lab Data: No details on hospitalization aside from palliative care are noted.
CDC Split Type:

Write-up: No details on hospitalization aside from palliative care are noted.


VAERS ID: 1475434 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-07
Onset:2021-07-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-13
   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: unknown
Current Illness: unknown
Preexisting Conditions: enlarged heart
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient died 6 days after receiving dose #2


VAERS ID: 1475654 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-20
Onset:2021-03-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Vaccine positive rechallenge
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   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: Thyroid medication levothyroxine, prediabetes metformin use as needed.
Current Illness: No illnesses during or prior.
Preexisting Conditions: She was pre diabetic but no chronic or long standing health issues.
Allergies: Aleve medication and shrimp food.
Diagnostic Lab Data: My mom was rushed to the hospital and I dont have her hospital report at the moment.
CDC Split Type:

Write-up: headache, some what tiered and slightly lost of appetite from what I recall my mom telling me after her first shot and then same symptoms on her second shot a month later.


VAERS ID: 1478018 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-01
Onset:2021-06-07
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Headache, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin, Levothyroxine, Warfarin, Atorvastatin, Carvedilol, Lasix
Current Illness: None
Preexisting Conditions: COPD, Hodgkins lymphoma (age 31), aortic valve replacement (10/1/20)
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Wife reports that patient went to see his cardiologist on 6/7/21 for a follow up to the aortic valve replacement on 10/1/20. He received a good report from the cardiologist and was going to be taken off Warfarin the following week. On the way home he complained of a headache and felt like it was sinus headache. When he got home he went to bed as the headache had worsened. His wife assisted him up to the bathroom and back to bed and he went to sleep. She could hear him breathing from the other room. Later in the evening she became aware that she could not hear him breathing and upon checking on him she found him unresponsive, not breathing and he was blue in the face. She call 911 and they attempted to resuscitate him without success. Wife also reported that after the aortic valve replacement in 10/20, her husband went to the hospital with a fever and was diagnosed with covid and sepsis on 12/14/20. He was admitted and started on IV antibiotics and was hospitalized for 5 days. He had home health care coming into his home for 6 weeks of IV antibiotic therapy. He made a good recovery and was followed by an infectious disease doctor who put him on Amoxicillin po tid until the end of May. She states that he was doing very well physically and was playing golf, walking and felt better than he had in a long time.


VAERS ID: 1478056 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-19
Onset:2021-07-14
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M2OA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Apnoea, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cyanosis, Death, Dyspnoea, Fatigue, Fibrin D dimer, Hypoxia, Lung opacity, Oedema, Pain, Pneumonia, SARS-CoV-2 test positive, Sputum increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown med list at time of vaccinations. Medication list at time of admission include - Coreg, vitamin B12 injections, Aricept, Synthroid, prazosin, Crestor, Zyprexa, albuterol, ferrous sulfate, mag oxide, omeprazole, sertraline
Current Illness:
Preexisting Conditions: Hypertension, hyperlipidemia, hypothyroidism, peptic ulcer disease, sick sinus syndrome
Allergies:
Diagnostic Lab Data: 7/14: SARS-CoV-2 PCR + 7/14 D-dimer 1.93 7/14: CXR Bilateral patcy airspace opacities consistent with multifocal pneumonia vs edema 7/14: Chest CT probable right LL and right ML pneumonia
CDC Split Type:

Write-up: Presented to ED with shortness of breath. Tested + for COVID-19 at nursing home 1 day prior to presentation. Reports complaints of increasing fatigue, body aches, and respiratory difficulties. Was hypoxic on arrival to ER and required high flow nasal cannula at 45L 60% FiO2 initially. Admitted to floor for oxygen/dexamethasone treatment. Patient''s oxygen was titrated as needed. The day following admission patient developed apnea/cyanosis with large amounts of thick sputum. Patients respiratory status declined rapidly and patient expired.


VAERS ID: 1478240 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: American Samoa  
Vaccinated:2021-02-07
Onset:2021-03-11
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Brain injury, Cerebral haemorrhage, Computerised tomogram head abnormal, Confusional state, Death, Disorientation, Haemorrhagic stroke, Immediate post-injection reaction, Loss of consciousness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Catscan on 3/11/21 Massive brain bleed on right side of brain
CDC Split Type:

Write-up: Hemorageic stroke, died next day on 03/12/21 My mother became noticeably and increasing confused, quiet and forgetful after the first dose. Immediately after the second dose, she became confused and shakey. On the third day after the second shot, she was disoriented and unable to communicate sufficiently. She was rushed to a local hospital, where she was diagnosed with a brain bleed. She was transported immediately to a hospital, where she was given a catscan and it showed unreparable damage to the right side of her brain, she never regained consciousness and died the next day.


VAERS ID: 1478259 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute hepatic failure, Acute myocardial infarction, Aortic stenosis, Brain hypoxia, Cardiac arrest, Cardiogenic shock, Cardiomyopathy, Condition aggravated, Death, Dyspnoea, General physical health deterioration, Laboratory test, Lactic acidosis, Malaise, Pulmonary embolism, Rash, Rash erythematous, Rash papular, Renal failure, Rheumatoid arthritis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Arthritis (narrow), Tumour lysis syndrome (broad), Respiratory failure (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: 2021-07-10
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: asprin, citalopram, prednisone, furosemide
Current Illness:
Preexisting Conditions: anxiety & rheumatoid arthritis
Allergies: nka
Diagnostic Lab Data: multiple diagnostic tests and labs done as patient ended up in critical care
CDC Split Type:

Write-up: no known cardiovascular disease. He has been feeling less well recently . About 1 month ago, he received the 2nd dose of the Moderna COVID-19 vaccine, and he developed an erythematous, non-raised rash involving the upper and lower extremities. This has subsided, but still persists on his thighs. He presented to the emergency department on 7/3 with worsening dyspnea. and diagnosed with pulmonary emboli. After a week in the hospital deteriorating with the following the patient expired. Pulmonary embolism Active Problems: Cardiogenic shock NSTEMI (non-ST elevated myocardial infarction) Cardiomyopathy Acute liver failure without hepatic coma Rheumatoid arthritis Renal failure Aortic stenosis Lactic acidosis Cardiac arrest Cerebral anoxia


VAERS ID: 1478327 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-27
Onset:2021-06-11
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 23
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: colace and famotidine
Current Illness:
Preexisting Conditions: ilieus , GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS, PARKINSON''S DISEASE, QUADRIPLEGIA, NONTRAUMATIC INTRACEREBRAL HEMORRHAGE
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: PE diagnosed 6/11/21 death 7/4/21


VAERS ID: 1478374 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-22
Onset:2021-03-31
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Bladder hypertrophy, Blood pressure increased, Condition aggravated, Confusional state, Death, Dizziness, Heart rate increased, Herpes zoster, Hypotension, Injection site mass, Laboratory test, Lung disorder, Lymphadenectomy, Mental status changes, Oedema, Pain in extremity, Pulmonary artery dilatation, Pulmonary hypertension, Pulmonary mass, Retroperitoneal lymphadenopathy, Splenic lesion, Tenderness, Urinary tract infection
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   Days after onset: 98
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra, Triamterene-HCTZ, Stiolto, Carvedilol, Testostereon, Xarelto, Levothyroxine, Diclofenac, Celecoxib
Current Illness: None
Preexisting Conditions: Hypothyroid, Hypertension, Hyperlipid, sleep apnea, seizure disorder, edema, history of a-fib, coronary artery disease, squamous cell carcinoma
Allergies: Aspirin, Valacyclovir
Diagnostic Lab Data: Numerous tests and labs performed during course of complaints from march to july. Increased conspicuity of pulomnary nodules, bibasilar interlobular septal thickening, dilated pulmonary artery, new splenic lesions and hypodensity, new bilateral inguinal, iliac chanin and retroperitoneal lymphadenopathy, urinary bladder wall thickening
CDC Split Type:

Write-up: Patient contacted the office 3/31/21 with complaints of arm/shoulder/axillary pains since receiving the vaccines, treated in office 4/5/21 for lump at injection site and continued axillary pain, treated 5/25/21 for shingles outbreak on chest, contacted office again 5/28/21 with elevated bp, heart rate and confusion- possible med reaction, contacted office 6/9/2021 with low blood pressure, dizziness, confusion, increased edema, treated 6/15/21 for urinary tract infection. Treated with oncology - notes from 4/13/21 notes patient is doing well, but with ''knot'' on arm and axillary tenderness following COVID vaccine, then notes from oncology 6/24/21 notes patient found to have new retroperitoneal and pelvic lyphadenopathy, along with new splenic lesions with sudden rapid change in mental status and new diagnosed pulmonary hypertension. Patient placed on hospice and deceased as of 7/7/2021


VAERS ID: 1478375 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-28
Onset:2021-05-16
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Parkinson''s dementia, multiple ischemic CVA''s, and HTN
Preexisting Conditions: Dementia, parkinsons disease, malnutrition, cerebral infarction
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient passed away 18 days after vaccine receipt. Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient had end-stage Parkinson''s dementia which was the cause of death. Not attributed to vaccination.


VAERS ID: 1478387 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-16
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Death, No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Dementia, spinal stenosis, overweight, varicose veins, history of subdural hemorrhage, BPH, CAD, aortic valve insufficiency, HLD, vitamin d deficiency, IFG, allergic rhinitis
Preexisting Conditions: Dementia, spinal stenosis, overweight, varicose veins, history of subdural hemorrhage, BPH, CAD, aortic valve insufficiency, HLD, vitamin d deficiency, IFG, allergic rhinitis
Allergies: Antihistamines, niacin, losartan, codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: death 13 days following receipt of vaccination. Patient was not previously COVID-19 positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Cause of death not documented. Significant comorbidities include dementia with neuropsychiatric behaviors including anxiety.


VAERS ID: 1478393 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-15
Onset:2021-06-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / UNK - / IM

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

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

Write-up: PT was found on floor in dining room expired by wife on 6/20/21 at approximately 7:30. Body was hard and cold. Called EMS immediately , EMS provided treatment. Declared dead. Body taken to coroner for autopsy.


VAERS ID: 1478430 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-25
Onset:2021-04-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Brain oedema, Cognitive disorder, Cyanosis, Emotional distress, Gun shot wound, Impaired driving ability, Intentional self-injury, Marital problem, Mental disorder, Swelling, Thinking abnormal
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Suicide/self-injury (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: medication for PTSD,
Current Illness: None
Preexisting Conditions: PTSD, bipolar
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The lot number for the first dose of vaccine was taken on 04/06/2021is: EW0153, and the lot number for the second dose of vaccine that was taken on 04/25/2021 is: EW0162. He started swelling really bad, and the mortician said all of his organs were very swollen. He was in terrible mental condition, he couldn''t think. He had so much swelling that his feet were blue. He was so swollen in his brain he couldn''t make basic cognitive decisions. His chest was so swollen his chest was up to almost double his normal size. He was under severe mental strain to the point that it took him 14 hours to make a 10 hour drive. He was dealing with maratil strain and shot himself on 05/20/2021.


VAERS ID: 1478607 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-21
Onset:2021-03-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   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: Lisinopril, Carvediol
Current Illness: UNK
Preexisting Conditions: Hypertension
Allergies: NKDA
Diagnostic Lab Data: Autopsy 03/24/2021
CDC Split Type:

Write-up: Received Vaccine on 03/21/2021 accoring to niece and had shortness of breath after. Found dead on 03/24/2021. No pneumonia, pulmonary thrombus or meningitis at autopsy but posmortem COVID test positive.


VAERS ID: 1478618 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-25
Onset:2021-07-15
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Death, Resuscitation, Seizure like phenomena, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: homebound client for vaccine outreach, this RN not precisely sure of circumstances leading up to "homebound" status.
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported deceased to public health today. Date of death: 7/15/2021. Sister of patient reports that case reported chest pain while at home walking on his treadmill, he then had to lie down and sister asked him if he was having pain and wanted ambulance called. Reports that patient declined 911 call. Sister then reports that patient had what looked like a seizure, but then went completely unresponsive, so she initiated CPR and called 911. Reports that CPR and 911 response was not successful and patient passed away.


VAERS ID: 1478647 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-11
Onset:2021-03-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Coma, Death, Pyrexia, Seizure
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 10
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: folic acid, furosemide, spironolactone, pantoprazole
Current Illness: heart failure (had an upcoming surgery scheduled before passing away)
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient began running a fever day 1 after vaccination, this exacerbated a seizure, he was admitted to the hospital on 3/13/21 and stayed in a coma until his death


VAERS ID: 1478698 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-10
Onset:2021-03-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Back pain, Chemotherapy, Death, Febrile neutropenia, Illness, Non-Hodgkin's lymphoma
SMQs:, Agranulocytosis (narrow), Haematopoietic leukopenia (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Malignant lymphomas (narrow), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   Days after onset: 116
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BLOOD PRESSURE MEDS. CURRENTLY UNKNOWN
Current Illness: NONE
Preexisting Conditions: UNKNOWN / NONE
Allergies: NONE
Diagnostic Lab Data: WE HAVE NOT BEEN GIVEN HER MEDICAL RECORDS AS OF THIS TIME
CDC Split Type:

Write-up: ILLNESS, LOWER ABDOMINAL PAIN, LOWER BACK AND UP SIDES - IN AND OUT OF DR.''S APPT. AND MEDS. FINALLY DIAGNOSED WITH NON-HODGKINS LYMPHOMA AROUND 6/6/2021 AND BEGAN CHEMO 6/28/2021. DECEASED FROM "NEUTROPENIC FEVER" (NOT OFFICAL AS THEY HAVE YET TO PRODUCE A DEATH CERTIFICATE.).


VAERS ID: 1478896 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-05-13
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Military       Purchased by: ?
Symptoms: Abdominal X-ray, Aspiration pleural cavity, Cardiogenic shock, Cerebrovascular accident, Chest X-ray, Computerised tomogram, Deep vein thrombosis, Echocardiogram, Electrocardiogram, Electroencephalogram, Endotracheal intubation, Magnetic resonance imaging head, Respiratory failure, Seizure, Thrombocytopenia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Ventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 9
Permanent Disability? No
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: Lisinopril, Furosemide, Metoprolol, Tamsulosin, Atorvastatin,
Current Illness: None
Preexisting Conditions: High Blood Pressure, High Cholesterol, Heart Valve Replacement 2013
Allergies: None
Diagnostic Lab Data: EKG, CT Scan,Multiple Chest X-Rays, Heart Ultrasound, xray of Abdomen, Brain MRI, Chest fluid Removal, EEG, Insertion of Breathing tube,
CDC Split Type:

Write-up: Cardiogenic shock, Respiratory failure, Ventricular fibrillation, thrombocytopenia, Acute Stroke, seizure, acute deep venous thrombosis


VAERS ID: 1479422 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-24
Onset:2021-05-13
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 13508314 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy lung, Death, Dyspnoea, Loss of consciousness, Malaise, Pneumonia, Pulmonary haemorrhage, Red blood cell count decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   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: nerve pain medication
Current Illness: none
Preexisting Conditions: she had a genetic disorder called NF2 she had been dealing with it for 47 yrs. but she was fine!
Allergies: none
Diagnostic Lab Data: they did a biopsy on her lungs to try to figure out why she was bleeding in her lungs. lots of blood test daily noticing her red blood cells were so low
CDC Split Type:

Write-up: after her first shot on FEB 24 she began looking white as ghost. She was very weak, unstable, in pain, and felt like her life force was getting drained out of her. Then her 2nd shot on MAR 24 and she continued to not feel good. On May 9th she lost consciousness on the bathroom floor, rushed to the ER. She was admitted and told she had pneumonia. By that evening she could not breathe. Her lungs filled with blood and she was dead within 6 days.


VAERS ID: 1481067 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 79
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210710119

Write-up: DEATH; SLIGHT HEADACHE; This spontaneous report received from a patient via social media (Blog) by a company representative concerned a 53 year old male. Initial information was processed along with the additional information received on 06-JUL-2021. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, and expiry: unknown) dose was not reported, 1 total administered on or around 13-APR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On APR-2021, after vaccination the patient experienced slight headache. On 19-JUN-2021, nine weeks after vaccination, the patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died on 19-JUN-2021, and the outcome of slight headache was not reported. This report was serious (Death). This case, from the same reporter is linked to 20210711387.; Sender''s Comments: V0: 20210710119-COVID-19 VACCINE AD26.COV2.S -Death. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1481132 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Vaccine breakthrough infection
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210724474

Write-up: BREAKTHROUGH CASE; This spontaneous report received from a health care professional via social media concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose,1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient was hospitalized at the time of death and was a vaccine breakthrough case. On an unspecified date, the patient died. It was unknown autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome was fatal. This report was serious (Death, and Hospitalization Caused / Prolonged). This report was associated with product quality complaint:90000185655; Sender''s Comments: V0; 20210724474 -covid-19 vaccine ad26.cov2- vaccine breakthrough case. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1481184 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210726824

Write-up: DEATH; This spontaneous report received from a consumer via social media company representative concerned a male of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2. s (suspension for injection, route of admin not reported, batch number: Unknown expiry: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died from unknown cause of death. It was reported that, the patient death occurred after getting the vaccine. It was unknown, if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2. s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210726824-Covid-19 vaccine ad26.cov2. s -Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1481259 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210730562

Write-up: PASSED AWAY DUE TO THE JOHNSON AND JOHNSON VACCINE; This spontaneous report received from a patient concerned a 4 decade old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown), 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient passed away due to the Johnson and Johnson vaccine and cause of death was unknown. It was unspecified if autopsy performed. Reporter just got off the phone with her cousin it was her best friend who passed away. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210730562-covid-19 vaccine ad26.cov2.s-passed away due to the Johnson and Johnson vaccine. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1481360 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-09
Onset:2021-07-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT DEATH


VAERS ID: 1481541 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-26
Onset:2021-05-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Myocarditis, Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lomotil Immodium
Current Illness: None. Had actually seen by her gyn-onc and colon surgery physicians and her stoma wound care nurse in the 3 days prior to her sudden death, and was given a clean bill of health.
Preexisting Conditions: Endometrial adenocarcinoma 5/2020 treated with definitive radiation therapy, palliative surgery, developed a colovaginal fistula and needed an ileostomy in 12/2020. She had a saddle pulmonary embolus in 6/2020.
Allergies: None
Diagnostic Lab Data: Autopsy noted myocarditis as the most significant anatomic finding.
CDC Split Type:

Write-up: Sudden cardiac arrest 5/30/21 (4 days after vaccination)


VAERS ID: 1481694 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, C-reactive protein, C-reactive protein increased, Death, Decreased appetite, Haemorrhage, Renal disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 48
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac disorder NOS
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210203; Test Name: CRP; Result Unstructured Data: 128 it gradually increased to 246 and 259
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Had given him vitamin K to stop the bleeding; kidneys started shouting down; Died; Raised C-reactive protein; Shoulder pain; Loss of appetite; Stomach discomfort; This case was initially received via an unknown source (no reference has been entered for a health authority or license partner) on 26-Feb-2021. The most recent information was received on 08-Jul-2021 and was forwarded to Moderna on 08-Jul-2021. This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of DEATH (Died) and HAEMORRHAGE (Had given him vitamin K to stop the bleeding) in a 73-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Cardiac disorder NOS. On 01-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Feb-2021, the patient experienced DECREASED APPETITE (Loss of appetite), ABDOMINAL DISCOMFORT (Stomach discomfort) and ARTHRALGIA (Shoulder pain). On 03-Feb-2021, the patient experienced C-REACTIVE PROTEIN INCREASED (Raised C-reactive protein). On an unknown date, the patient experienced HAEMORRHAGE (Had given him vitamin K to stop the bleeding) (seriousness criterion medically significant) and RENAL DISORDER (kidneys started shouting down). The patient was treated with VITAMIN K NOS for Bleeding, at an unspecified dose and frequency. The patient died on 23-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HAEMORRHAGE (Had given him vitamin K to stop the bleeding), RENAL DISORDER (kidneys started shouting down), DECREASED APPETITE (Loss of appetite), ABDOMINAL DISCOMFORT (Stomach discomfort), C-REACTIVE PROTEIN INCREASED (Raised C-reactive protein) and ARTHRALGIA (Shoulder pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Feb-2021, C-reactive protein: 128 (High) 128 it gradually increased to 246 and 259. Concomitant medications were not provided. The patient was given a steroid shot for raised c-reactive protein. On 01-Mar-2021 the patient''s kidneys started to shut down. On an unreported date, the patient was given Vitamin -K to stop unspecified bleeding. On 23-Mar-2021 the patient died, specific cause of death was not reported. Treatment included Vitamin K. Very limited information regarding these events has been provided at this time. Further information has been requested. Further information is not expected This case was linked to MOD-2021-252597 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 08-Jul-2021: Additional events reported: Patient died; kidneys started to shut down and bleeding. Current conditions updated to include ''heart patient''. Date of vaccine confirmed as first dose.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested. Further information is not expected; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1481741 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-06-27
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coma, Death, Disorientation, Malaise
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: feeling very ill; in an induced coma; in a complete disorientation; passed away; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DEATH (passed away), MALAISE (feeling very ill), COMA (in an induced coma) and DISORIENTATION (in a complete disorientation) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MALAISE (feeling very ill) (seriousness criterion hospitalization), COMA (in an induced coma) (seriousness criterion medically significant) and DISORIENTATION (in a complete disorientation) (seriousness criterion medically significant). The patient died on 27-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, MALAISE (feeling very ill), COMA (in an induced coma) and DISORIENTATION (in a complete disorientation) outcome was unknown. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) was not applicable. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1481758 (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: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / OT

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

Write-up: passed away; blood in lungs; This spontaneous case was reported by a pharmacist and describes the occurrence of DEATH (passed away) and PULMONARY HAEMORRHAGE (blood in lungs) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Jun-2021, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and PULMONARY HAEMORRHAGE (blood in lungs) (seriousness criteria death and medically significant). The patient died on 18-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: Very limited information regarding the events has been provided at this time. Further information is expected.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1481771 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-07
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriosclerosis, Parkinson's disease
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (Allergy to Sinemet)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Cause of death to be Parkinson''s Disease secondary to ASHD (atherosclerotic heart disease); Atherosclerotic Cardiovascular Disease; This spontaneous case was reported by a nurse and describes the occurrence of PARKINSON''S DISEASE (Cause of death to be Parkinson''s Disease secondary to ASHD (atherosclerotic heart disease)) and ARTERIOSCLEROSIS (Atherosclerotic Cardiovascular Disease) in an 84-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Allergy to Sinemet). On 07-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PARKINSON''S DISEASE (Cause of death to be Parkinson''s Disease secondary to ASHD (atherosclerotic heart disease)) (seriousness criteria death and medically significant) and ARTERIOSCLEROSIS (Atherosclerotic Cardiovascular Disease) (seriousness criterion death). The patient died on 08-Jul-2021. The reported cause of death was parkinson''s disease and Atherosclerotic cardiovascular disease. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The patient passed away (08Jul2021 at 4:10 PM). The HCP reported that the death certificate showed cause of death to be Parkinson''s Disease secondary to ASHD (atherosclerotic heart disease). No concomitant medication details was provided. No treatment medication details was provided. Very Limited information regarding the events has been provided at this time . Further information has been requested.; Sender''s Comments: Very Limited information regarding the events has been provided at this time . Further information has been requested.; Reported Cause(s) of Death: Parkinson''s Disease; Atherosclerotic Cardiovascular Disease


VAERS ID: 1481780 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-01
Onset:2021-06-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chills, Death, Dyspnoea, Joint swelling, Mobility decreased, Peripheral swelling, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure; Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: lungs filled up with fluids; terrible pain in his back; couldn''t lay had to sleep sat down; swelling of his ankles; swelling of his hands; shortness of breath; chills; died; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DEATH (died) and PULMONARY OEDEMA (lungs filled up with fluids) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. unknown) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Blood pressure and Diabetes. In May 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 an unknown date, the patient experienced PULMONARY OEDEMA (lungs filled up with fluids) (seriousness criterion medically significant), BACK PAIN (terrible pain in his back), MOBILITY DECREASED (couldn''t lay had to sleep sat down), JOINT SWELLING (swelling of his ankles), PERIPHERAL SWELLING (swelling of his hands), DYSPNOEA (shortness of breath) and CHILLS (chills). The patient died on 01-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PULMONARY OEDEMA (lungs filled up with fluids), BACK PAIN (terrible pain in his back), MOBILITY DECREASED (couldn''t lay had to sleep sat down), JOINT SWELLING (swelling of his ankles), PERIPHERAL SWELLING (swelling of his hands), DYSPNOEA (shortness of breath) and CHILLS (chills) outcome was unknown. No treatment medication was provided. Patient took concomitant medication for Blood pressure and Diabetes.; Sender''s Comments: This is case of death in a 72-year-old male patient with medical history of blood pressure and diabetes who died more than a month after receiving the mRNA-1273 vaccine. Cause of death was not reported. Very limited information regarding the event has been provided at this time. Further information has been requested. Based on the current available information and temporal association between the use of the product and the start date of the remaining events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1481796 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Toxicity to various agents
SMQs:, Anticholinergic syndrome (broad), Drug abuse and dependence (broad)

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

Write-up: Toxic effects of Moderna vaccine; This spontaneous case was reported by a consumer and describes the occurrence of TOXICITY TO VARIOUS AGENTS (Toxic effects of Moderna vaccine) in a 26-year-old male patient 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 TOXICITY TO VARIOUS AGENTS (Toxic effects of Moderna vaccine) (seriousness criterion death). The reported cause of death was toxic effects of moderna vaccine. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. No treatment information was provided. Company comment: Very limited information regarding this event has been provided at this time. Critical details including medical history, concomitant medication, date of vaccine administration and the event term, and cause of death is required for further assessment.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Critical details including medical history, concomitant medication, date of vaccine administration and the event term, and cause of death is required for further assessment.; Reported Cause(s) of Death: Toxic effects of Moderna vaccine


VAERS ID: 1481803 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-01-04
Onset:2021-02-07
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0111Z0A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Cerebrovascular accident, Erythema, Heart rate, Herpes zoster, Hypersensitivity, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE; HYDROXYZINE; DONEPEZIL; LISINOPRIL; MYRBETRIQ; TIMOLOL; LATANAPROST/TIMOLOL; VITAMIN D3
Current Illness: Alzheimer''s disease (Alzheimer''s Disease worsened after taking vaccination.); Chronic kidney disease stage 3 (Chronic Kidney Disease (CKD) Stage 3 or 4 worsened after taking vaccination); Glaucoma (Glaucoma); Incontinence (Incontinence); Thyroid disorder (Thyroid Disorder)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Blood Pressure; Result Unstructured Data: All within normal ranges; Test Date: 2021; Test Name: Body Temperature; Result Unstructured Data: All within normal ranges; Test Date: 2021; Test Name: Heart Rate; Result Unstructured Data: All within normal ranges
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Stroke; itching/pruritus; redness/erythema; Hypersensitivity reaction; Shingles; Rash; This spontaneous case was reported by a patient family member or friend and describes the occurrence of CEREBROVASCULAR ACCIDENT (Stroke), PRURITUS (itching/pruritus), ERYTHEMA (redness/erythema), HYPERSENSITIVITY (Hypersensitivity reaction), HERPES ZOSTER (Shingles) and RASH (Rash) in an 88-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 010MZ0A and 0111Z0A) for COVID-19 vaccination. Concurrent medical conditions included Alzheimer''s disease (Alzheimer''s Disease worsened after taking vaccination.), Thyroid disorder (Thyroid Disorder), Incontinence (Incontinence), Glaucoma (Glaucoma) and Chronic kidney disease stage 3 (Chronic Kidney Disease (CKD) Stage 3 or 4 worsened after taking vaccination). Concomitant products included DONEPEZIL from an unknown date to 01-Mar-2021 for Alzheimer''s disease, HYDROXYZINE from an unknown date to 01-Mar-2021 for Anxiety, LISINOPRIL from an unknown date to 01-Mar-2021 for Blood pressure fluctuation, TIMOLOL from an unknown date to 01-Mar-2021 and LATANOPROST, TIMOLOL MALEATE (LATANAPROST/TIMOLOL) from an unknown date to 01-Mar-2021 for Glaucoma, MIRABEGRON (MYRBETRIQ) from an unknown date to 01-Mar-2021 for Incontinence, LEVOTHYROXINE from an unknown date to 01-Mar-2021 for Thyroid disorder, VITAMIN D3 from an unknown date to 01-Mar-2021 for an unknown indication. On 04-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 07-Feb-2021, the patient experienced PRURITUS (itching/pruritus) (seriousness criterion death), ERYTHEMA (redness/erythema) (seriousness criterion death), HYPERSENSITIVITY (Hypersensitivity reaction) (seriousness criterion death), HERPES ZOSTER (Shingles) (seriousness criterion death) and RASH (Rash) (seriousness criterion death). On 01-Mar-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criteria death and medically significant). The patient died on 01-Mar-2021. The reported cause of death was Stroke. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Blood pressure measurement: normal mmHg (normal) All within normal ranges. In 2021, Body temperature: normal DF (normal) All within normal ranges. In 2021, Heart rate: normal (normal) All within normal ranges. Additional information was provided by the reporter that 7 days after taking vaccination patient got bumps, on left leg that spreaded to her groin region and all over her thighs, which were painless but itchy. Patient''s Home Health Nurse took pictures and sent to the physician on which the physician prescribed medications. Treatment information were not reported. This is a case of death in a 88-year-old female subject with a medical history of Alzheimer''s disease, Thyroid disorder, Incontinence, Glaucoma and Chronic kidney disease stage 3, who died 28 days after receiving the second dose of vaccine. Very limited information has been provided at this time. Further information has been requested. Additional information provided was that 7 days after taking vaccination patient got bumps, on left leg that spreaded to her groin region and all over her thighs, which were painless but itchy. Patient''s Home Health Nurse took pictures and sent to the physician on which the physician prescribed medications. This case was linked to MOD-2021-006200 (Patient Link). Reporter did not allow further contact; Reporter''s Comments: Event Outcomes were given as Recovered in SD but the patient has passed away so captured as Fatal.; Sender''s Comments: This is a case of death in a 88-year-old female subject with a medical history of Alzheimer''s disease, Thyroid disorder, Incontinence, Glaucoma and Chronic kidney disease stage 3, who died 28 days after receiving the second dose of vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Stroke


VAERS ID: 1481806 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arkansas  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood disorder, Blood test, Body temperature, Cough, Fatigue, Impaired work ability, Myocardial infarction, Pyrexia, Sinusitis, Thrombosis, Vaccination site pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 51
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: Blood disorder; Dialysis; Renal failure
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: normal; Test Date: 202102; Test Name: Temperature; Result Unstructured Data: started running a temperature
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Thick blood; Missed a whole week of work; second shot:-heart attack; second shot: tired; second shot- started running a temperature; second dose- throwing up; Sinus infection; second dose-coughing; second dose- blood clots; left arm was hurting; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (second shot:-heart attack) and THROMBOSIS (second dose- blood clots) 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. The patient''s past medical history included Renal failure. Concurrent medical conditions included Dialysis and Blood disorder. In January 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. In January 2021, the patient experienced VACCINATION SITE PAIN (left arm was hurting). On 14-Feb-2021, the patient experienced SINUSITIS (Sinus infection), COUGH (second dose-coughing) and VOMITING (second dose- throwing up). On 15-Feb-2021, the patient experienced FATIGUE (second shot: tired) and PYREXIA (second shot- started running a temperature). In February 2021, the patient experienced THROMBOSIS (second dose- blood clots) (seriousness criteria death and medically significant). On 21-Feb-2021, the patient experienced MYOCARDIAL INFARCTION (second shot:-heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced BLOOD DISORDER (Thick blood) and IMPAIRED WORK ABILITY (Missed a whole week of work). The patient was treated with IBUPROFEN for Fever, at an unspecified dose and frequency and ONDANSETRON (ZOFRAN MELT) for Stomach pain, at an unspecified dose and frequency. On 21-Feb-2021, SINUSITIS (Sinus infection), COUGH (second dose-coughing), VOMITING (second dose- throwing up) and FATIGUE (second shot: tired) outcome was unknown and PYREXIA (second shot- started running a temperature) had resolved with sequelae. The patient died on 21-Feb-2021. The reported cause of death was blood clots leading to heart attack. An autopsy was not performed. At the time of death, BLOOD DISORDER (Thick blood), IMPAIRED WORK ABILITY (Missed a whole week of work) and VACCINATION SITE PAIN (left arm was hurting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In February 2021, Body temperature: abnormal (abnormal) started running a temperature. On an unknown date, Blood test: normal (normal) normal. Patient took first dose of moderna vaccine in JAN 2021 and second dose in FEB 2021. Patients body temperature was 98-104 after taking ibuprofen for few days. Patient''s blood was thick as pancake syrup. Patient was on dialysis for 5 years before the shot. On 16 FEB 2021 Dialysis and blood work was done. Patient went to doctor on 19 FEB 2021. Patient missed her work a week from 15 FEB 2021 to 21 FEB 2021. Very limited information regarding this event/s has been provided at this time. Further information has been requested. This case was linked to MOD-2021-256627 (Patient Link).; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Blood clots leading to heart attack


VAERS ID: 1483122 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-10
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: Patient History: No
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021807831

Write-up: Received first dose on 27May2021/ received second dose on 10Jun2021; he had a massive heart attack; This is a spontaneous report from a contactable consumer (patient parent). A 36-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) Lot number EW0176, on 10Jun2021 at single dose (at the age of 36-year-old) for COVID-19 immunization. Medical history and concomitant medication were none. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) Lot number : EW0176, on 27May2021 and experienced chest pain. Reporter stated Pfizer drug kill the patient yesterday (28Jun2021). He had a massive heart attack in Jun2021. The outcome of massive heart attack was fatal. Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: he had a massive heart attack


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