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From the 9/17/2021 release of VAERS data:

Found 15,386 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

This is page 56 out of 154

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VAERS ID: 1483260 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021818626

Write-up: Ended up passing away about seven days after she received the second shot of the vaccine; Extreme headache; This is a spontaneous report from a non-contactable consumer. A female patient (reporter''s mother) of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), for covid-19 immunisation. Patient actually took both of the vaccines and she experienced extreme headache after she received her second vaccine and she ended up passing away, she ended up passing away about seven days after she received the second shot of the vaccine. The outcome of headache was unknown, while other event was fatal. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: Ended up passing away about seven days after she received the second shot of the vaccine


VAERS ID: 1483478 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:2021-02-08
Onset:2021-02-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021831962

Write-up: Heart attack; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 08Feb2021 as a Dose number unknown, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The reporter stated that, came to know a man who walked outside of the center and died right after the Covid vaccine from a heart attack. The reporter was unsure if it was Pfizer. People were there to help the patient right away and he still died. The reporter can''t find much information about this event on the internet because of censorship. On 08Feb2021, the patient collapsed and later died after leaving the vaccination site. The patient died 25 mins after receiving the vaccine. First responders got to the man in seconds, and he passed away in the hospital. It was not reported if an autopsy was performed or not. Information on the lot/batch number had been requested.; Reported Cause(s) of Death: Heart attack


VAERS ID: 1483486 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-06-16
Submitted: 0000-00-00
Entered: 2021-07-18
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: 2021-06-16
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021832027

Write-up: died in his sleep 3 days after taking the Pfizer covid vaccine; This is a spontaneous report from a contactable consumer. A 13-years-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose 2, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Historical Vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) for COVID-19 immunisation. The patient experienced died in his sleep, 3 days after taking Pfizer COVID vaccine on 16Jun2021. This is coincidental, this is not causative. Cause of death was unknown. No investigation assessment. The patient died on 16Jun2021. The county health department confirmed the investigation and the autopsy was being performed. The information is being sent the CDC to see if there is a correlation. The reporter mentions that we all know a lot of 13-year-old falling over for that. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Cause of death was unknown


VAERS ID: 1483490 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021832116

Write-up: I read a headline online that said a thirteen year old died in his sleep after taking the Pfizer vaccine and the CDC is investigating. Another article headline may have said it was a boy but; This is a spontaneous report from a contactable consumer via Pfizer Colleague. A 13-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection,Batch/Lot number was not reported) via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On an unspecified date, the reporter read a headline online that said a thirteen-year-old died in his sleep after taking the Pfizer vaccine and the CDC was investigating. Another article headline may have said it was a boy, but reporter can''t find that article again. The reporter don''t have a subscription to newsweek so could not read the article and get more specifics.The patient died on an unspecified date. It was unknown if an autopsy was performed. The outcome of event was reported as fatal. Follow up needed, further information was requested.; Reported Cause(s) of Death: a thirteen year old died in his sleep after taking the Pfizer vaccine


VAERS ID: 1483525 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-17
Onset:2021-06-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / OT

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Death, Dyspnoea, Oxygen saturation increased, SARS-CoV-2 test
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (if covid prior vaccination: Yes); Diabetes mellitus (other medical history: Muscular sclerosis, Myasthenia Gravis, Diabetes Mellitus); Multiple sclerosis (other medical history: Muscular sclerosis, Myasthenia Gravis, Diabetes Mellitus); Myasthenia gravis (other medical history: Muscular sclerosis, Myasthenia Gravis, Diabetes Mellitus)
Allergies:
Diagnostic Lab Data: Test Name: covid; Test Result: Positive ; Comments: if covid prior vaccination: Yes
CDC Split Type: USPFIZER INC2021839689

Write-up: Patient went into unexpected and sudden cardiac arrest and died on 18Jun2021, prior to cardiac arrest patient was short of breath and was using increased oxygen (5L to maintain at 92%); Patient went into unexpected and sudden cardiac arrest and died on 18Jun2021, prior to cardiac arrest patient was short of breath and was using increased oxygen (5L to maintain at 92%); Patient went into unexpected and sudden cardiac arrest and died on 18Jun2021, prior to cardiac arrest patient was short of breath and was using increased oxygen (5L to maintain at 92%); Patient went into unexpected and sudden cardiac arrest and died on 18Jun2021, prior to cardiac arrest patient was short of breath and was using increased oxygen (5L to maintain at 92%); This is a spontaneous report from a contactable nurse. A 65-years-old non pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via intramuscular route, administered in right arm on 17Jun2021 16:00 (age at vaccination: 65 years) as DOSE 1, SINGLE for covid-19 immunisation. The medical history included muscular sclerosis, myasthenia gravis, diabetes mellitus, multiple sclerosis and covid-19. The patient had covid prior vaccination. There were no known allergies. On 18Jun2021, the patient went into unexpected and sudden cardiac arrest and died, on 18Jun2021 22:00, prior to cardiac arrest patient was short of breath and was using increased oxygen (5l to maintain at 92%). The patient was attempted for resuscitation via CPR and EMS. On an unknown date, the patient underwent sars-cov-2 test which was positive. The patient received other medications received within 2 weeks of vaccination. The patient has not been tested for covid-19 since the vaccination. The patient died on 18Jun2021 due to cardiac arrest. An autopsy was not performed. The device timestamp was 04Jul2021. Information on Lot/Batch information has been requested.; Sender''s Comments: Based on temporal association, the causal relationship between BNT162B2 and the events, cardiac arrest, Dyspnea, Death cannot be completely ruled out. The impact of this report on benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethic committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Cardiac arrest


VAERS ID: 1483546 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-18
Onset:2021-04-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic aneurysm rupture, Herpes zoster, Investigation, Shock haemorrhagic
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypovolaemic shock conditions (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Dye in the bloodstream; Result Unstructured Data: Test Result:not reported; Comments: where they check for any "insularism
CDC Split Type: USPFIZER INC2021842299

Write-up: Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Passed away/Hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm; Shingles; This is a spontaneous report received from a contactable consumer or other non hcp (patient''s child). A 67-years-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/lot number: ER8731) via an unspecified route of administration in arm (arm shoulder) on 18Apr2021 (age at vaccination 67years old) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient had the test (before vaccination) where they put dye in the bloodstream and where they check for any "insularism" (presented as reported until clarified) or anything he had that process done, may be in March (result: not reported). There was no other prior vaccination. On 20Apr2021, the patient had shingles. He broke out to shingles 2 days after receiving the Pfizer Covid-19 vaccine, reported the shingles broke out. The patient went to the Doctor and they gave him some medicine (unspecified medication) for his pain (onset date: 2021). Therapeutic measures were taken as a result of shingles. In May2021 (one month to the date he got his vaccine exactly), the patient went into the hospital (as per death record but the patient told reporter that 2 days after getting the vaccine, he broke out shingles and when he called, they gave him a confirmation). The patient had hemorrhagic shock acute blood loss ruptured abdominal aortic aneurysm on an unspecified date and patient passed away (as per death record). The reporter stated that patient had passed away and reporter believed it was due to the Pfizer BioNTech Covid-19 Vaccine. The clinical outcome of the events shingles was unknown. The patient died on 20May2021. Autopsy was performed with results not reported. Follow-Up 07Jul2021: Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: hemorrhagic shock acute blood loss; Acute blood loss ruptured abdominal aortic aneurysm


VAERS ID: 1483624 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Organ test; Result Unstructured Data: Test Result:Normal Results; Comments: she was perfectly fine
CDC Split Type: USPFIZER INC2021873485

Write-up: Stroke; This is a spontaneous report received from a contactable consumer. This consumer reported for a female patient (reporters friend''s mom) that an unspecified age elder female patient received second dose BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, lot number and expiration date was not reported), via unspecified route of administration on an unspecified date in 2021 as dose 2, single for COVID-19 immunization. The patient medical history and concomitant medication was not reported. The patient previously took first dose BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, lot number and expiration date was not reported), via unspecified route on an unspecified date as single dose for COVID-19 immunization. On an unspecified date patient died she had a stroke, and they were trying to say that because she was older, she just passed her organ test, and she was perfectly fine and 2 days later after her second shot she had a stroke (Not clarified hence split not made) and it was like they keep on and understood that there were multiple reasons that someone could have a stroke specially if patient was older. The outcome of evet was fatal Information on the lot/batch number has been requested. Additional information is requested.; Reported Cause(s) of Death: stroke


VAERS ID: 1483629 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-29
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Cytokine storm, Deep vein thrombosis, Haemophagocytic lymphohistiocytosis, Nervous system disorder, Platelet count
SMQs:, Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
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 Name: Platelets; Result Unstructured Data: Test Result:15,000
CDC Split Type: USPFIZER INC2021879891

Write-up: Neurologic damage (Shaking/memory/speech/motorskills); DVT; Afib; Secondary hlh; Cytokine Storm; This is a spontaneous report from a Pfizer-sponsored program. A female patient of an unspecified age received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 29Mar2021 as single dose for covid-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection; Lot number: unknown), via an unspecified route of administration on unspecified date as single dose for COVID-19 immunization. The patient experienced neurologic damage (Shaking/memory/speech/motorskills), DVT, Afib, secondary hlh, cytokine storm on 2021. The patient was hospitalized for neurologic damage (Shaking/memory/speech/motorskills), dvt, Afib, Secondary hlh and cytokine storm from 12Apr2021 to an unknown date. The patient underwent lab tests and procedures which included platelet count: 15,000. The patient died on 12Jun2021. It was not reported if an autopsy was performed. The outcome of all the events was Fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Based on temporal association, the causal relationship between BNT162B2 and the events cannot be excluded. The information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available.,Linked Report(s) : US-PFIZER INC-2021879892 same source, different reporter/ patient; Reported Cause(s) of Death: The Pfizer shots killed my beautiful mother


VAERS ID: 1483859 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-14
Onset:2021-04-14
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metropolol Anti-depressant Cholosterol med.
Current Illness: None
Preexisting Conditions: Dementia
Allergies: Sulpha drugs
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Mom was feeling fine before she had the Moderna vaccines. A few weeks later, she became extremely ill. She died on May 14, 2021.


VAERS ID: 1483888 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-20
Onset:2021-03-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dysstasia, Guillain-Barre syndrome, Hypoaesthesia, Intensive care, Laboratory test, Mechanical ventilation, Paraesthesia, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Peripheral neuropathy (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), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Demyelination (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 63
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 62 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Many 3/29/2021 thru 5/29/2021
CDC Split Type:

Write-up: Tingling/numbness in feet on 3/27/2021. By 3/29/2021 woke up and could not stand. Went to local ER. Transferred to other hospital that evening. Put on ventilator 3/30/2021 for 2 weeks. Diagnose Guillian Barre Syndrome. Adverse reaction to GBS treatment caused kidney failure and many complications. In ICU 2 months then dies on 05/29/2021.


VAERS ID: 1483917 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-06-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiogenic shock, Intensive care, Respiratory failure
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: admitted with STEMI and acute hypoxic respiratory failure and severe cardiogenic shock requiring ICU vasopressor support.


VAERS ID: 1483928 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Neuralgic amyotrophy, Paralysis, Seizure, Sepsis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), 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), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 90
Permanent Disability? Yes
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: Left brachial plexus neuritis with paralysis 3 days after second covid shot. hospitalized again for seizure episode on 4/21/21 , hospitalized again for sepsis on 6/10/2021


VAERS ID: 1483976 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-03-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Gastroenteritis, General physical health deterioration
SMQs:, Noninfectious diarrhoea (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? 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: previously health, hospitalized on 3/11 for gastroenteritis, recovered well, received second shot of covid vaccine on 3/18, subsequently deteriorated in a TCU and died within one month.


VAERS ID: 1483977 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-03-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (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? 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: admitted on 4/1/21 for respiratory failure, COVID positive after completing 2 dose vaccine series, requiring ICU cares. expired in the ICU.


VAERS ID: 1483980 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-03-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: admitted with sepsis secondary to pneumonia, later readmitted and died


VAERS ID: 1484023 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-08
Onset:2021-03-24
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Bedridden, COVID-19, Dyspnoea exertional, Oedema, SARS-CoV-2 test positive, Unresponsive to stimuli, Urinary incontinence, Weight decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions: end stage CHF, Atrial Fib, Diabetes, Renal Cell cancer - one kidney removed.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was in decline in the last month due to increase weakness and increase edema. Daughter visited, found patient unresponsive, taken to hospital - found to be Covid Positive. Patient had had a 15lbs weight loss, had become bed bound, SOB on minimum exertion, incontinent of bowel & bladder. Patient had a pacemaker placed 3 weeks ago. Patient taken to hospice


VAERS ID: 1484030 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-25
Onset:2021-04-06
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Depression, Alzheimer''s, GERD, Chronic Kidney Disease,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4/6/21: unwell , tested for Covid 4/15/21: Patient condition continues to decline - family informed 4/15/2021, 8:56am Patient expired


VAERS ID: 1484098 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-05-01
Onset:2021-06-19
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, Blood lactic acid, Blood pressure decreased, COVID-19, COVID-19 pneumonia, Confusional state, Death, Haematocrit decreased, Haemoglobin decreased, Hypotension, Hypoxia, Oxygen saturation decreased, Pyrexia, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Sepsis, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 15
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: Aspirin, norvasc, lipitor, plavix, iron, meclizine, oasis, metformin, carvedilol, januvia, norco, medrol dose pack, allopurinol, zeta,
Current Illness: None
Preexisting Conditions: DMII, obesity, HTN, CAD, non obstructive, OSA, on cpap, gout, hypercholesterolemia, GERD, Hx of CVA with left facial droop, chronic kidney disease
Allergies: Lisinopril
Diagnostic Lab Data: 6/19/2021, positive rapid antigen for SARS-CoV2, on 7/4/2021, hemoglobin at 6.4, hematocrit at 19.8, WBC at 16.64, sed rate at 23, creatinine at 1.4 , lactate at 4.6
CDC Split Type:

Write-up: This patient developed COVID-19 about 3 weeks after being vaccinated. The patient had the Janssen adenovirus COVID-19 vaccine at a local pharmacy. She developed COVID-19 on 6/19/2021 and was diagnosed at the urgent care, placed on Zithromax, medrol dosepak, and albuterol MDI. Also was placed on hydroxychloroquine. She developed hypoxia on the 25th of June, and acute on chronic renal failure, was transferred for higher level of care to medical Center. Discharged eventually and re-presented on 7/1/2021. Was sent home with continued oxygen. Patient was confused and kept taking oxygen off at home and was direct admitted by myself on7/1/2021. I was treating her daughter for the same infection (COVID-19). The patient rebounded, had normal mental status, but continued to have signs and symptoms of a severe COVID-19 pneumonia. On 7/4/2021, the patient had a sudden escalation in oxygen requirement, sudden drop in blood pressure, and she became febrile and hypotension and septic. She did not recover. Eventually family elected to withdraw care and the patient expired. Was on remdesivir,dexamethasone, had a dose of actemra, had vitamin C, Vitamin D, zinc


VAERS ID: 1484107 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-08
Onset:2021-07-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: arrhythmia, presumed MI, death


VAERS ID: 1484118 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-18
Onset:2021-07-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   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: Aspirin
Current Illness: Nil
Preexisting Conditions: Nil
Allergies: Nil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1484524 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-09
Onset:2021-06-30
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   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: Potassium Chloride
Current Illness: acute kidney failure, acute respiratory failure, anemia, blepharitis, acidosis, encephalopathy, hyperkalemia, sepsis, and a previous COVID-19 diagnosis
Preexisting Conditions: developmentally delayed, seizures
Allergies: unknown
Diagnostic Lab Data: a second COVID swab was done post-mortem, those results are pending
CDC Split Type:

Write-up: death 18 days after vaccine


VAERS ID: 1484573 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-01
Onset:2021-06-27
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, COVID-19, Cardiac failure acute, Cardiogenic shock, Condition aggravated, Cough, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Renal replacement therapy, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), 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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   Days after onset: 15
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: N/A - Unknown
Current Illness: N/A - unknown
Preexisting Conditions: CHF, COPD on 2 L of oxygen baseline, A. fib on Xarelto, hypertension, lymphedema, chronic kidney disease, gout, chronic pain, hyperlipidemia, alcohol abuse, anemia
Allergies: No known drug allergies
Diagnostic Lab Data: COVID PUI LIAT 6/27/21 @ 22:20 - positive
CDC Split Type:

Write-up: 74 year old male with a past medical history of CHF, CKD stage III, paroxysmal atrial fibrillation treated on Xarelto, hypertension, hyperlipidemia, history of alcohol abuse who presented to hospital postacute care with hypoxemia and worsening shortness of breath over the previous week. He noticed a progression of the shortness of breath and subsequently developed cough without productive sputum. Due to his worsening shortness of breath and cough he underwent PCR testing for COVID-19 was found to be positive. He reports that he received 2 doses of the Pfizer Covid vaccine the last of which was 6 weeks ago. The patient had an extensive hospital stay that included acute decompensated heart failure, ARDS with COVID, intubation, cardiogenic shock, and AKI on CKD requiring CRRT. His family ultimately made the decision to transition to hospice care and the patient passed away 7/12/21.


VAERS ID: 1484587 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-11
Onset:2021-01-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Daughter called on 07/19/21 and stated patient had a CVA on 01/17/2021. Patient was transported to Hospital and patient died on 01/23/2021.


VAERS ID: 1484651 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-08
Onset:2021-06-02
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown, ptpt not a primary care ptpt at clinic
Allergies: NKA
Diagnostic Lab Data: No further information provided.
CDC Split Type:

Write-up: Daughter, came to clinic and informed participant, passed away on 6/2/21 from COVID complications at Hospital.


VAERS ID: 1484665 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-07-17
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chills, Death, Diarrhoea, Dyspnoea, Intensive care, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: COVID 19 Death - 7/17/2021 - Admitted to ICU from ED with symptoms of shortness of breath, productive cough, diarrhea, and chills. Started 1 week ago. COVID19 PCR positive while in ED. Diagnosed with COVID19 Pneumonia. Expired later on same day 7/17/2021.
CDC Split Type:

Write-up: COVID 19 Death - 7/17/2021 - Admitted to ICU from ED with symptoms of shortness of breath, productive cough, diarrhea, and chills. Started 1 week ago. COVID19 PCR positive while in ED. Diagnosed with COVID19 Pneumonia. Expired later on same day 7/17/2021.


VAERS ID: 1484677 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-07-06
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Carditis, Death, Electrocardiogram abnormal, Inflammation
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-06
   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: Hair, Skin, nail vitamin B6 Calcium
Current Illness:
Preexisting Conditions: LUpus
Allergies: NONE
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Daughter stated that patient passed on 07/06, a few weeks after getting her 1st vaccine. Daughter stated that she noticed that her mother had stomach pains the day before and the day of passing. Daughter stated tat Mother had EKG test and heart inflammation was found. Patient passed due to heart inflammation.


VAERS ID: 1484736 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-06
Onset:2021-05-26
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Anxiety, Depression
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s mother states that after receiving the 2nd dose of Phizer vaccine the Pt. collapsed 05/26/2021 and passed away. Currently waiting for Autopsy results.


VAERS ID: 1484890 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-09
Onset:2021-06-29
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: telmisartan, labetalol, amlodipine, KDur, lasix, aspirin, lipitor, gabapentin, allopurinal, vitamin D2, amitriptyline, integra
Current Illness: refractory anemia, headahces, hypercholesterolemia, CAD with HTN, systolic heart failure
Preexisting Conditions: white matter disease, history of hodgkin''s lymphoma
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death, found dead at home


VAERS ID: 1484899 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-01
Onset:2021-05-25
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain stem haemorrhage, Computerised tomogram head abnormal, Death, Intracranial aneurysm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   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: Veralin PM
Current Illness: None
Preexisting Conditions: Irregular heartbeat, joint replacements
Allergies: Penicillin, oxycontin
Diagnostic Lab Data: CT scan
CDC Split Type:

Write-up: Brain aneurysm with no prior symptoms and no medical history or family history of aneurysms. Grade three hemorrhage at brain stem. Resulting in death


VAERS ID: 1484908 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-22
Onset:2021-07-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   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 J18.9 - Pneumonia N17.9 - Acute renal injury


VAERS ID: 1484918 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-07-17
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Seizure like phenomena
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), Convulsions (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death R56.9 - Seizure-like activity (CMS/HCC) Cardiac arrest


VAERS ID: 1484925 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-06
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 10
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 - Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung - Acute kidney failure, unspecified


VAERS ID: 1484930 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-07-03
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Blood osmolarity decreased, Death, Hyponatraemia
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), Hyponatraemia/SIADH (narrow), Chronic kidney disease (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: 2021-07-16
   Days after onset: 13
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 E87.1 - Hypo-osmolality and hyponatremia N17.9 - AKI (acute kidney injury) (CMS/HCC)


VAERS ID: 1484940 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-06-28
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), 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: 2021-07-15
   Days after onset: 17
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 (non-ST elevated myocardial infarction) (acute kidney injury)


VAERS ID: 1484959 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-07-08
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Facial paresis
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   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 Acute CVA (cerebrovascular accident) Facial weakness


VAERS ID: 1484966 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-12
Onset:2021-07-06
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood osmolarity decreased, Death, Hyponatraemia
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), Hyponatraemia/SIADH (narrow), Chronic kidney disease (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: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - Acute kidney failure, unspecified E87.1 - Hypo-osmolality and hyponatremia


VAERS ID: 1484972 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-07-03
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I61.9 - Intracerebral hemorrhage (CMS/HCC)


VAERS ID: 1485039 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-28
Onset:2021-07-17
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac death, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   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: N/A
Current Illness: High Pressure; Neuropathy; Diabetes
Preexisting Conditions: Diabetes; High Pressure
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of a heart attack on 07/17/2020 while sleeping.


VAERS ID: 1485145 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-31
Onset:2021-04-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain operation, Cerebral haemorrhage, Loss of consciousness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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:
Current Illness: no
Preexisting Conditions: gastrointestinal
Allergies: no
Diagnostic Lab Data: surgery on brain found HEMERAGE
CDC Split Type:

Write-up: Woke up at 5am and transported to hospital . never regain conciousmess


VAERS ID: 1485157 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-03-20
Onset:2021-03-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Amphetamines, Autopsy, Blood cannabinoids, Blood chloride, Blood creatinine, Blood potassium, Blood sodium, Blood urea, Cardiac disorder, Death, Drug abuse, Drug screen, Pneumonia
SMQs:, Drug abuse and dependence (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   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: amlodipine, aspirin, atorvastatin, lisinopril, metformin, Tresiba flextouch U-100, Vitamin D3
Current Illness:
Preexisting Conditions: Type 2 diabetes, essential hypertension, body mass index $g30 - obesity, hypertriglyceridemia, substance abuse
Allergies: NKDA
Diagnostic Lab Data: Drug screen for amphetamine, methamphetamin, delta-9 carboxy THC, Delta-9 THC, creatinine, sodium, potassium, chloride, urea nitrogen
CDC Split Type:

Write-up: Death - coroner''s report received on 7/15/2021. Coroner Dr performed an autopsy and determined the cause of death as brochopneumonia. Heart disease and drug use also contributed to his death. The manner of death is natural.


VAERS ID: 1485234 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-16
Onset:2021-07-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   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: INSULIN LISPRO, DIGOXIN,PAROXETINE MESYLATE, PRO-STAT, VYNDAMAX, MIRTAZAPINE, POTASSIUM, MULTIVITAMINS, LOPERAMIDE HCL, ADVAIR DISKUS, BUMETANIDE, ATORVASTATIN, APIXABAN, PANTOPRAZOLE SODIUM, LOSARTAN POTASSIUM
Current Illness:
Preexisting Conditions: CHF, DIABETES MELLITUS TYPE 2, UNSPECIFIED ASTHMA, ABNORMAL POSTURE, ATRIAL FLUTTER, HYPOOSMOLALITY, HYPONATREMIA, ABNORMAL LEVELS OF ENZYMES, GERD, DEPRSSIVE DISORDER, FLUID OVERLOAD, HYPERTENSIVE AND HEART DISEASE, HYPERLIPIDEMIA, ANEMIA, ATRIAL FIBRILLATION
Allergies: SULFA, ERYTHROMYCIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH THE FOLLOWING DAY


VAERS ID: 1485423 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-13
Onset:2021-07-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Pyrexia, Respiratory distress, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   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: Mycophenolate mofetil, rituximab (last administered 4/2021), losartan, furosemide, metoclopramide, cyclobenzaprine, gabapentin, calcium carbonate
Current Illness: He had an ED visit for headaches (which resolved after administration of migraine cocktail), with normal head imaging.
Preexisting Conditions: Mixed connective tissue disease complicated by ILD (which was stable on most recent imaging and PFTs), pulmonary hypertension (with normal RVSP on recent echocardiogram), Raynaud''s , and sensory $g$g motor polyneuropathy.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: After his office visit with me on Tuesday 7/13, the patient went to get the Moderna COVID vaccine. He received the vaccine on Tuesday evening. On Wednesday, he developed new fevers as high as 104F (measured at home). Fevers improved with Tylenol. He did not report his symptoms, as per his wife, he assumed this was related to the COVID vaccine. By the following morning, his fevers had resolved. He took a nap midday, and shortly after waking, he reported to his wife that he was feeling short of breath. According to his wife, he appeared in respiratory distress and she heard wheezing. He asked to be helped to the ground, and she immediately called EMS. Unfortunately, before they could get him to a hospital, he died. At the hospital, his wife was told that because his death was outside the hospital, it was presumed to be due to "natural causes". She was told an autopsy would cost $5000, which she could not afford.


VAERS ID: 1485987 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-02
Onset:2021-05-21
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017821A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood test, Cardiac failure congestive, Cough, Death, Dyspnoea, Dyspnoea exertional, Echocardiogram, Fatigue, Laboratory test, Leukaemia, Muscular weakness, Peripheral swelling, Walking aid user
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 41
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:
Current Illness:
Preexisting Conditions: Diabetes, COPD
Allergies: Sulfa
Diagnostic Lab Data: 6/22/21 Echo-cardiogram; 6/22/21 blood work (no results yet); numerous tests in hospital 6/24-30/21
CDC Split Type:

Write-up: Within 4-6 weeks of the second vaccine, patient started showing signs of shortness of breathe, swollen feet, cough, weak muscles, tired and no energy. patient had been walking with walker up to that point 5 times a week for 15-20 minutes. Since these symptoms began, he was not been able to walk more than a few feet without resting and being out of breath. He had been put on a diuretic and inhaler which didn''t seem to be doing much. He saw his primary and heart Dr since the beginning of June. On June 24th he was admitted into the Hospital with Congestive Heart Failure. After blood tests, he was also diagnosed with Leukemia. A week later, on July 1, 2021, patient passed away.


VAERS ID: 1485991 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-10
Onset:2021-04-14
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Full blood count, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole, zoloft, anacin, singulair, miralax
Current Illness: Myelodysplastic Syndrome
Preexisting Conditions: Myelodysplastic Syndrome - approximately 5 years that he was managing with blood transfusions after chemotherapy didn''t seem to help.
Allergies: penicillin
Diagnostic Lab Data: White Blood Cell counts from 2/19/2021 through 4/23/2021 2/19 - 6.6 2/23 - 4.6 2/26 - 5.8 3/2 - 7.0 3/5 - 7.2 3/9 - 8.5 3/12 - 7.7 3/16 - 6.7 3/19 - 4.8 3/23 - 5.8 3/26 - 6.4 3/30 - 6.5 4/2 - 6.4 4/6 - 7.4 4/8 - 6.8 4/14 - 11.3 4/16 - 18.8 4/20 - 23.0 4/23 - 27.3 I have all of these lab results saved if you would like to see the entire CBC.
CDC Split Type:

Write-up: White blood cell count almost doubled one month after the second vaccine and nearly tripled 6 weeks after the second vaccine. Patient was placed on hospice on April 23rd and passed away on May 8th.


VAERS ID: 1486022 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-25
Onset:2021-04-12
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Confusional state, Death, Dizziness, Dyspnoea, Hallucination, Myasthenia gravis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart attack (20 years ago)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Myasthenia Gravis; Death; Hallucinations; confusion; shortness of breath; dizziness; stroke like symptoms; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death), MYASTHENIA GRAVIS (Myasthenia Gravis) and HALLUCINATION (Hallucinations) in an 85-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. The patient''s past medical history included Heart attack (20 years ago). On 25-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced MYASTHENIA GRAVIS (Myasthenia Gravis) (seriousness criteria death, hospitalization prolonged and medically significant), HALLUCINATION (Hallucinations) (seriousness criterion medically significant), CONFUSIONAL STATE (confusion), DYSPNOEA (shortness of breath), DIZZINESS (dizziness) and CHEST DISCOMFORT (stroke like symptoms). The patient died on 12-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HALLUCINATION (Hallucinations), CONFUSIONAL STATE (confusion), DYSPNOEA (shortness of breath), DIZZINESS (dizziness) and CHEST DISCOMFORT (stroke like symptoms) outcome was unknown. Patient started experiencing side effects 2 weeks after taking the vaccine. He was taken to the hospital for stroke like symptoms but it was ruled out by X-ray. He went to the hospital as symptoms persisted & got admitted on 13March2021. He died 24 hour later after being diagnosed with Myasthenia Gravis and thymus removal refusal. Concomitant medications were not provided by the reporter. Treatment medications were not provided by the reporter. 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: unknown cause of death


VAERS ID: 1486071 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-09
Onset:2021-07-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Cough, Diarrhoea, Dyspnoea, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: General complaints of feeling unwell, no specific symptoms
Preexisting Conditions: DM 2
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: daily fever of 103.3, cough, diarrhea, chest pain, SOB, sore throat


VAERS ID: 1486322 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021856673

Write-up: stroke; This is a spontaneous report from a contactable other hcp. The other hcp reported for both the husband and wife, this is the case for wife. A female patient of an unspecified age received bnt162b2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN), via an unspecified route of administration on unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced stroke on unspecified date and died. It was not reported if an autopsy was performed. Information about batch/lot number has been requested.; Sender''s Comments: Based on known drug safety profile, there is reasonable possibility of causal association between the event Cerebrovascular accident and the suspect drug bnt162b2. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-2021856461 Same reporter/ drug/event, different patients; Reported Cause(s) of Death: stroke


VAERS ID: 1486583 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-29
Onset:2021-05-12
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / N/A UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abstains from alcohol, Aortic arteriosclerosis, Arteriosclerosis, Cholelithiasis, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Death, Decreased appetite, General physical health deterioration, Hepatic cirrhosis, Hepatic mass, Hepatomegaly, Induration, Lymphadenopathy, Metastases to lung, Pulmonary mass, Ultrasound abdomen abnormal, Umbilical hernia, Weight decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 65
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: Levothyroxine, timolol, crestor, lisinopril, tramadol prn, lantus, novolog
Current Illness: None
Preexisting Conditions: DM-2, HTN, Hyperlipidemia, OA, Hx Melanoma s/p excision 2008/No hx of recurrence (has annual dermatology checks and f/u)
Allergies: PCN
Diagnostic Lab Data: 6/30/2021 CT abd/pelvis Mild hepatomegaly. Hepatic contour suggest possible cirrhosis. Poorly defined focus of low attenuation in right lobe of liver suggesting an infiltrative lesion possibly representing a neoplasm. The area of involvement is difficult to accurately measure but is approximately 6.5 x 8.4 cm. There are no other focal hepatic lesions. The contour of the liver is slightly lobular suggesting possible hepatic cirrhosis.Consideration for hepatocellular carcinoma should be given based on this appearance. Limited images above the diaphragms demonstrate multiple pulmonary nodules bilaterally. In patient with liver lesion the findings are concerning for possible metastatic involvement of the lungs. Significant calcification of distal abdominal aorta and iliac arteries bilaterally. Small periumbilical hernia. Cholelithiasis. 7/13/21 CT abd/pelvis 1. Pulmonary metastatic disease suspect. Pattern stable 2. Cirrhotic liver. Large right lobe liver mass cannot be excluded. 3. Pathologic adenopathy in multiple locations as described. 4. Induration about the celiac and SMA be manifestation of lymphatic obstruction. The liver has a micronodular contour. Question cirrhosis. Diffusely nonuniform liver density pattern with a broad low-density focus involving the entire right lobe measuring up to 14 cm. There is induration of the fat about the celiac and SMA origins. There is peripancreatic adenopathy in adenopathy in the porta hepatis. Porta hepatis nodes measure up to 18 mm. These lymph nodes appear progressive There is aorticocaval and periaortic adenopathy as well. These retroperitoneal nodes measure up to 18 mm. No pelvic adenopathy
CDC Split Type:

Write-up: Pt was in his usual state of health. He received the J and J Covid 19 vaccine on 4/29/2021. By Mid May pt c/o sudden decline c/o sudden abdominal pain and poor appetite and lost 9 lbs by the end of may. In June the pain and poor appetite worsened and he saw his primary care provider who recommended an abdominal u/s and then a ct scan which showed liver masses/lung metastasis and lymphadenopathy . She scheduled a PET Scan and biopsy but the cancer progressed so rapidly a full work up including a biopsy and PET scan could not be done and he expired the afternoon of 7/16/21. Comparing the 2 CT scans he had on 6/30/21 and 7/13/21 show that the cancer rapidly progressed from 6.5 x 8.4cm lesion in the right lobe of the liver with no adenopathy seen and pulmonary nodules suggestive of metastatic disease to in 13 days the lesion encompassing the entire R lobe of the liver and then measuring 14 cm with no rapid progression of diffuse adenopathy and possible lymphatic obstruction. He was not a smoker (quit over 30 yrs ago per family and only smoked while in the military) and did not drink alcohol. His family denies any history of toxin exposure and He worked as a prison guard and then as a teacher. He was active prior and actively golfed, worked in the garden and was active in the gun club. He had no hx of hepatitis C. He had a past history of Melanoma s/p local incision 2008 with no history of recurrence. He was compliant with annual dermatology follow ups with no signs or symptoms of recurrence.


VAERS ID: 1486590 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-25
Onset:2021-06-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Patient was found at home passed away. no autopsy was performed to determine cause of death-Severe, Additional Details: Patient received his vaccine from our pharmacy. He waited for 15 minutes after vaccine and no adverse effects were reported. Niece states he went home and was found passed away in his room two hours later


VAERS ID: 1486784 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral thrombosis, Death, Deep vein thrombosis, Pulmonary thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 63
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Developmental delay since birth with limited speech and inability to read, Cardiac patent foramen ovale
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lower extremity deep vein thromboses, pulmonary thromboses, cerebral thromboses and hemorrhage, death


VAERS ID: 1486808 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-07-07
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   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 renal failure, unspecified acute renal failure


VAERS ID: 1486814 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-05-19
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 52
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.


VAERS ID: 1486815 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-06-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 UN / SYR

Administered by: Pharmacy       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: 2021-06-14
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Cause of death was heart attack.
CDC Split Type:

Write-up: Death. Body was found and pronounced dead on 6/14/2021. It is assumed he died on 6/4/2021 as body was badly decomposed at time he was pronounced dead.


VAERS ID: 1486852 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EB7533 / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood pH decreased, Cardiac arrest, Cardioversion, Confusional state, Death, Echocardiogram abnormal, Ejection fraction decreased, Laboratory test, Resuscitation, Seizure, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   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: None
Current Illness: fever 101.6 for 3 days after vaccine
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Terminal echo 30- 35 % EF WBC 43.3 ABG PH 6.8 BE-28
CDC Split Type:

Write-up: 4/14/21 became confused and had cardiac arrest with seizure EMS called 1757 was taken to 2 hospitals with multiple resuscitation efforts and defibrillations declared deceased 0042 4/15/2021


VAERS ID: 1486859 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-04
Onset:2021-02-19
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M2011 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain death, Computerised tomogram head abnormal, Fall, Fatigue, Fibrin D dimer, Haemorrhage intracranial, Headache, Intensive care, Laboratory test normal, Loss of consciousness, Malaise, Motor dysfunction, Organ donor, Pain in extremity, Platelet count normal, Respiration abnormal, Snoring, Trismus, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (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), Akathisia (broad), Dyskinesia (broad), Dystonia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 1
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: Lisinopril 10mg daily; Metoprolol 100mg daily; Vit D3 25mcg daily; Azelastine HCL twice a day; Fluticasone 50mcg twice a day; MVI daily; Tums one daily; Sertraline HCL 150mg daily; Ec ASA 81mg daily; Atorvastatin Calcium 10mg once daily a
Current Illness: NONE
Preexisting Conditions: Depression; Gout; Hypertrophic obstructive cardiomyopathy; Vit D deficiency; Gastroesophageal reflux disease; Hyperlipidemia; essential hypertension
Allergies: Penicillins
Diagnostic Lab Data: Platelet Ct 207; D Dimer 691; other labs within normal limits. No alcohol or drugs noted.
CDC Split Type:

Write-up: 2/19/2021; 15 days after receiving 1st Moderna vaccine. Pt had no complaints other than sore arm and tiredness after vaccination. Skiing with family; walking in ski boots to get skis on. She complained of sudden onset of headache and "not feeling well". Ski patrol was nearby and got her a glass of water. Patient stood up and fell to the ground unconscious. Taken to ski patrol hut; unresponsive with left sided deficits, snoring respirations & trisamus present. Unable to transport to major medical center due to adverse weather. Taken by ambulance to local hospital. CT showed significant hyperdense acute intracranial blood including lateral ventricles, 3rd & 4th ventricles with parenchymal blood in right greater than left bilateral parietal periventricle regions. Left midline shift. ER Physician: Transported to Medical Center via air & then ambulance due to adverse weather. Overnight in Neuro ICU; brain dead; organ donation.


VAERS ID: 1486881 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-26
Onset:2021-05-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Death, Dyspnoea, Pneumonia, 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), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 2 puffs BID, Amlodipine 10 mg QD, Benazepril 40 mg Q, Atorvastatin 40 mg QD, Clopidogrel 75 mg QD, CoenzymeQ10 100 mg QD, Ferrous Sulfate 325 mg BID, Culturelle QD, Dulera 100/5 2 puffs QD, Multivitamin QD, Sildenafil 100 mg PRN.
Current Illness:
Preexisting Conditions: Anemia, hyperlipidemia, hypertension, COPD, History of MI (2006), PVD,
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received two doses of Moderna Vaccine at a Facility on the reported dates of 3/16/21 and 4/14/21. On 7/5/21 patient presented to ED with complaints of breathing difficulties and was diagnosed with multifocal pneumonia and COVID Positive with symptom onset of 7/1/21. Patient subsequently developed acute renal failure.Patient expired on 7/19/21 from complications of acute hypoxic respiratory failure due to COVID-19.


VAERS ID: 1486995 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-19
Onset:2021-04-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B12A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood gases, Chest X-ray abnormal, Chest scan, Cough, Diarrhoea, Dyspnoea, Fatigue, Fibrin D dimer, Laboratory test, Lung opacity, Nausea, Pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: morbid obesity, hypertension, chronic back pain
Allergies: Fentanyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath, fatigue, body aches, cough, diarrhea, nausea. Supplemental nasal cannula O2, labs, VBG, D-Dimer, chest imaging, COVID-19 test. Low probability of pulmonary embolism; CXR- bilateral hazy opacities on wet read; dexamethasone


VAERS ID: 1487226 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-07-02
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: methadone, tramadol, furosemide, depakote, metformin, klor-con, prilosec, coreg, iron, colestid, lanoxin, cymbalta, namenda, lisinopril, norvasc, xalatan, cosopt, prednisolone, simethicone, aspirin, narcan, tylenol, vit b6, vit d3, melatoni
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/02/2021


VAERS ID: 1487263 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-16
Onset:2021-06-03
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cozaar, Cymbalta, Prilosec, Ativan, Imitrex, aspirin
Current Illness:
Preexisting Conditions:
Allergies: Gabapentin, Maxalt
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 06/03/2021


VAERS ID: 1487270 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-07-09
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   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: albuterol, dulcolax, senna, tylenol, roxanol, haldol, ativan, atropine sulfate, diphenhist, benadryl
Current Illness:
Preexisting Conditions:
Allergies: Brazil nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/09/2021


VAERS ID: 1487285 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-23
Onset:2021-07-12
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, Imdur, Klor-Con, Lasix, Prinivil, Norvasc, magnesium oxide, Flaxseed oil, calcium/vitamin D, cerovite senior tab, plavix, toprol, pepcid, tylenol, aspirin
Current Illness:
Preexisting Conditions:
Allergies: Zocor, Crestor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/12/2021


VAERS ID: 1487290 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-06-25
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oxycodone, ferrous sulfate, amiodarone, vit d3, citalopram, clonazepam, furosemide, hydralazine, lansoprazole, mag chloride, melatonin, minoxidil, acetaminophen
Current Illness:
Preexisting Conditions:
Allergies: Blood-group specific substance- anti-c
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 06/25/2021


VAERS ID: 1487364 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-01
Onset:2021-07-04
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Dyspnoea, Neurodegenerative disorder, Paralysis, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   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: potassium, levothyroxine, tizanidine, gabapentin, diflofenac
Current Illness: polyneuropathy, arthritis, chronic back pain, hyperesthesia, history of falls Patient did not go for follow-up
Preexisting Conditions: as above
Allergies: NKDA
Diagnostic Lab Data: none went on hospice
CDC Split Type:

Write-up: patient went on hospice 7/16/21 and expired 7/17/21 developed sudden neuro degenerative disease unspecified with paralysis of lower extremities first then arms, neck and complained of shortness of breath, swelling left and then progressive swelling


VAERS ID: 1487409 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-05-19
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Cerebrovascular accident, Death, Pulmonary embolism, Right ventricular failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), 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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt admitted to inpatient rehab hospital following a stroke with PMH significant for hypertension and hyperlipidemia. She had multiple cardiac arrests secondary to massive pulmonary embolism and right ventricular failure. Patient expired on 5/20/2021 upon chart review it was identified patient had received J&J vaccine on 4/7/2021.


VAERS ID: 1487416 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-04
Onset:2021-07-15
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   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: n/a
Current Illness: n/a
Preexisting Conditions: No
Allergies: Azo Urinary Tract Defense, Clindamycin, Codeine, Doxycycline, Peniccillians, Sulfas.
Diagnostic Lab Data: Patient COVID-19 positive by PCR on 07/04/2021.
CDC Split Type:

Write-up: The patient expired 7/15/2021 under Hospice care.


VAERS ID: 1487432 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-19
Onset:2021-07-09
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL3302 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   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: Protonix, Synthroid, Lasix, Toprol, Tylenol, Aranesp, Colace, Calazime, Dialyvite, vanicream, Viscosup
Current Illness:
Preexisting Conditions:
Allergies: Cholecalciferol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/09/2021


VAERS ID: 1487451 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-06-10
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Decadron, Roxicodone, Norco, Senokot, Ativan, Lasix, Zofran, Emla
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 06/10/2021.


VAERS ID: 1488518 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-26
Onset:2021-05-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dehydration, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

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: Atorvastatin 40 mg Turmeric 500 mg Promethazine 25 mg (as needed) Venlafaxine 37.5 mg Alprazolam .5 mg Albuterol Sulfate Inhaler (as needed) Oxycodone (as needed)
Current Illness:
Preexisting Conditions: Stage III lung cancer - was taking Infenzi Immunotherapy twice a month - cancer was stable and had not metastasized COPD Atherosclerosis Oncologist recommended she get to vaccine. She received a full immunotherapy treatment on May 25th and the second Moderna vaccine on May 26th. She passed May 27th AM.
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first Moderna vaccine on April 28th. Did not complain of any adverse effects. Patient received second Moderna vaccine on May 26th at approximately 11am. Spoke to son at 11pm that night and reported that she felt fine, her arm felt fine, the only complaint was "mouth feels funky" and she felt dehydrated. Was in typical spirits. She passed on May 27th. Time of death cannot be confirmed as an autopsy was not completed but the assumption is between 6-9am. This would have been less than 24 hours after she received the second vaccine.


VAERS ID: 1489529 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Dependence on respirator
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 31
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: Comments: The patient had no health problems
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210731688

Write-up: PATIENT PLACED ON VENTILATOR; DEATH; COVID PNEUMONIA; This spontaneous report received from a consumer via a company representative via social media concerned a 49 year old female of unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient had no health problems. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry unknown) dose was not reported, administered in late 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. In late APR-2021, on the night of vaccination, the patient experienced flu like symptoms. She was hospitalized and was in intensive care unit (ICU) (date unspecified), she never got better from flu like symptoms. It was claimed that the patient had Covid pneumonia. On an unspecified date, patient experienced sever lung damage and lung complications, and the patient was placed on ventilator. On 02-MAY-2021, the patient died from unknown cause of death It was unknown if the autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on 02-MAY-2021, and the outcome of covid pneumonia and patient placed on ventilator was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, and Life Threatening).; Sender''s Comments: V0 -20210731688-Covid-19 vaccine ad26.cov2.s-Death, Covid Pneumonia, Patient placed on ventilator. 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: 1489530 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USJNJFOC20210732113

Write-up: PASSED AWAY; This spontaneous report received from a consumer via a company representative via social media concerned a 5 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: not reported, expiry date: unknown) dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient passed away due to vaccination. The cause of death was unknown. 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: 20210732113-COVID-19 VACCINE AD26.COV2.S-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1489537 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210733844

Write-up: DEATH; This spontaneous report received from a consumer concerned a 5 decade old male of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported, UNKNOWN expiry) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from unknown cause of death. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). It was unknown whether the Autopsy was performed.; Sender''s Comments: V0: 20210733844-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s); Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1489603 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-04-10
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dehydration, Disorientation, Lethargy, Pulmonary oedema
SMQs:, Cardiac failure (narrow), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-26
   Days after onset: 77
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CRESTOR; AGGRENOX; PREDNISONE
Current Illness: COPD
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Fluid in lungs; Lethargic after second vaccine; disoriented/confusion; Dehydration; Death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death), DEHYDRATION (Dehydration), PULMONARY OEDEMA (Fluid in lungs), LETHARGY (Lethargic after second vaccine) and DISORIENTATION (disoriented/confusion) in an 89-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 018821A and 024M20A) for COVID-19 vaccination. Concurrent medical conditions included COPD since 06-Jan-2021. Concomitant products included PREDNISONE from 10-May-2020 to an unknown date for Bullous pemphigoid, ROSUVASTATIN CALCIUM (CRESTOR) and ACETYLSALICYLIC ACID, DIPYRIDAMOLE (AGGRENOX) for an unknown indication. On 11-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 10-Apr-2021, the patient experienced DEHYDRATION (Dehydration) (seriousness criterion hospitalization), LETHARGY (Lethargic after second vaccine) (seriousness criterion hospitalization) and DISORIENTATION (disoriented/confusion) (seriousness criterion hospitalization). On an unknown date, the patient experienced PULMONARY OEDEMA (Fluid in lungs) (seriousness criteria hospitalization and medically significant). The patient died on 26-Jun-2021. The cause of death was not reported. An autopsy was not performed. At the time of death, DEHYDRATION (Dehydration), LETHARGY (Lethargic after second vaccine) and DISORIENTATION (disoriented/confusion) had resolved and PULMONARY OEDEMA (Fluid in lungs) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. After 2nd vaccine 09-apr-2021, 36 hrs later (name) Lethargic, Disorientated ems to hospital. Some dehydration, fluids, than he has fluid in lungs. 8 days hospital. Never the some after discharged 4/19/21. (name) declined until his DEATH on 26-Jun-2021. Company comment: 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. This case was linked to MOD-2021-042828 (Patient Link).; 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: 1489604 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Death; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided Concomitant product was not reported. Treatment was not reported. Company Comment : Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1489619 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Died of covid; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Died of covid) in an 81-year-old female 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 first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced COVID-19 (Died of covid) (seriousness criterion death). The patient died on 16-Jul-2021. It is unknown if an autopsy was performed. No concomitant medications were reported. No treatment information was reported. Very limited information regarding this event has been provided at this time. Further information has been requested. Further information is not expected.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested. Further information is not expected.


VAERS ID: 1490255 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-21
Onset:2021-07-21
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: 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: 2021-07-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypothyroidism, diabetes mellitus, depressive disorder, schizophrenia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Family reported patient had increased seizures after receiving vaccines. No documented hx of seizures prior to vaccines.


VAERS ID: 1490310 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Pharmacy       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: 2021-04-04
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Had marginal zone lymphoma in 2018 and beat it, pre diabetic.
Allergies: Didn''t like sulfa or codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 mini heart attacks the night of 4/3/2021, major heart attack morning of 4/4/2021 which lead to her death.


VAERS ID: 1490373 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-16
Onset:2021-06-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Mobility decreased, Speech disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 24 hours of taking the vaccine my mom was very sick. She could not get out of bed and didn''t leave her room for two days. She was shaking hard as if she was cold and could barely talk.


VAERS ID: 1490419 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-04
Onset:2021-04-30
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   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: Trulicity, metformin
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pain in upper abdomen, sudden cardiac arrest on 5/3/21


VAERS ID: 1490478 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-06-22
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Death, Dyspnoea, Peripheral ischaemia, Pulmonary embolism, 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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: 2021-07-12
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: chronic kidney, disease, cardiovascular disease, severe obesity, pacemaker
Allergies: unknown
Diagnostic Lab Data: positive COVID -19 by PCR on 6-30-21
CDC Split Type:

Write-up: She received her first COVID vaccine on 1-13-21 and her second on on 2-3-21. She was hospitalized for shortness of breath and multiple subsegmental pulomnary emboli without acute cor pulmonnale. Other active hospital problems were: acute hypoxemic respiratory failure due to CVOID-19, acute kidney injury, lower limb ischemia. Patient was admitted to the hospital on 6-22-21 and tested positive for COVID-19 on 6-30-21. Patient was put on comfort measures on 7-9-21 and died at the facility on 7-12-21.


VAERS ID: 1490511 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-01
Onset:2021-07-21
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, Cardiac arrest, Condition aggravated, Diabetes mellitus, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin
Current Illness: None known
Preexisting Conditions: CHF, NIDDM
Allergies: NKDA
Diagnostic Lab Data: BGL 600
CDC Split Type:

Write-up: Family notes patient started to have issues controlling blood glucose levels, prior to day of event patient had syncope episodes. 7/21/2021 patient had sudden cardiac arrest.


VAERS ID: 1490520 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-20
Onset:2021-07-07
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Death, Dyspnoea, Fatigue, Microbiology test normal
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with fatigue and SOB starting about a week after vaccination. Was admitted to hospital SOB. No evidence of TTS. Progressive ARDS and death in 2 weeks after admission. Microbiology negative. No aetiology identified.


VAERS ID: 1490551 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-20
Onset:2021-07-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-20
   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: Trulicity, Aspirin, Metoprolol, Lipitor, Metformin
Current Illness: N/A
Preexisting Conditions: NIDDM, HTN, Obesity, CAD, Hyperlipidemia, Hx of MI, Heart Failure
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: UNKNOWN COVID-19 vaccine was administered within the community on the same day patient expired. Family might have this information. Was not shared with us.


VAERS ID: 1490566 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-15
Onset:2021-01-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Cough, Dysphonia, Fatigue, Hiccups
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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: High blood pressure medication
Current Illness: Non
Preexisting Conditions: Non
Allergies: None
Diagnostic Lab Data: Chest x-ray rays, blood work March 2021
CDC Split Type:

Write-up: Non stop hiccups, fatigue, coughing, raspy voice


VAERS ID: 1490599 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-04
Onset:2021-04-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 28
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: 30 days after receiving the vaccination, patient passed away due to blood clots and being sepsis.


VAERS ID: 1490628 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Diabetes mellitus, Functional gastrointestinal disorder, Hypertension, Recurrent cancer, Throat cancer
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Oropharyngeal neoplasms (narrow), Gastrointestinal nonspecific inflammation (narrow), Hypertension (narrow), Non-haematological malignant tumours (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type 2 diabetes, high blood pressure inactive remission throat cancer.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bowel issues. After vaccination all of her medical conditions became worse. (type 2 diabetes, high blood pressure, and throat cancer was no longer in remission.)


VAERS ID: 1490662 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: See report as previously noted.
CDC Split Type:

Write-up: Office of the Regulatory Authority reported to the Dept. of Health that this patient had a "sudden collapse witnessed by a friend" approximately one hour after receiving vaccine. Notified in March. At that time no VAERS reports found or noted by CDC. As of today, no VAERS received from CDC for this patient so submitting the limited information available. Final findings were released on 7/18/21 (decided on 7/16/21) were: "CAUSE A: Anaphylaxis CAUSE B: Status post COVID vaccination Should you have any questions about this case please contact Dr. Please note he is leaving state service at the end of this month."


VAERS ID: 1490902 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood glucose normal, Cardiac arrest, Cardioversion, Chest tube insertion, Cyanosis, Death, Electrocardiogram abnormal, Endotracheal intubation complication, Mini-tracheostomy, Muscle tightness, Pulse absent, Pupil fixed, Resuscitation, Reversal of opiate activity, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dystonia (broad), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diphenhydrAMINE/lidocaine/aluminum hydroxide/magnesium hydroxide/simethicone mucous membrane suspen , HX SIG - FOR REFERENCE ONLY: SWISH AND SPIT 5 ML BY MOUTH EVERY TWO HOURS AS NEEDED FOR SORE THROAT, MOUTH IRRITATION OR PAIN, Mouth or th
Current Illness: Sarcoidosis with recurrent syncope and possible tachyarrhythmia, concern for possible cardiac vs CNS sarcoid (7/9/21) Bipolar disorder Chronic pain/opioid use
Preexisting Conditions: Opioid overdose and hospitalization (5/27/21) Asthma Autoimmune sensorineural hearing loss Bipolar disorder Constipation Elevated creatine kinase level Fibromyalgia Long term methotrexate user Low back pain Morbid obesity Neuropathy History of Non-Hodgkin lymphoma PTSD - Post-traumatic stress disorder Sarcoidosis Syncope Tachycardia
Allergies: morphine (Anaphylaxis) immune globulin intravenous (Rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer COVID vaccine dose #2 administered 15 Jul 2021 @ 07:59. ED physician documentation on 19 Jul 2021: "37-year-old female came the emergency department after found down by her husband. Has a history of attempted overdose in the past,, she was found down by her husband at 545, and unresponsive on scene. Medic was on scene and patient was noted to be in V. fib and therefore CPR was started, compressions were in progress upon arrival, however the patient remained in cardiac arrest. Other history was able to be gathered from the patient or family, however EMS stated that they had found that her glucose was 99 on scene, and she been given full dose Narcan as well on scene. And was shocked 3 times a 200 J, she was given 2 doses of epinephrine, as well as 300 of amiodarone. They attempted to intubate the patient however the patient was clamped down, and therefore they could not pass any sort of apparatus to control the airway, therefore they placed a nasal trumpet. Pertinent physical exam findings: Jaw clamped shut, pupils fixed, and was obviously cyanotic, no palpable pulses. No chest rise. EKG as interpreted by me (ED attending): Monitor showed that the patient was in asystole the entire time. Medical Decision making and plan of care: Patient was immediately moved from gurney onto bed, and chest compressions were continued without interruption. Given that the patient was in V. fib in the field, we did decide to place dual pads for dual sequential defibrillation, is on the plats however, the patient was noted to be in asystole, therefore chest compressions were continued, epinephrine, as well as calcium, as well as bicarb. See code chart for further details. IO was also placed in the patient''s left proximal tibia. Regarding the patient''s airway, several attempts were made to pass an ET tube, as well as paralyzed the patient with rocuronium, however tube passing was unsuccessful, and therefore I performed a cricothyrotomy. Followed by bilateral finger thoracostomies. See procedure notes below for further details. Despite 5 rounds of ACLS, with multiple doses of epinephrine, as well as bicarb and calcium carbonate administered, the patient remained in cardiac arrest, death was declared at 1851."


VAERS ID: 1490927 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-21
Onset:2021-07-16
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cardio-respiratory arrest, Death, Endotracheal intubation, Intensive care, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Aspergillus lung infection, MAC prophylaxis
Preexisting Conditions: Non Hodgkin''s lymphoma, asplenia, marginal zone lymphoma, autoimmune hepatitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to hospital with acute hypoxemic resp failure. Pt had history of COVID19 infection in Nov 2020. Pt has chronic medical conditional including but not limited to marginal zone lymphoma on chemo, h/o aspergillus, MAC on atovoqone and voriconazole. Pt received moderna vaccine in May (1st shot), and June (2nd shot). Pt admitted on 7/16 found to have positive covid infection second time. Pt resp status steadily worsen from NC to reservoir, and then HFNC. Despite on remdesivir, prednisone, antibiotics, and antifungal. Pt had code blue due to resp arrest, intubated, then coded again in ICU for over 1 hour. Family elevated make patient DNR, and she died soon after on 7/20.


VAERS ID: 1490965 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-10
Onset:2021-07-08
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Clostridium difficile colitis, Cough, Death, Dyspnoea, Laboratory test, Lethargy, Pneumonia, Pneumonia aspiration, Pneumonitis, Sepsis
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Pseudomembranous colitis (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not aware of meds at time of vaccination. Admitted to Beecher Manor 6/28/2021.
Current Illness: Not aware of illnesses at time of vaccination. Admitted to Beecher Manor 6/28/2021.
Preexisting Conditions: COPD, CHF, Chronic Kidney Disease.
Allergies: Cipro, Medrol
Diagnostic Lab Data: Testing and labs completed at hospital.
CDC Split Type:

Write-up: Resident was vaccinated. Pt was admitted on 6/28 with dx of pneumonia, cdiff and sepsis. On admission pt noted to have dry cough and lethargy. Pt had signs of aspiration and dyspnea and was sent to ED for evaluation within five hours of admission to Beecher Manor. She was treated for aspiration pneumonia w/diagnosis of pneumonitis r/t food and vomit. She was re-admitted to Beecher Manor on 7/3 with orders for Augmentin PO 7/4 - 7/9. She continued to decline w/plans by family to begin Hospice care. She expired during process of initiating hospice care.


VAERS ID: 1490980 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-07-15
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration, Laboratory test
SMQs:

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: apap, acidophilis, amytriptyline, amlodipine, ativan, atorvastatin, famotidine, Eliquis, Depakote, morphine, metoprolol, losarten, duo neb, Keppra
Current Illness: no acute
Preexisting Conditions: Collapsed vertebrae, CVA, anxiety, Dysphagia, Altered mental status, Atelectasis, Aphasia, Afib, HTN, Osteoarthritis, diverticulitis, Breast implant, Gastrostomy
Allergies: Sotalol, Adhesive Tape
Diagnostic Lab Data: Under hospice care, limited labs and not aggressive treatment. Focus on comfort.
CDC Split Type:

Write-up: Steady decline under hospice care which began 1/4/2021 r/t CVA hx. Mild improvment at times with consistent decline throughout until expiration 7/15/21 at facility.


VAERS ID: 1491016 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-16
Onset:2021-07-18
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Femur fracture
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   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: not known. Was not a resident at Beecher manor at time of vaccination.
Current Illness: not known. Was not a resident at Beecher manor at time of vaccination.
Preexisting Conditions: Diverticulitis, Anxiety, Dysphagia, Dementia, GERD, Osteoarthritis, Neuropathy, Osteoporosis, Cognitive Communication deficit
Allergies: no known allergies
Diagnostic Lab Data: none completed during end of life hospice comfort care.
CDC Split Type:

Write-up: Admitted 4/1/2021 and discharged to Sunrise assisted living 5/14/21. Return admission to Hospital from hospital 7/17/21 w/dx R femur fracture under Hospice Comfort Care for end of life. Expired at facility 7/18/21 at hospital.


VAERS ID: 1491031 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-05
Onset:2021-07-15
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Facial paralysis, Gastrostomy, Hemiparesis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (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: apap, acidophilus, ativan, plavix, lasix, potassium chloride
Current Illness: Conjunctivitis
Preexisting Conditions: Dementia, CHF/HTN, Osteoporosis,
Allergies: no known drug allergies. Laundry soap, Scented products
Diagnostic Lab Data: none during end of life hospice care.
CDC Split Type:

Write-up: Stable at time of vaccine 1/15/21 and 2/5/21, Transferred to ER for pocketing food, Left facial drooping and left sided weakness on 7/4/21. Returned from hospital 7/14/21 w/gastrostomy nutritional status and hospice care. She expired w/end of life hospice care in place on 7/15/21.


VAERS ID: 1491638 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-23
Onset:2021-04-11
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke. Death.


VAERS ID: 1491659 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-01
Onset:2021-05-01
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Blood test, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram abnormal, Confusional state, Coronary artery thrombosis, Death, Dysarthria
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-31
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, pain meds, bladder meds, anxiety meds
Current Illness: None
Preexisting Conditions: Type II diabetes, fibromyalgia, arthritis
Allergies: Shrimp,
Diagnostic Lab Data: CT scans, blood work on May 24th. Major strokes, blood clots, possible heart attack. Death reported as related to complications to type II Diabetes
CDC Split Type:

Write-up: Blood clots, strokes, death I believe that there were subtle unrecognized signs starting in March - off balance, slurred speech, confusion- thought to be diabetes related. I would have her check her sugar and it would be fine, but I dismissed it as a good thing that her sugar was ok. It didn?t cross my mind until the major strokes that it could be related to the vaccine. She had major strokes in May as a result of blood clots in heart and head. I strongly believe that her death is related to the vaccine. She was well, and had her diabetes under control, and three months after getting the vaccine, she was dead.


VAERS ID: 1491868 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-03-03
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O14MZOA / 1 AR / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Brain neoplasm, Computerised tomogram, Craniotomy, Electrocardiogram, Magnetic resonance imaging, Neoplasm malignant
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 107
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood Pressure, statin,
Current Illness: none
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: MRI, CT, EKG....March 18
CDC Split Type:

Write-up: alphasia , ..March 4 March 18....MRI, CT SCAN, EKG.... brain tumors March 23....Crainiotomy Brain Cancer


VAERS ID: 1493247 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antibody test, COVID-19, Cough, Drug ineffective, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), 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: 2021-07-10
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bypass surgery (She had bypass 19 years ago); COPD
Allergies:
Diagnostic Lab Data: Test Name: Antibody Test; Result Unstructured Data: Test Result:no antibody at all; Test Date: 2021; Test Name: Covid-19; Test Result: Positive ; Comments: She caught Covid and died.
CDC Split Type: USPFIZER INC2021881403

Write-up: My mother in law received the vaccine 4-5 months ago. She caught Covid and died; My mother in law received the vaccine 4-5 months ago. She caught Covid and died; Just couldn''t breathe; A little cough; This is a spontaneous report received from a contactable consumer via Pfizer sponsored program. The caller is calling on behalf of her deceased Mother-in-law. A 73-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported, Expiration Date: Unknown), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunization. Medical history included COPD from an unknown date and unknown if ongoing, Bypass (She had bypass 19 years ago) from an unknown date and unknown if ongoing. The reporter stated that " I don''t know what else was she taking." The patient''s concomitant medications were not reported. Reporter wants to know if Pfizer was giving a placebo or the actual vaccine. She believes her mother-in-law had received a placebo vaccine. My mother-in-law received the vaccine 4-5 months ago. She caught Covid and died (2021). The doctor confirmed she did not have any antibodies. We all had been exposed to her. We are currently in quarantine. My father-in-law is 80 years old and was nervous. He was wondering why did he take the vaccine if it did not protect his wife or him. Reported doctor had basically tested her and they had found no antibodies. At the moment she was nervous because her father-in-law lived with them and they were both quarantined and he was 80 years old. Reporter stated they said she had no antibodies like she never got the vaccine. Reporter stated I do not know the name of antibody Test, but the hospital did it and they said she had no antibody at all. Date of Death: Reporter stated, I am not sure my father-in-law did knows exactly when they got vaccinated but it was 3 or 5 months ago. Reporter stated, "No, she went to the hospital on Thursday evening, and she had been on the ventilator like 3 hours later and she died on Saturday morning 2 O''clock. She had no fever, she had a little cough not major stuff, it was like flu the fever and usual cough she did not had any of that. She had no flu, she just couldn''t breathe (2021). Anatomical Site of Administration: Reporter stated, I just know that she received it 4 months ago. The patient underwent lab tests and procedures which included antibody test: no antibody at all, Covid-19: positive on 2021 (She caught Covid and died). Therapeutic measures were taken as a result of my mother in law received the vaccine 4-5 months ago. she caught covid and died, just couldn''t breathe. The patient died on 10Jul2021. An autopsy was not performed. The outcome of events just couldn''t breathe and cough was unknown, while other events was fatal. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: My mother in law received the vaccine 4-5 months ago. She caught Covid and died


VAERS ID: 1493251 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-02-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021884595

Write-up: states her husband died 5 months ago with the second shot, after he had his second shot in 5 days; This is a spontaneous report from a contactable consumer (patient wife). A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot number: Unknown), via an unspecified route of administration on 02Feb2021 as dose 2, single for COVID-19 immunisation. No medical history and concomitant medications were reported. The patient previously received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot number: Unknown), via an unspecified route of administration on an unspecified date as dose 1, single for COVID-19 immunisation. The reporter stated that on 05Feb2021, her husband died 5 months ago with the second shot, after he had his second shot in 5 days and reporter confirmed that her husband had the Pfizer Covid-19 vaccine. She stated that her husband was in the hospice before that, he died a little bit over 5 months. Reporter stated she was a nursing student and said no to completing a report, by saying that her husband was gone, he died but because she looked at the medical statement that the Medicare paid for him the first time $35 and the second time $35 but she sees he took the second shot on 02Feb2021 and he died on 05Feb2021. He was in the emergency right after the shot, she thought, on the same day he had the shot on 02Feb2021 and he died in the hospital, but he was in the nursing home facility paid for seven months and hospice for seven months. She stated they wouldn''t let her visit him and she was not able to visit him for a while before he died. The patient died on 05Feb2021. Cause of death was not provided. The outcome of event was fatal. Information on Lot/Batch information has been requested.; Reported Cause(s) of Death: states her husband died 5 months ago with the second shot, after he had his second shot in 5 days


VAERS ID: 1493382 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

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


VAERS ID: 1493419 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Dementia / Alzheimer''s
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. Passed away in her sleep at night following receiving her 2nd Covid vaccination earlier in the day.


VAERS ID: 1493615 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-29
Onset:2021-05-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac disorder, Critical illness, Death, Dialysis, Dyspnoea, Heart rate irregular, Liver disorder, Lung disorder, Mechanical ventilation, Renal disorder
SMQs:, Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Enbrel
Current Illness: NONE
Preexisting Conditions: Arthritis
Allergies: NONE
Diagnostic Lab Data: Hospital from 05/11/2021 to 06/24/2021
CDC Split Type:

Write-up: He had Covid 19 on Thanksgiving 2020 and recovered fully. Even though he now had natural antibodies, his Doctor convinced him that he needed the so called Covid 19 vaccine "mRNA gene therapy". On 04/29/2021, he was injected with the so called vaccine and that was the beginning of the end. On 05/10/2021, he was admitted to the Hospital with irregular heartbeat and trouble breathing. The Hospital could not get him stabilized so they transported him to another Hospital. He was there a couple of weeks or so and was now having issues with his kidneys and liver. It appeared the spike proteins had started to battle the rest of his viable organs. The hospital had to transport him to a nursing home facility because his number of days in the hospital per insurance had run out. Then on the evening of 06/13 or 14/ 2021, he became violently ill. He was taken to hospital again and was subsequently transferred back to another Hospital. The Spike proteins had now gone into overdrive attacking all his major organs. His liver, kidneys, lungs and heart were being attacked by the spike proteins created by this deadly vaccine. He was put on 24 hour dialysis and then had to be put on a ventilator. He died 06/24/2021.


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