National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

Found 17,128 cases where Vaccine is COVID19 and Patient Died



Case Details

This is page 58 out of 172

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157   next


VAERS ID: 1509224 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-07-09
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   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 I63.9 - Cerebral infarction, unspecified


VAERS ID: 1509547 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-05-25
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-26
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
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: 1509613 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-07-27
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose #1 Moderna 01/20/2021 Lot # 041L20A Pt died while in the hospital


VAERS ID: 1509620 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-07-27
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose #1 Moderna 01/21/2021 Lot # 041L20A Pt died while hospitalized


VAERS ID: 1509660 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arterial thrombosis, Autopsy, Malaise, Pain in extremity, Pyrexia, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 58
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt developed fever later the day after getting his covid vax so he took ibuprofen and went to bed. Next day he went back to work. Pt showed no symptoms until the month of June when he started complaining about pain in both arms. He was using a heating pad on his shoulders to help with the pain. He was taking Aleve for the pain but it was not helping so he no longer wanted to take it. He had a vomiting episode on the afternoon of June 16th stating he thought he has eaten a bad lemon. He wasn''t feeling well the morning of June 18th, 2021 but continued working. He only wanted something light to eat since he didn''t feel well and was headed to bed. When his wife went to go to bed she found him collapsed on the bedroom floor with face forward in the bed. She turned him around and found him unresponsive. She contacted 911 and he was taken to Medical Center ER. They were not able to revive him. County conducted an autopsy where they found a blood clot in left artery.


VAERS ID: 1509756 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-03-12
Onset:2021-05-21
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Cancer
Allergies: Ascriptin, Aspirin
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient was hospitalized and passed away. 2nd vaccine given 4/6/2021


VAERS ID: 1509847 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-20
Onset:2021-05-20
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is 88yo old male, received 2nd dose of Pfizer on 4/20/21. Started feeling sick on 5/21/2021, tested positive for covid on 5/21/2021. Potentially exposed at Dialysis Clinic. Admitted to Hospice on 6/3/2021


VAERS ID: 1509983 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Cardiac arrest, Condition aggravated, Death, Dyspnoea, Intensive care, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 50
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine Budesonide-fomoterol Montelukast Albuterol
Current Illness: None
Preexisting Conditions: Asthma, mild-intermittent Essential Hypertension Hyperlipidemia
Allergies: None known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received the Janssen vaccine on 5-29-21 and had previously well controlled asthma. The patient presented to ED on 6-1-21, 6-13-21, 6-28-21, and 7-19-21 with acute asthma exacerbation. On 7-21-21 the patient was admitted into the ED and later ICU with cardiac arrest related to asthma acerbation and pronounced deceased on 7-25-21. Symptoms: - Wheezing -Shortness of breath - Onset following the day after vaccine administration Treatments: - Albuterol/ipratropium nebulizers - Prednisone -Albuterol inhaler


VAERS ID: 1510133 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-29
Onset:2021-03-09
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-13
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions: Alzheimer''s dementia GERD Hypothyroidism
Allergies: Penicillin
Diagnostic Lab Data: Positive COVID test on 03/09/21
CDC Split Type:

Write-up: Patient is a 97 year old female, received first dose on 12/29/21 and second dose on 02/09/2021. Patient had previously tested positive for COVID on 12/07/2020. Patient was living in a long term care facility, when she was sent to ER for abnormal labs, where she again tested positive for COVID on 03/09/21. She did not have any symptoms of COVID. Patient was discharged back to the care facility for hospice care and died on 03/13/21.


VAERS ID: 1510268 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Feeling abnormal, Seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (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: 2021-07-14
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sprintec ocp. xanax prn 1 mg.
Current Illness: none known
Preexisting Conditions: anxiety, ptsd
Allergies: nkda
Diagnostic Lab Data: Autopsy pending, I am reporting by report only. I did not give the vaccine, and the patients mother has given the information I have. She felt very bad for days after the vaccine, and then went to sleep and apparently had a seizure and died. She was otherwise heatlthy with no seizure history at all. Death date is assumed per patients mothers report, we cannot confirm at this time.
CDC Split Type:

Write-up: Patient died.


VAERS ID: 1510691 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Dyspnoea, Fatigue, Paralysis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diabetes Shot and Pills, Gabatin
Current Illness:
Preexisting Conditions: Uncontrolled Diabetes Mellitus, Coronary Artery Disease, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease Stage 3B
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death; paralyzed before, couldn''t breath, tired, weak


VAERS ID: 1511092 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-06-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Death, Delirium, Electrocardiogram normal, Endotracheal intubation, Myocardial infarction, Nausea, Oxygen saturation decreased, Panic attack
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   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:
Current Illness:
Preexisting Conditions: Cancer but was cancer free at the time of vaccination
Allergies: Penicillin
Diagnostic Lab Data: Ct scan EKG Blood work All completed at hospital 6/1/21-6/2/21
CDC Split Type:

Write-up: Patient began feeling like she was having panic attacks. She was nauseous and went to the ER. ER ran tests including Ct scan, ekg and blood work. All tests came back normal. A couple of hours later patient became delirious and oxygen started to drop. Then patient was intubated at which point she had a major heart attack and died.


VAERS ID: 1511267 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-02-01
Onset:2021-02-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Fatigue, General physical health deterioration, Mobility decreased, Multiple organ dysfunction syndrome, Plasma cell myeloma
SMQs:, 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), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   Days after onset: 48
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Statin, Insulin & Warfarin
Current Illness: None
Preexisting Conditions: Diabetes & High Blood Pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 2 days of second shot, Patient exhibited extreme fatigue. This continued for the next several weeks culminating with the inability to move which resulted in admission to Hospital the week of 2/22/21. After weeks to stabilize vital systems, a diagnosis of multiple myeloma was obtained. Patient continued to decline until multiple organ failure occurred within 30 days of admission. Death occurred on 3/25/21. It is not clear whether the vaccine potentially caused and/or exacerbated a previously undiagnosed condition (multiple myeloma). However, the proximity of an immune cell related cancer which resulted in rapid decline and death within 60 days of vaccination should be noted in case there are any other previously undiagnosed blood cancers being found in newly vaccinated individuals.


VAERS ID: 1511553 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210748471

Write-up: DEATH; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received via social media (news article) and concerned 26 multiple patients. Initial information was processed along with the additional information received from Regulatory Authority on 23-JUL-2021 and 27-JUL-2021. The patient''s weight, height, and medical history were not reported. The patient''s received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients had a breakthrough infection after being vaccinated (suspected clinical vaccination failure and suspected covid-19 infection). It was reported that it was only 25 to 54 days after that last dose of the vaccine when the patients got sick. It was also reported that, on an unspecified date vaccinated patients were hospitalized and four experienced death from unknown cause of death. The number of days hospitalization was not reported. It was unknown if an autopsy was performed to the patients. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died on an unspecified date, and the outcome of suspected clinical vaccination failure and suspected covid-19 infection was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged). This report was associated with product quality complaint number: 90000186897.; Sender''s Comments: V0:20210748471-COVID-19 VACCINE AD26.COV2.S-Death, suspected COVID-19 infection . 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).20210748471-COVID-19 VACCINE AD26.COV2.S-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1511577 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-29
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: USJNJFOC20210756409

Write-up: DIED 24 HOURS LATER AFTER TAKING VACCINE; This spontaneous report received from a company representative via Pfizer. via social media was received on 23-JUL-2021 and concerned a 21 year old of an unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died 24 hours later after taking vaccine. On an unspecified date, the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: 20210756409-Covid-19 vaccine ad26.cov2.s -died 24 hours later after taking vaccine. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1511611 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-29
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 after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death after vaccination) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. An autopsy was not performed. Concomitant medication and treatment information were not reported. Company Comment: Very limited information regarding this event has been provided at this time. Further information is not expected (Follow up contact denied) Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information is not expected (Follow up contact denied); Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1511612 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-22
Onset:2021-07-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: He passed in his sleep that night.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (He passed in his sleep that night.) in a 52-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 091D21A) for COVID-19 vaccination. No Medical History information was reported. On 22-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 22-Jul-2021 The patient died on 22-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medication was given. No treatment information was given. Patient received the 1st dose of the Moderna Covid-19 vaccine. He died in his sleep that night. This a report of dead one day after the first dose of the product in an 52-year-old patient with no comorbidities. Very limited information regarding the event has been provided for inferring causality. Further information is not expected.; Sender''s Comments: This a report of dead one day after the first dose of the product in an 52-year-old patient with no comorbidities. Very limited information regarding the event has been provided for inferring causality. Further information is not expected.; Reported Cause(s) of Death: unknown


VAERS ID: 1511613 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Hypokinesia, Lung disorder, Neuromyelitis optica spectrum disorder
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Optic nerve disorders (narrow), Cardiomyopathy (broad), Demyelination (narrow), Hypotonic-hyporesponsive episode (broad), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: weakness; difficulty breathing; unable to move his legs; Lung problem; neuromyletis optica; This spontaneous case was reported by a consumer and describes the occurrence of NEUROMYELITIS OPTICA SPECTRUM DISORDER (neuromyletis optica), ASTHENIA (weakness), DYSPNOEA (difficulty breathing), HYPOKINESIA (unable to move his legs) and LUNG DISORDER (Lung problem) in a 24-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced NEUROMYELITIS OPTICA SPECTRUM DISORDER (neuromyletis optica) (seriousness criteria death, hospitalization and medically significant), ASTHENIA (weakness) (seriousness criteria death and hospitalization), DYSPNOEA (difficulty breathing) (seriousness criteria death and hospitalization), HYPOKINESIA (unable to move his legs) (seriousness criteria death and hospitalization) and LUNG DISORDER (Lung problem) (seriousness criteria death and hospitalization). The patient was hospitalized on 09-Jun-2021 due to ASTHENIA, DYSPNOEA, HYPOKINESIA, LUNG DISORDER and NEUROMYELITIS OPTICA SPECTRUM DISORDER. The patient died on 08-Jul-2021. The reported cause of death was Neuromyelitis optica. It is unknown if an autopsy was performed. No concomitant medication was reported. The patient was placed on ventilator and had a tracheotomy tube. No treatment information was provided. No laboratory data was provided. Very limited information regarding the events has been provided at this time. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding the events has been provided at this time.; Reported Cause(s) of Death: Neuromyelitis optica


VAERS ID: 1511620 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Neoplasm malignant
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Non-haematological malignant tumours (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 INC202100911615

Write-up: Caller states that the woman in the study had brain hemorrhaging and a cancerous growth, after the vaccine.; Caller states that the woman in the study had brain hemorrhaging and a cancerous growth, after the vaccine.; This is a spontaneous report from a Pfizer-sponsored program Support reported by a contactable consumer or other non-health care professional. A female patient of an unspecified age received unknown dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number and Expiration date not reported), via an unspecified route of administration in an unspecified anatomical location on an unspecified date as a single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Reporter stated that cardiologist gave him a study which reported a woman, who had the vaccine, died on the operating table, after her brain was haemorrhaging and they found a cancerous growth. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information about Lot/ Batch number have been requested.; Reported Cause(s) of Death: after her brain was hemorrhaging; and they found a cancerous growth


VAERS ID: 1512372 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-04-27
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Coronary artery disease, Death, Decreased activity, Diabetes mellitus, Dyspnoea, Hypophagia, Hypoxia, Mechanical ventilation, Metabolic acidosis, Oliguria, Pneumoconiosis, Polymerase chain reaction positive, Renal failure, Serology positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (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 (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Mass in upper lobe
Preexisting Conditions: HTN, CVD - CHF, CAD, chronic lung disease - COPD, coal workers pneumoconiosis, DM2
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 79 Male received both doses of Pfizer. Developed symptoms - SOA, decreased activity, generalized weakness, decreased P. O. intake. Tested PCR positive 4/26/2021 & serology 4/29/2021. Hospitalized 4/27/2021. Diagnosis at time of death: Hypoxic ARF requiring MV, COVID-19 PNA, rule out superimposed bacterial PNA, renal failure, oliguric, metabolic acidosis. CWP/COPD exacerbation, CAD, DM present on admission


VAERS ID: 1512389 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-29
Onset:2021-03-12
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 8
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: Diabetes type 2, hypertension
Allergies:
Diagnostic Lab Data: Tested positive for COVID on 03/12/2021.
CDC Split Type:

Write-up: Patient received both doses of the Pfizer COVID vaccine on 01/29/2021 and 02/22/2021. Patient tested positive for COVID on 03/12/2021. She was admitted on 03/14/2021 where she was diagnosed with Covid pneumonia with acute hypoxic respiratory failure. Discharged on 03/18/2021 Nursing & Rehab, where she died on 03/21/2021.


VAERS ID: 1512405 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-21
Onset:2021-02-24
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Bacteraemia, Bilevel positive airway pressure, COVID-19 pneumonia, Cardio-respiratory arrest, Computerised tomogram thorax abnormal, Convalescent plasma transfusion, Dyspnoea, Encephalopathy, Endotracheal intubation, Gastrointestinal tube insertion, Haemodialysis, Hypoxia, Intensive care, Mechanical ventilation, Polymerase chain reaction positive, Renal replacement therapy, Respiratory disorder, Thrombocytopenia, Tracheostomy
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 38
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: coal workers pneumoconiosis, DM2, CKD stage 4, protein CNS deficiency, CHF
Allergies:
Diagnostic Lab Data: CT of chest showed bilateral airspace
CDC Split Type:

Write-up: 74 Male hospital admission for SOA with COVID-19 PNA. PCR positive 2/20/2021 & 3/23/2021. Started on convalescent plasma, remdesivir, Zyvox, meropren. Developed hypoxia with worsening respiratory problems 2/24/2021 & placed on BiPAP. Transferred to ICU - required mechanical ventilation, intubation. 3/19/2021 had tracheostomy & PEG tube. Placed on Rocephin & vancomycin until 4/4/2021 for bactermia developed 3/17/2021. Required CRRT & hemodialysis for worsening renal function. Developed thrombocytopenia. Patient became encephalopathic. 4/4/2021 several rounds of epinephrine given and patient coded.


VAERS ID: 1512407 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-02
Onset:2021-02-19
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Apnoea, Cardioversion, Death, Myocardial infarction, Resuscitation, Snoring
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   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: 81mg aspirin metformin Valsartan Tresiba Amlodipine Hydrochlorot Rosuvastatin Trajenta Clonidine
Current Illness: None
Preexisting Conditions: Diabetes 2 Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient awakened me with 2 deep snoring sounds and then stopped breathing. I began CPR. Fire Dept, Paramedics and Hospital used paddles to get a heart beat but it was unstainable. He was pronounced deceased at the hospital due to a heart attack. He had no previous heart disease diagnosis.


VAERS ID: 1512416 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-14
Onset:2021-03-26
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cellulitis, Condition aggravated, Death, Respiratory arrest, SARS-CoV-2 test positive, Unresponsive to stimuli
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), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cellulitis
Preexisting Conditions: Morbid obesity, chronic respiratory failure
Allergies:
Diagnostic Lab Data: Tested positive for COVID on 03/26/2021
CDC Split Type:

Write-up: Patient tested positive for COVID on 12/16/2020. Patient received both doses of the Pfizer COVID vaccine on 01/14/2021 and 02/04/2021, and again tested positive for COVID on 03/26/2021. She was transferred from outside medical facility to Medical Center on 03/28/2021 due to concerns over new COVID infection and cellulitis. Patient was found unresponsive and not breathing the morning of 03/30/2021 and died at 5:34AM from cardiac arrest.


VAERS ID: 1512430 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-06-23
Onset:2021-07-21
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO180 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Medical procedure
SMQs:

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: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: Hospital performed their procedures that are unknown to the family.
CDC Split Type:

Write-up: Patient past away.


VAERS ID: 1512442 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-03-25
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Multiple organ dysfunction syndrome, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   Days after onset: 43
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: Positive COVID test on 03/25/2021
CDC Split Type:

Write-up: Patient received both doses of the Moderna COVID vaccine on 02/02/2021 and 02/26/2021. Patient tested positive for COVID on 03/25/2021 and was admitted to hospital 03/25/2021 - 04/23/2021. Patient was readmitted on 04/27/2021 for UTI. Patient died on 05/07/2021, suspected cause of death was multi organ failure.


VAERS ID: 1512493 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-24
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Acute cardiac event, Autopsy, Death, Laboratory test normal, Pathology test, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: All lab tests and organ pathology tests came back clear. Autopsy showed she had genetically inherited congenitally narrow arteries.
CDC Split Type:

Write-up: She collapsed in her bathroom and her boyfriend immediately began CPR. Paramedics were unable to revive her. Cardiac event.


VAERS ID: 1512524 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-04-28
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Haematuria, Pseudomonas infection, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   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:
Current Illness:
Preexisting Conditions: CAD, DM2, Interstitial lung disease, HLD, hypothyroidism, HTN, CKD stage 3
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 97 Male PCR positive 4/28/2021. Vaccinated with Pfizer 1/6/2021 & 1/28/2021. Hospitalized 4/28/2021- 5/6/2021 for COVID PNA & fatigue, SOA, diarrhea. Placed on Rocephin for UTI. Required more than 4L of oxygen, decreased appetite. Developed hematuria due to Pseudomonas. Transferred. Passed away 5/13/2021.


VAERS ID: 1512556 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-08
Onset:2021-05-14
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1538554 / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Mental status changes, Nucleic acid test, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-27
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro - Detected on 03/23/21
CDC Split Type:

Write-up: Pt. presented to UC with change in mental status; arrived from extended care facility; discharged home on 05/20/21 to hospice care. Pt.''s son called to cancel subsequent appointments because pt. passed away on 05/27/21.


VAERS ID: 1512561 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-05-08
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Chest pain, Death, Intensive care, Pericardial drainage, Resuscitation, SARS-CoV-2 test positive, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test on 5/8/21
CDC Split Type:

Write-up: Patient received both doses of the Pfizer vaccine on 2/24/21 and 3/17/21. Patient came to the ER on 5/8/21 with chest pain, where she tested positive for COVID. While patient was receiving a precordial drain she went into V. tach but was successfully resuscitated. She went to ICU but went into cardiopulmonary arrest and died on 5/9/21.


VAERS ID: 1512612 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-05-24
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cardiac failure, Chest wall haematoma, Computerised tomogram thorax abnormal, Condition aggravated, Death, Delirium, Encephalopathy, Fall, Haematoma, Hypoxia, Lung opacity, Pneumonia, Pulmonary hypertension, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xeralto, Tylenol
Current Illness:
Preexisting Conditions: CAD sp CABG, A-fib, mitral valve regurgitation, heart failure preserved ejection fraction, OSA on CPAP, DM2, osteoporosis, obesity, insomnia, depression, OA, chronic back pain
Allergies:
Diagnostic Lab Data: CT shows Ground glass appearance supporting of COVID
CDC Split Type:

Write-up: 92 year female admitted to hospital for fall on 5/24/2021. Unknown exposures in 14 days prior. Pfizer vaccine 2/25/2021 & 3/19/2021. PCR positive 5/24/2021. Transferred to hospice on 29th. Passed on 5/30/2021. Diagnosis at time of death: ARF on chronic with hypoxia, hematoma anterior chest wall left hip and upper thigh, suspected mild heart failure preserved ejection fraction, mechanical fall, delirium, bilateral PNA, pulmonary HTN, acute encephalopathy.


VAERS ID: 1512619 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-07-24
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions: CHF, COPD, GERD, HTN, CAD, BPH
Allergies: Ivabradine
Diagnostic Lab Data: COVID-19 positive 7/20/2021.
CDC Split Type:

Write-up: COVID-19 positive 7/20/2021. Pt expired at the hospital on 7/24/2021.


VAERS ID: 1512650 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-18
Onset:2021-04-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

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

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

Write-up: Patient told family members he received second dose of Pfizer-BioNTech COVID19 vaccine on April 18, 2021. Sheriff''s Department contacted next of kin on morning of April 20, 2021 stating that patient had died suddenly on April 19, 2021.


VAERS ID: 1512688 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-01-13
Onset:2021-04-22
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aggression, Asymptomatic COVID-19, Chromaturia, Death, Discomfort, Emotional distress, Hypophagia, Refusal of treatment by patient, Respiratory rate increased, Rhinorrhoea, SARS-CoV-2 test positive, Urine odour abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   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: Aspirin, Finesteride, Miralax, Tamsulosin, Lorazepam, Colace,Metoprolol, Levothyroxine, Tylenol ES
Current Illness: None
Preexisting Conditions: Vascular Dementia, A.Fib, Obstructive/ Reflux Uropathy, Constipation, Urinary Device, Hypothyroidism, Chronic Pain, Essential Hypertension, dysphagia, Falls, BPH, Anxiety, nutritional Anemia
Allergies: No Known Allergies
Diagnostic Lab Data: 4/22/2021 SARS-COV-2-Asymptomatic PCR Screen- COVID-19 detected.
CDC Split Type:

Write-up: 4/22/2021 Tested positive for Covid-19 discovered during Universal Swabbing on Specific Unit. Resident was asymptomatic. COVID-19 screening were completed every 4 hours. 5/3/2021 COVID-19 screening revealed runny nose, declining meds and combative. Urine tea colored and foul smelling, Poor PO Intake. 5/4/2021 resident appeared uncomfortable and distressed with increased respiratory rate. Morphine and Ativan given for comfort measures. 5/5/2021 Deceased.


VAERS ID: 1512695 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-07-28
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   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 I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)


VAERS ID: 1512705 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-04-30
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Eye disorder, Fatigue, Joint swelling, Lung infiltration, Vision blurred
SMQs:, Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Former smoker, macular degeneration, glaucoma, A-fib, HTN, HLD, CAD, aortic valve insufficiency
Allergies:
Diagnostic Lab Data: CXR 4/30/2021 - infiltrate
CDC Split Type:

Write-up: 93 Male vaccinated Pfizer 1/06/2021 & 1/28/2021. Symptom onset 4/30/2021 - SOA, fatigue. Taken to ER 5/10/2021 for blurry vision. Diagnosed with COVID 4/30/2021. Started dexamethasone. Patient claims left eye problems secondary to dexamethasone. Discharged and final diagnosis at time of death 5/24/2021 - COVID-19 with PNA


VAERS ID: 1512749 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-06-04
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breath sounds abnormal, COVID-19, Chronic respiratory failure, Condition aggravated, Death, Depressed level of consciousness, Mechanical ventilation, SARS-CoV-2 test positive, Tracheo-oesophageal fistula
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   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:
Current Illness:
Preexisting Conditions: Anoxic brain injury, DVT, HTN, seizures, pulmonary embolism, severe TBI, chronic respiratory failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 39 Male tested positive 6/4/2021. Vaccinated with Pfizer 12/22/2021 & 1/12/2021. 6/4/2021 hospital admission for tracheo-esophageal fistula (TEF) transfer from hospital. Diminished breathing sounds, minimally conscious. Removed from ventilator support 6/17/2021. Problems at time of death 6/19/2021 - chronic respiratory failure, COVID-19, history of severe TBI, TEF, trach vent/PEG dependent.


VAERS ID: 1512824 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-08
Onset:2021-05-15
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 UN / SYR

Administered by: Public       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: 2021-05-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized and died of COVID-19 after being vaccinated.


VAERS ID: 1512861 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-01-13
Onset:2021-04-22
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Body temperature increased, Death, Fatigue, General physical health deterioration, Pain, SARS-CoV-2 test positive, Urine odour abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   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: Levothyroxine, Acetaminophen, Coal Tar Extract 2% Shampoo, Sinemet, Ketoconazole 2% Cream
Current Illness: None
Preexisting Conditions: Parkinson''s Disease, Hypothyroidism, Depression, Contractures R/L Hands, Dementia
Allergies: No known Allergies
Diagnostic Lab Data: 4/22/2021 SARS-COV-2- Asymptomatic PCR Screen- COVID-19 detected
CDC Split Type:

Write-up: 4/22/2021 Tested positive for COVID-19 discovered during Universal Testing on specific Unit. Resident was asymptomatic. COVID-19 screening completed every 4 hours. 4/26/2021 Received therapeutic treatment Etesev-Bam 1400mg IV. 5/2/2021 Developed increased temperature and foul smelling urine. Rocephin 1 Gram given daily on 5/2/2021 and 5/3/2021. 5/4/2021 declining clinical presentation with fatigue. Morphine and ativan started for End Of Line/Comfort Care. 5/10/2021 Continued declining vital signs, fatigue, pain. Deceased on 5/10/2021


VAERS ID: 1512863 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-16
Onset:2021-04-11
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized and died of COVID after being vaccinated.


VAERS ID: 1512933 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-28
Onset:2021-06-08
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M208 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized and died due to COVID1-19 after being vaccinated.


VAERS ID: 1512969 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-03-07
Onset:2021-03-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Fatigue, Influenza like illness, Life support, Pain, Syncope, Withdrawal of life support
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   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: Yes but the medication is unknown
Current Illness:
Preexisting Conditions: Diabetes, Minor stroke
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: After the vaccine the pt said she felt like she had the flu. She was tired and sore and achy. And a week later she went to bed and woke her husband up to help her to go the the bathroom, she collapsed on the way and the husband called 911 and was taken to the hospital and the doctor said she had a massive brain bleed, she was put on life support, she passed away five minutes after being taken off of life support.


VAERS ID: 1513095 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: acetaZOLAMIDE 250 mg oral tablet, 250 mg, 1 tablet, ORAL, Daily amiodarone 200 mg oral tablet, 300 mg, 1.5 tablet, ORAL, qPM (once a day in the evening) dilTIAZem 240 mg/24 hours oral capsule, extended release, 240 mg, 1 capsule, ORAL, BI
Current Illness: Acute on chronic heart failure with preserved ejection fraction (HFpEF) Anemia due to blood loss Lymphedema Microcytic anemia scrotal bleeding
Preexisting Conditions: DM, PAF, GERD, Transgender, OSA , severe morbid obesity, asthma, depression
Allergies: Peanuts, Topamax
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death. Died on 7-9-21 (approximately 24 hours after vaccine).


VAERS ID: 1514458 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-22
Onset:2021-07-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNK / 1 - / OT

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: 2021-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: heart attack; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of MYOCARDIAL INFARCTION (heart attack) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unk) for COVID-19 vaccination. No Medical History information was reported. On 22-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Jul-2021, the patient experienced MYOCARDIAL INFARCTION (heart attack) (seriousness criteria death and medically significant). The patient died on 22-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were reported. No laboratory data was provided. No treatment information was provided. Very limited information regarding this event has been provided at this time. No further information is expected at this time. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this event has been provided at this time. No further information is expected at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1515049 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-01-08
Onset:2021-01-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Lymphadenopathy, Lymphoedema
SMQs:, Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-13
   Days after onset: 173
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: CHF Diabetes
Preexisting Conditions: CHF Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother developed a neck swollen lymph nodes after the first vaccine. It resolved on its own. After the second vaccine she was diagnosed as having widespread lymphedema. Her doctor reviewed her past medical records that did not show swollen wide spread lymphedema in November of 2020. My mother passed on 7.13.21. While I will never be able to get a medical professional to say the vaccine may have caused the lymphedema . I feel sure I will read of this reverse reaction in the medical journals in the next few years.


VAERS ID: 1515162 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-04
Onset:2021-07-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19 pneumonia, Death, Drain placement, Echocardiogram, Electrocardiogram ST segment elevation, Endotracheal intubation, Endotracheal intubation complication, General physical health deterioration, Intensive care, Lung opacity, Mediastinal disorder, Pneumothorax, Right ventricular dilatation, Right ventricular failure, Superinfection, Tachycardia
SMQs:, Cardiac failure (narrow), Angioedema (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CTPA 18/07/21: The pulmonary vasculature is well opacified with no convincing features of acute pulmonary thromboembolic disease. The calibre of the main pulmonary arterial trunks is normal. Note the trace of free mediastinal air. Diffuse ground-glass opacification that is predominantly in the peribronchovascular distribution but extends to the periphery in some areas. The appearances are consistent with COVID-19 pneumonitis. No pleural or pericardial effusions. Conclusion: No acute pulmonary thromboembolism. Trace of free mediastinal air. PCT 23/07/21: 0.16 PCT 25/07/21: 1.84 PCT 27/07/21: 77.62 ECHO 26/07/21: Difficult to accurately assess function due to tachycardia but LV function appears good / dynamic. RV appears dilated with pressure and volume overload. RV function appears mildly reduced. No significant valve lesions. No pericardial effusion.
CDC Split Type:

Write-up: Patient admitted to hospital on 13/07/21, and to Intensive Care on 14/07/21 for nasal high flow oxygen. He received dexamethasone IV. He was intubated on 24/07/21 following deterioration that day, and was proned. On 26/07/21 he had a chest drain inserted for a pneumothorax, and his endotracheal tube was changed due to a kinked tube. He was also started on antibiotics and antifungals to cover for superimposed infection. He passed away on 27/07/21 following further deterioration and ST elevation on ECG.


VAERS ID: 1515179 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-22
Onset:2021-06-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Unknown
Preexisting Conditions: Hyperlipidemia, carotid artery disease, prostate cancer
Allergies: No known drug allergies
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient''s death was reported to our facility by a file. Any other information is unknown at this time.


VAERS ID: 1515338 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-07-08
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043142119 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Bacteraemia, COVID-19, Death, Mechanical ventilation, Mental status changes, Metabolic acidosis, Respiratory failure, SARS-CoV-2 test positive, Septic shock, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-20
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, diclofenac topical, losartan, multivitamin, omega-3 polyunsaturated fatty acids (Fish Oil oral capsule)
Current Illness:
Preexisting Conditions: HTN, HLD, afib, DM2, CVA w/hemiplegia, alzheimer''s dementia, urethral stenosis s/p stent, bladder tumor s/p transurethral resection
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/16/21: patient presented to ED with altered mental status. found to be PCR COVID-19 positive. Patient received J&J COVID-19 vaccine on 4/5/21. Diagnosed with septic shock secondary to bacteremia and UTI, acute hypoxic and hypercapnic resp failure requiring mechanical ventilation, resp metabolic acidosis, COVID-19 infection. 7/20/2021: Patient expired


VAERS ID: 1515405 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-22
Onset:2021-07-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Blood glucose decreased, Blood potassium increased, Blood sodium decreased, Blood urea increased, Cardiac arrest, Confusional state, Critical illness, Respiratory arrest, Unresponsive to stimuli, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Redness and swelling in leg
Preexisting Conditions: ETOH dependency Anasarca COPD DVT
Allergies:
Diagnostic Lab Data: All on WBC 9.5, NA 126, potassium 6.0, CO2 10, BUN 50, Cr 3.4, Glucose 24
CDC Split Type:

Write-up: Pt found unresponsive at home and confused. Enroute to hospital by EMS, pt respiratory arrested. ROSC was achieved. Pt cardiac arrested 2nd time, with ROSC. Pt critical upon admission.


VAERS ID: 1515487 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-02-02
Onset:2021-07-23
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inhaler, aspirin, cilostazol, furosemide, hydrocodone/acetaminophen, humalog mix 75/25, magnesium oxide, omeprazole, pravastatin, pregabalin, quetiapine, flomax
Current Illness: CKD stage IV, hypertension, BPH, dementia
Preexisting Conditions: CKD stage IV, hypertension, BPH, dementia
Allergies: no known allergies
Diagnostic Lab Data: covid + 7/23/21
CDC Split Type:

Write-up: Admitted to hospital 7/23/21 with covid pneumonia requiring high flow nasal cannula. Respiratory status never improved and patient transitioned to hospice care. Expired 7/30/31


VAERS ID: 1515492 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-26
Onset:2021-04-05
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Bladder catheterisation, COVID-19, Cerebral atrophy, Cerebral small vessel ischaemic disease, Coma scale abnormal, Computerised tomogram head abnormal, Death, Endotracheal intubation, Intensive care, Mechanical ventilation, Paranasal sinus inflammation, Pulse absent, Pulseless electrical activity, Respiratory distress, Resuscitation, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 4/6/21 at 0554 - CT Head/Brain w/o contrast. Impression: 1) No acute intracranial process, 2) Atrophy & chronic ischemic disease suspected, & 3) Paranasal sinus disease
CDC Split Type:

Write-up: Staff at SNF stated, "feeling well yesterday." On 4/5 at staff initiated a call for resp. distress at 2235, he was pulseless, and CPR was started. Fire Dept. there at 2245 to assume CPR. EMS arrived at 2252 and found pt. in PEA with vomit in airway. He received 2 rounds of epi with return of circulation. He was intubated in the field. His post-arrest rhythm appeared to be ST. He was transferred to local ER at 2256 where a right SC line and FC placed. He received Zosyn while in local ER. His GCS was 3. FiO2 = 80%, COVID-19 PCR positive. He was transferred to another facility r/t lack of beds. He was placed in COVID ICU on with ventilator. He remains unresponsive during stay 4/6 - 4/7. Pt. expired on 4/7/21


VAERS ID: 1515497 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-28
Onset:2021-07-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apallic syndrome, Cardio-respiratory arrest, Death, Pyrexia, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   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: ZINC 50MG EVERY DAY VITAMIN C 500MG TWICE A DAY LIPITOR 40MG DAILY ASPIRIN 81MG DAILY VALPROIC ACID 750MG TWICE DAILY SENOKOT ONE TAB AT BEDTIME MIRALAX POWDER 17GM DAILY KEPPRA 750MG TWICE DAILY LANTUS INSULIN 47 UNITS TWICE DAILY NORVASC
Current Illness: HYPERTENSION DIABETES MELLITUS HYPERLIPIDEMIA CVA EPILEPSY
Preexisting Conditions: HYPERTENSION DM HYPERLIPIDEMIA
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ON 7/30/21 @ 0329 AM, RESIDENT BEGAN RUNNING FEVER 104.2 DEGREES WITH A RESPIRATORY RATE OF 60 BPM. B/P 54/30. PULSE RATE OF 74 BPM. O2 SAT OF 88% ON O2 @ 4LPM PER TRACHE COLLAR. RESIDENTS BASLINE COGNITIVE STATUS UNCHANGED FROM PERSISTENT VEGETATIVE STATE. DR. WAS CALLED BY NURSE AND ORDERS WERE GIVEN TO SEND TO ER. UPON ARRIVAL, EMS HAD TO START CPR AS RESIDENT CODED DURING PICKUP. RESIDENT WAS PRONOUNCED DEAD AT 0520.


VAERS ID: 1515732 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-02-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 146
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: Lisinopril 10 mg QD
Current Illness:
Preexisting Conditions: History of prostate cancer, Hypertension, Obesity
Allergies: Codeine, Penicillins (Rash), Fluorescein
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received dose #1 of Moderna Vaccine on 1/20/2021, and dose #2 of Moderna Vaccine on 2/26/2021 from another Facility. The patient was admitted in 7/19/2021 with a diagnosis of Pneumonia due to COVID-19 virus. Patient expired on 7/23/2021 despite treatment with supplemental oxygen, steroids, and remdesivir.


VAERS ID: 1515743 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-02-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Death
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 151
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin 500 mg BID, Aspirin 81 mg QD, B Complex QD, (cont), Bisoprolol 10 mg QD, Vitamin D3 - 2000 units QD, Dulaglutide 1.5 mg WEEKLY, Apixaban 5 mg BID, Furosemide 20 mg QD, Insulin Glargine 30 units QAM and 20 units QPM, Insulin Lisp
Current Illness:
Preexisting Conditions: Basal cell carcinoma, BPH, H/O DVT, Diabetes, Hyperlipidemia, Hypertension, H/O Melanoma, Rheumatoid Arthritis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received dose #1 of Moderna Vaccine on 1/20/2021, and dose #2 of Moderna Vaccine on 2/26/2021 from a Facility. The patient was admitted in 7/9/2021 with a diagnosis of Acute respiratory failure due to COVID-19. Patient expired on 7/28/2021 despite treatment with supplemental oxygen, steroids, and remdesivir, and tocilizumab.


VAERS ID: 1516529 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-20
Onset:2021-04-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 5-10-2021


VAERS ID: 1516531 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-12
Onset:2021-04-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 - / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Death, General physical health deterioration
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: digoxin, carbadopa/levadopa, eliquis, tamsulosin, metoprolol, atorvastatin, metformin
Current Illness: Parkinson''s Disease, Congestive Heart Failure, Type II Diabetes
Preexisting Conditions: Parkinson''s Disease, Congestive Heart Failure, Type II Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Weakness, declining health, admitted to hospice 6 days later, followed by death on 4/21/21 (9 days following vaccine).


VAERS ID: 1516750 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-08
Onset:2021-07-22
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold 21.3 on 7/22/21
CDC Split Type:

Write-up: Hospitalization from COVID-19 reported per vaccine


VAERS ID: 1517882 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Aortic valve incompetence, Blood bicarbonate, Blood creatine phosphokinase, Blood creatinine, Blood culture, Blood lactic acid, Blood pressure measurement, Body mass index, C-reactive protein, Death, Echocardiogram, Electrocardiogram, Heart rate, Incorrect dose administered, Myocarditis, Off label use, Oxygen saturation, PCO2, PO2, Procalcitonin, Pulmonary arterial wedge pressure, Renal impairment, Respiratory failure, Respiratory rate, Septic shock, Troponin, pH body fluid
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Multiple sclerosis
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Heart rate; Result Unstructured Data: 145 bpm; Test Name: Heart rate; Result Unstructured Data: 125 BPM; Test Name: Blood pressure; Result Unstructured Data: 117/70 mmHg; Test Name: Respiratory rate; Result Unstructured Data: 39; Test Name: Body mass index; Result Unstructured Data: 27.5; Test Name: Electrocardiogram; Result Unstructured Data: sinus tachycardia; Test Name: Blood culture; Result Unstructured Data: Negative for all viruses; Test Name: Procalcitonin; Result Unstructured Data: 185.71 ng/mL; Test Name: Troponin; Result Unstructured Data: 1.260-2.050 ng/mL; Test Name: Transthoracic echocardiogram; Result Unstructured Data: 2+ aortic regurgitation and diffuse left ventricular hypokinesis; Test Name: Echocardiogram; Result Unstructured Data: Diffuse left ventricular hypokinesis with severely reduced contraction; Test Name: Pulmonary arterial wedge pressure; Result Unstructured Data: 14 mmHg; Test Name: Creatinine; Result Unstructured Data: 1.21 mg/dL; Test Name: Bicarbonate; Result Unstructured Data: 16 mmol/L; Test Name: Troponin; Result Unstructured Data: <0.010 ng/mL; Comments: reference range =0010 ng/mL; Test Name: Creatine phosphokinase; Result Unstructured Data: 53 U/L; Test Name: Procalcitonin; Result Unstructured Data: 0.07 ng/mL; Test Name: C-reactive protein; Result Unstructured Data: 7.2 mg/L; Test Name: pH; Result Unstructured Data: 7.02; Test Name: Partial pressure CO2; Result Unstructured Data: 94 mmHg; Test Name: PaO2; Result Unstructured Data: 27 mmHg; Test Name: Lactate; Result Unstructured Data: 8.3 mmol/L; Test Name: Creatinine; Result Unstructured Data: worsening; Test Name: Oxygen saturation; Result Unstructured Data: 75 %
CDC Split Type: USJNJFOC20210754113

Write-up: VACCINE INDUCED MYOCARDITIS (VIRAL MYOCARDITIS); ACUTE HYPOXIC HYPERCAPNIC RESPIRATORY FAILURE; SEPTIC SHOCK; DECLINE IN RENAL FUNCTION; 2+ AORTIC REGURGITATION; PATIENT ADMINISTERED WITH 2 DOSES OF VACCINE; OFF LABEL USE; DEATH; This spontaneous report was received from literature: Case report with literature review. This report concerned a 70 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included multiple sclerosis. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown), frequency 2 total doses, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, after two days post second dose (inappropriate dose of vaccine administered and off label use) the patient experienced developed dyspnea at home and eventually required an ambulance for hospital transfer. The vital signs on arrival included a heart rate of 145 bpm, a 75% oxygen saturation level on room air, a blood pressure of 117/70 mmHg, a respiratory rate of 39, and a BMI of 27.5. The electrocardiogram (ECG) on admission revealed sinus tachycardia with a heart rate of 125bpm and T-wave inversions in leads V4-V6 without any ST-segment change. The patient arrived at the emergency department in severe respiratory distress that warranted immediate intubation. She was admitted to the intensive care unit (ICU) with the provisional diagnoses of acute hypoxic hypercapnic respiratory failure and septic shock. The laboratory screening and blood culture proved negative for all viruses, Mycoplasma pneumonia, and chlamydophila pneumonia. A repeat investigation revealed marked elevations in procalcitonin [185.71(ng/mL)] and troponin [1.260-2.050 ng/mL] levels on the second day of admission. The patient required multiple vasopressors to maintain the mean arterial pressure above 65 mmHg. The transthoracic echocardiogram on admission revealed 2+ aortic regurgitation and diffuse left ventricular hypokinesis with severely decreased left ventricular ejection fraction (10%). A repeat echocardiogram with contrast medium showed diffuse left ventricular hypokinesis with diagnostic monitoring via Swanz-Ganz catheter revealed a pulmonary wedge pressure (PWP) of 14mmHg. The patient continued receiving vasopressors and antibiotic therapy, while her renal function deterioration since admission warranted the prompt administration of renal replacement therapy. Further decline in renal function was marked by oliguria and worsening of creatinine levels. The patient declined cardiac catheterization and remained. On an unspecified date the patient was hospitalized and it was for 8 days. On unspecified date patient died with vaccine induced myocarditis (viral myocarditis) on eighth day of admission to hospital. The exact cause of death was not reported and it was unknown whether autopsy was performed. The other laboratory data includes, Creatinine (NR: 0.05 - 1.20) 1.21 mg/dL, Bicarbonate (NR: 22 - 29) 16 mmol/L, Creatine phosphokinase (NR: 20 - 190) 53 U/L, Procalcitonin (NR: 0.02 - 0.10) 0.07 ng/mL, C-reactive protein (NR: 0 - 3.00) 7.2 mg/L, pH (NR: 7.35 - 7.45) 7.02 (units unspecified), Partial pressure CO2 (NR: 35 - 48) 94 mmHg, Lactate (NR: 0.6 - 1.4) 8.3 mmol/L, PaO2 (NR: 83 - 108) 27 mmHg, The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine induced myocarditis (viral myocarditis), acute hypoxic hypercapnic respiratory failure, septic shock, decline in renal function, 2+ aortic regurgitation, patient administered with 2 doses of vaccine, off label use was not reported. This report was serious (Death, Life Threatening, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210754113-covid-19 vaccine ad26.cov2.s - Death, vaccine induced myocarditis, acute hypoxic hypercapnic respiratory failure, septic shock, decline in renal function, 2+ aortic regurgitation. 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: 1517885 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test, Suspected COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BNT 162; MRNA 1273
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210756412

Write-up: DEATH; BREAKTHROUGH COVID CASES; SUSPECTED COVID 19 INFECTION; This spontaneous report received from a patient by other company (Pfizer Inc.) received on 23-JUL-2021 and concerned multiple patients. No past medical history or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. Concomitant medications included bnt 162, and mrna 1273. It was reported that there were 4450 breakthrough Covid cases. Among 4450 cases, 247 patients were hospitalized for suspected Covid 19 infection and 79 patients died among the population who were fully vaccinated by Pfizer or Moderna vaccine both doses or Janssen vaccine one dose. Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of breakthrough covid cases and suspected covid 19 infection was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0:20210756412-covid-19 vaccine ad26.cov2.s-death,breakthrough covid cases. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210756412-covid-19 vaccine ad26.cov2.s -suspected covid 19 infection. This event(s) is considered not related. The event(s) is deemed to be scientifically implausible, i.e., there is scientific evidence against a drug/event relationship; AND there is no known class effect.; Reported Cause(s) of Death: CONFIRMED COVID-19 INFECTION


VAERS ID: 1517971 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100909825

Write-up: Reporter had a friend die from the covid vaccine.; This is a spontaneous report from a non-contactable consumer.A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Reporter had a friend die from the covid vaccine. Outcome of 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: Reporter had a friend die from the covid vaccine.


VAERS ID: 1517987 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100912595

Write-up: died from the vaccine; This is a spontaneous report from a contactable consumer reporting same event under the same suspect product for 4 patients. This is one of four reports. A patient of unspecified age and gender received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) at single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced died from the vaccine on an unspecified date. The reporter stated in his neighborhood 4 people died from the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up attempts have been completed and no further information is expected. Information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100970595 same reporter, event and drug, different patient;US-PFIZER INC-202100970596 same reporter/drug/event, different pt;US-PFIZER INC-202100970597 same reporter, event and drug, different patient; Reported Cause(s) of Death: died from the vaccine


VAERS ID: 1518030 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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 INC202100922421

Write-up: sudden death of a 13-year-old (place)child who had a second dose of Pfizer vaccine; This is a spontaneous report from a non-contactable consumer (columnist). A 13-year-old male patient received second dose of BNT162b2 (FIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that remained strangely silent over the sudden death of a 13-year-old child who had a second dose of Pfizer vaccine. 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: Sudden death


VAERS ID: 1518133 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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: 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 INC202100944709

Write-up: 5 death happen; This is a spontaneous report from a non-contactable consumer. This consumer reporting same event under the same suspect product for 5 patients. This is 3rd of 5 reports. A patient of an unknown age and gender received 2nd dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) at single dose via an unknown route on an unknown date for Covid-19 immunization. Medical history and concomitant drug were not provided. Patient died after Pfizer vaccine. It was further reported that couple of deaths occurred after Pfizer vaccine, some of them immediately, some in few hours. The reporter stated that in one village with 2000 population, 5 death happen and some after the 2nd vaccine and one of them immediately after vaccine, The vaccine was kept in ice box for like 5 hours, other village it just about 3, another village or 2. The reporter stated if the vaccine was carried by just ice for like 5 hour, may be this was the problem. Outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100944572 same reporter/drug/event, different patient; Reported Cause(s) of Death: 5 death happen


VAERS ID: 1518134 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100944710

Write-up: deaths occurred after Pfizer vaccine; This is a spontaneous report from a non-contactable consumer. This consumer reported similar events for 5 patients, this is the forth report. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via unspecified route single dose for COVID-19 immunization on an unspecified date. The patient medical history was not reported. The patient''s concomitant medications were not reported. Patient died after Pfizer vaccine. It was reported that couple of deaths occurred after Pfizer vaccine, some of them immediately, some in few hours. The reporter stated that in one village with 2000 population, 5 death happen and some after the 2nd vaccine and one of them immediately after vaccine, The vaccine was kept in ice box for like 5 hours, other village it just about 3, another village or 2. The reporter asked if the vaccine was carried by just ice for like 5 hour, may be this was the problem. Outcome of the event was fatal. The patient died on an unspecified date. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100944572 same reporter/drug/event, different patient; Reported Cause(s) of Death: deaths occurred after Pfizer vaccine


VAERS ID: 1518135 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100944711

Write-up: Couple of deaths occurred after Pfizer vaccine, some of them immediately, some in few hour/5 death happen and some after the 2nd vaccine and one of them immediately after vaccine; This is a spontaneous report from a non-contactable consumer. This consumer reported similar events for 5 patients, this is the 5th report. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died on an unspecified date. Reporter wanted to ask about the question about moving the vaccine in packets of ice for like 2or 3 or 4 hour. Will it make it less effective or may be bad effect? Reporter stated, the question was about couple of deaths occurred after Pfizer vaccine, some of them immediately, some in few hour. Their question was about the vaccine that was carried by just ice for like 5 hour, may be this was the problem. Reporter stated, everything is fine you know in one village with 2000 population, 5 death happen and some after the 2nd vaccine and one of them immediately after vaccine. The vaccine was kept in ice box for like 5 hours, other village it just about 3, another village or 2. The question is, if the ice box is enough for carrying the vaccine. It was not reported if an autopsy was performed. Seriousness criteria was resulted in death. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100944572 same reporter/drug/event, different patient; Reported Cause(s) of Death: Couple of deaths occurred after Pfizer vaccine, some of them immediately, some in few hour/5 death happen and some after the 2nd vaccine and one of them immediately after vaccine


VAERS ID: 1518168 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100963386

Write-up: Caller states that 5 deaths, from that vaccine was reported; This is a spontaneous report from a contactable consumer reporting for a patient received from a Pfizer-sponsored program. This is the 2nd of 5 reports. A patient of an unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot number: unknown) via an unspecified route of administration on an unspecified date as DOSE NUMBER UNKOWN, SINGLE for Covid-19 immunization, age at vaccination unknown. The patients medical history and concomitant medications were not reported. Consumer stated that he did took a survey in his neighborhood, going door to door, and some people had taken the vaccine and some had not. Consumer stated that 5 deaths, from that vaccine was reported, and over 50% of people reported a debilitating disease, or cannot function, and have thousands of dollars in medical bills. The outcome of event was fatal. Autopsy was unknown. No follow-up attempts are needed; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100913512 Same reporter/drug/AE, different patient; Reported Cause(s) of Death: Consumer stated that 5 deaths, from that vaccine was reported


VAERS ID: 1518169 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100963754

Write-up: 5 deaths, from that vaccine was reported; This is a spontaneous report from a contactable consumer received from a Pfizer-sponsored program. This is the 3rd of 5 reports. A patient of an unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot number: unknown) via an unspecified route of administration on an unspecified date as dose number unknown, single for Covid-19 immunization. The patient''s medical history and concomitant medications were not reported. On an unspecified date, Consumer stated that 5 deaths, from that vaccine was reported and over 50% of people reported a debilitating disease, or cannot function, and have thousands of dollars in medical bills. The outcome of event was fatal. Autopsy was unknown. Information on the lot/ batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100913512 Same reporter/drug/AE, different patient; Reported Cause(s) of Death: 5 deaths, from that vaccine was reported


VAERS ID: 1518170 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100963755

Write-up: Caller states that 5 deaths, from that vaccine was reported,; This is a spontaneous report from a contactable consumer received from a Pfizer-sponsored program. This consumer reported similar events for five patients. This is the 4th of five reports. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Reporter called about the COVID 19 vaccine, Pfizer. The reporter did a survey in his neighborhood, going door to door, and some people had taken the vaccine and some had not. Reporter stated that 5 deaths from that vaccine was reported, and over 50% of people reported a debilitating disease, or cannot function, and have thousands of dollars in medical bills. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100913512 Same reporter/drug/AE, different patient; Reported Cause(s) of Death: Callers states that 5 deaths, from that vaccine was reported


VAERS ID: 1518171 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100963756

Write-up: deaths from that vaccine; This is a spontaneous report from a contactable consumer received from a Pfizer-sponsored program. This consumer reported similar events for five patients. This is the fifth of five reports. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Reporter called about the COVID 19 vaccine, Pfizer. He did a survey in his neighborhood, going door to door, and some people had taken the vaccine and some had not. Reporter stated that 5 deaths from that vaccine was reported, and over 50% of people reported a debilitating disease, or cannot function, and have thousands of dollars in medical bills. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100913512 Same reporter/drug/AE, different patient; Reported Cause(s) of Death: deaths from that vaccine


VAERS ID: 1518172 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100970595

Write-up: died from the vaccine; This is a spontaneous report from a contactable consumer reporting same event under the same suspect product for 4 patients. This is one of four reports. A patient of unspecified age and gender received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) at single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced died from the vaccine on an unspecified date. The reporter stated in his neighborhood 4 people died from the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up attempts have been completed and no further information is expected. Information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100912595 same reporter, event and drug, different patient; Reported Cause(s) of Death: died from the vaccine


VAERS ID: 1518173 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100970596

Write-up: died from the vaccine; This is a spontaneous report from a contactable consumer reporting same event under the same suspect product for 4 patients. This is one of four reports. A patient of unspecified age and gender received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) at single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced died from the vaccine on an unspecified date. The reporter stated in his neighborhood 4 people died from the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up attempts have been completed and no further information is expected. Information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100912595 same reporter/drug/event, different pt; Reported Cause(s) of Death: died from the vaccine


VAERS ID: 1518174 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
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 INC202100970597

Write-up: died from the vaccine; This is a spontaneous report from a contactable consumer reporting same event under the same suspect product for 4 patients. This is one of four reports. A patient of unspecified age and gender received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) at single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient experienced died from the vaccine on an unspecified date. The reporter stated in his neighborhood 4 people died from the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up attempts have been completed and no further information is expected. Information about lot/batch number cannot be obtained.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100912595 same reporter, event and drug, different patient; Reported Cause(s) of Death: died from the vaccine


VAERS ID: 1518414 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Pharmacy       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: Unknown
Current Illness: None listed on vaccination pre-screening form.
Preexisting Conditions: None listed on vaccination pre-screening form.
Allergies: none listed
Diagnostic Lab Data: None known as of this date.
CDC Split Type:

Write-up: Unknown woman called on 7/30/21 to ask if we were vaccinating with "Covid shots approved by the government." She later began to cry and stated that her father had passed away 1 day after receiving the vaccine at our location. I asked her for her father''s name, she identified him as the patient. I vaccinated him on 7/28/21. She said she indicated that the family was in touch with his primary care physician and would provide us with updates. I will be in contact with his primary care provider on Monday, 8/2/21.


VAERS ID: 1518468 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-08
Onset:2021-07-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 AR / SYR

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

Write-up: Death. He died within 24 hours of receiving the 1st dose


VAERS ID: 1518627 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-03-14
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Condition aggravated, Hypertension, Pneumoconiosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: IV antibiotics for Pneumonia, DuoNebs and Solu-Medrol for COPD, pain medication and home meds.
Current Illness:
Preexisting Conditions: Hypertension, Cardiovascular disease, Chronic lung disease.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid-19 Pneumonia, Hypertension, Black lung


VAERS ID: 1518664 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-03-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / UNK - / -

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: 2021-04-09
   Days after onset: 19
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: AKI/CKD, CHF, Cardiomyopathy, Metabolic Alkalosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a 71-year-old Male, fully vaccinated with Moderna on 03/05/2021. Admitted to hospital on 03/21/2021 as he is tested positive for COVID-19 and passed away on 04/09/2021.


VAERS ID: 1518997 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-02-12
Onset:2021-02-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Brain scan abnormal, Chest pain, Death, Fall, Life support, Organ donor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lecemi- Flex Touch U-100 Insulin Lisinopril 20 MG methocarbamol - 500 mg Metroprolol succinate 100mg Prednisone 20 mg trazodone 50 mg hydroxyzine pamoate 25 mg Ventolin HFA 90 mcg Atorvastatin 40 mg cetirizine 10 mg gaberpentin 400 mg budes
Current Illness: Kidney failure on dialysis Stroke which left him unable to speak High Blood Pressure and cholesterol Type 1 diabetic since he was 12 Amputee (leg)
Preexisting Conditions: See above
Allergies:
Diagnostic Lab Data: Pending autopsy results still
CDC Split Type:

Write-up: After receiving vaccine he was with me (mom), visiting my grandkids, shopping and eating, for approximately 3 hours at which time I dropped him off at my ex husbands house where he lived. Within 30 minutes he walked to his dad and grabbed his chest and slumped to the ground. Emergency Ambulance was called and attempted unsuccessfully to revive him but transfer to hospital where they worked for an hour. He was placed on life support and transferred to one of their larger facilities. On 2-14-21 they did the brain activity test ad he was pronounced dead. Remain on live support until Core could harvest usable organs


VAERS ID: 1519067 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-06
Onset:2021-04-30
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Anticoagulant therapy, Catheter directed thrombolysis, Computerised tomogram abnormal, Death, Haemorrhagic stroke, Mesenteric artery thrombosis, Mesenteric vein thrombosis, Ultrasound scan
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Idiopathic Thrombocytopenic Purpura, Diabetes type 2, Hypertension
Allergies:
Diagnostic Lab Data: CTs showed mesenteric vein and arterial thrombi.
CDC Split Type:

Write-up: Patient received the 2nd Pfizer Covid-19 Injection on 4/27/2021. She began having severe stomach pain the following day that did not resolve. She went to the hospital and was admitted on 4/30/2019. She underwent CTs, Ultrasounds. Found that she had 1 blood clot in a mesenteric artery. A second CT performed 2 days later showed that she had a 2nd blood clot that formed in a mesenteric vein. She has a condition ITP where she does not clot very well, however, it was stable at this time. She was started on heparin drips which made no improvement to the clots. Lysis catheter inserted with a TPA drip. This resulted in hemorrhagic stroke. She was placed on palliative care and passed away on 05/11/2021.


VAERS ID: 1519700 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-20
Onset:2021-07-09
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Confusional state, Cough, Death, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: COPD
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 on 7/10/2021.
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 tested positive for COVID-19 on 7/10/2021. Vaccine Dose #1 given 2/27/2021. Vaccine Dose #2 given 3/20/2021. Client hospitalized on 7/14/2021 for shortness of breath, cough, confusion, and severe generalized weakness. Client died on 7/17/2021.


VAERS ID: 1519738 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-07-17
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SC

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Fall
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, HTN, Arthritis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit 7/17 due to weakness, fall at home and SOB


VAERS ID: 1519779 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-07-09
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SC
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SC

Administered by: Private       Purchased by: ?
Symptoms: Endotracheal intubation
SMQs:, Angioedema (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of Kidney transplant, on immunosuppression for kidney transplant, active lupus with lupus arthritis
Allergies: Benadryl, broccoli, calcitriol, clinidamycin, kelfex, prednisone, & sensipar
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit to Medical Center 7/9/2021. Intubated 7/18-7/24 & 7/26-7/30


VAERS ID: 1519797 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-07-11
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid, Death, Prothrombin time prolonged, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: anemia in chronic kidney disease, asthma, charcot''s syndrome, chf, chronic renal failure, DM, GERD, HTN, Morbid obesity
Allergies: lisinopril
Diagnostic Lab Data: WBC 7/12 13.3: 7/14 29.9. Protime 7/14 20.3. Lactic Acid 7/13 11.1,
CDC Split Type:

Write-up: Admit 7/1-7/4. Re-Admission 7/11. Expired 7/14.


VAERS ID: 1519803 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-05-14
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   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: CAD, CHF, COPD
Preexisting Conditions: Cardiovascular and Chronic lung disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a 92-year-old Female, fully vaccinated with Pfizer on 01/12/2021. Admitted to hospital as she is tested positive for COVID-19 and passed away on 05/14/2021.


VAERS ID: 1519840 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-01-28
Onset:2021-07-06
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Dyspnoea, Pulmonary congestion, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COPD CAD HYPERTENSION, ARTHRITIS
Preexisting Conditions: SAME
Allergies: soy, morphine, dried beans
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed CP SOB Chest Congestion, tested positive for COVID 19 on 7/8/2021


VAERS ID: 1519871 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-04-26
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK - / -

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

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

Write-up: Patient was a 100-year-old Female, fully vaccinated with Pfizer on 01/12/2021. Admitted to hospital as she is tested positive for COVID-19 and passed away on 04/26/2021.


VAERS ID: 1519899 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-06
Onset:2021-07-23
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Bilevel positive airway pressure, COVID-19, Death, Dyspnoea, 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), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 9
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: aspirin 81 MG PO Tablet Take 81 mg by mouth daily. atenolol (TENORMIN) 50 MG PO Tablet Take 50 mg by mouth daily. 11/26/18 doxycycline (VIBRAMYCIN) 100 MG PO Capsule Take 100 mg by mouth daily. gabapentin (NEURONTIN) 100
Current Illness:
Preexisting Conditions: Chronic myeloproliferative disorder (CMS-HCC: 48) 2017 ? Chronic renal insufficiency BUN/cr 20/1.41 (1/15/19) ? Erythrocytosis RBC 6.9 (1/15/19) ? Follicular lymphoma 01/2019 ? GERD (gastroesophageal reflux disease) ? History of shingles 2018 possible shingles, never had any open lesions per wife, rash only ? Hyperglycemia ? Hyperlipidemia ? Hypertension ? JAK-2 gene mutation 2017 positive ? Leukocytosis WBC 15.84 (1/15/19) ? Migraine throughout life ? Neck pain ? Polycythemia vera ? Seizures (CMS-HCC: 79) 1965 ? Shingles ? Snoring with witnessed apnea and bradycardia ? Thrombocytosis (CMS-HCC: 48) Platelets 644,000 (1/15/19) ? Vitamin D deficiency
Allergies: NKDA
Diagnostic Lab Data: CORONAVIRUS (COVID-19) NAA (Collected 07/23/21) - confirmed positive Patient reported testing positive for covd-19 5 days prior to hospital admission on 7/23/21.
CDC Split Type:

Write-up: Patient was hospitalized due to breakthrough covid-19 infection on 7/23/21 after worsening shortness of breath for the past 5 days. Patient tested positive for covid-19 5 days prior to admission. Patient was pronounced deceased on 8/1/2021 @22:53. Patient completed Pfizer vaccination series in February. Information below is copied from progress note (8/1/21): PLAN: NEURO: h/o peripheral neuropathy, HOH o Lyrica o PRN: Tylenol o PRN: Trazadone Cardio: h/o HTN o Hydralazine prn o Statin daily o ASA RESP: Acute Hypoxic Respiratory Failure Secondary to Covid - 19 o HFNC, goal O2 sat 88%, wean as able o Bipap QHS o CPT, flutter valve, IS o Solumedrol BID o Guaifenesin prn o Albuterol prn o ABG/CXR PRN RENAL/FEN: h/o CKD 3 o Regular diet o Monitor electrolytes and replete as needed o Monitor renal indices ENDO: o Blood glucose checks AC & HS with insulin sliding scale coverage PRN HEME: h/o non hodgkins lymphoma with bone, liver and pulm involvment o Monitor CBC o Stopped chemo in June- resume when feasible ID: Covid - 19 o Completed Remdesivir o No ABX at this time o Trend inflammatory markers o Supportive care PPX: o DVT ppx: SCDs, Lovenox o GI ppx: Protonix


VAERS ID: 1519902 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-02
Onset:2021-07-31
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, COVID-19, Death, Headache, Oxygen saturation decreased, Pain, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 2
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: Dementia, MS, COPD, hx CVA and nephrolithiasis w/ureteral stent
Allergies:
Diagnostic Lab Data: Positive PCR SARS-CoV-2 result from NP specimen collected 7/31/2021.
CDC Split Type:

Write-up: Patient presented to ED for evaluation of headache, body aches, agitation. Increased O2 needs once admitted, requiring high flow O2. Greater than 14 days post J&J vaccination. Patient passed away 8/2/2021


VAERS ID: 1519928 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-30
Onset:2021-07-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspercream, Morphine and Tramadol both PRN, Aspirin 81mg, Baza Protec Cre, Ferrous Sulfate Elx-220/5ml, Ipratropium/sol Albuter, metoprol 25mg, MI-Acid SUS, Nystatin Pow 10000, Robafen Syp 100/5ml, Milk of Mag, Isosorb Mono 30mg, Omeprazole
Current Illness: Closed right hip fracture Acute respiratory failure
Preexisting Conditions: DNR Hypertension Dementia
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: 5701

Write-up: None


VAERS ID: 1519940 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-20
Onset:2021-07-24
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Bilevel positive airway pressure, Blood lactic acid decreased, COVID-19, Chest X-ray abnormal, Chills, Cough, Culture negative, Death, Dizziness, Dyspnoea, Infection, Influenza virus test positive, Lung infiltration, Myalgia, Pneumonia, Procalcitonin increased, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   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: aspirin 81 MG PO Tablet Take by mouth daily. diclofenac (VOLTAREN GEL) 1 % TD Gel. Apply 2 g topically 4 times daily as needed (for pain or swelling). **Measure dose using enclosed dose card** 5/29/18 finasteride (PROSCAR) 5 MG
Current Illness:
Preexisting Conditions: BPH (benign prostatic hyperplasia) ? GERD (gastroesophageal reflux disease) ? Hypertension ? Thyroid activity decreased
Allergies: Iodine
Diagnostic Lab Data: 7/24/2021 by FLU/SARS-COV-2 (Rapid ED-Only) (Collected 07/24/21) - confirmed positive
CDC Split Type:

Write-up: Patient hospitalized due to breakthrough covid-19 infection on 7/24/21 with complaints of cough, SOB, generalized weakness, myalgias, fevers, chills and lightheadedness x 1 week. Patient was pronounced deceased on 7/25/2021 @ 8:52am. Patient completed the Moderna vaccination series in March/April. Information below is copied from the discharge summary: Summary of stay below: PNA present on admission- COVID 19 - cap - CXR bl infiltrates - high risk - o2 supplement, bipap at max settings, DNR - therapeutic ac renally adjusted -statin -recommended voluntary prone positioning 8hrs per day - solumedrol bid -procalcitonin elevated given abx for pna -borderline benefit for remdesivir, given Acute respiratory failure w hypoxia - setting of PNA - o2 supplement - as above Sepsis- sec to above - cultures were negative - lactic acid 6-2 - ivf for hydration given HTN- fairly controlled - home meds Hypothyroidism -synthroid BPH - flomax


VAERS ID: 1519955 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-29
Onset:2021-02-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Back pain, Myocarditis, Pathology test
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Xanax & Ambien
Current Illness:
Preexisting Conditions: Eleveated Cholesterol
Allergies:
Diagnostic Lab Data: Heart Pathology Report indicated Myocarditis
CDC Split Type:

Write-up: Back Pain & Stomach discomfort/Pain


VAERS ID: 1520136 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-05
Onset:2021-07-02
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CVO224 / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CVO224 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic lymphocytic leukemia, diabetes type II
Allergies: Unknown
Diagnostic Lab Data: RT-PCR positive on 7/2/2021
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 developed breakthrough infection and tested positive via PCR on 7/2/21. Vaccine dose #1 administered on 2/5/2021 and dose #2 administered on 3/5/2021. Client was hospitalized on 7/2 for COVID-19 pneumonia and subsequently died on 7/24/2021.


VAERS ID: 1521946 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-01
Onset:2021-05-13
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Thrombosis
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), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Strokes; Blood clots; Died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died), CEREBROVASCULAR ACCIDENT (Strokes) and THROMBOSIS (Blood clots) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Aneurysm. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (Strokes) (seriousness criteria death and medically significant) and THROMBOSIS (Blood clots) (seriousness criteria death and medically significant). The patient died on 13-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication use information was not provided by reporter. Treatment medication use information was not provided by reporter Patient had multiple medical issues , got vaccine after and aneurysm. Very limited information regarding this events has been provided at this time. Further information can''t be requested. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information can''t be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1521958 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-03
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: Lost her mother after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Lost her mother after getting the vaccine) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No treatment information was provided. No relevant concomitant medications were reported. Very limited information regarding the events has been provided at this time; Sender''s Comments: Very limited information regarding the events has been provided at this time; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1522680 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-08
Onset:2021-06-24
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Hepatic cirrhosis, SARS-CoV-2 test positive, Vomiting
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: The patient was is in end stage liver disease awaiting a transplant and was tested as part of routine testing for weekly paracentesis. The patient''s wife reports that he began three new medications on 6/24 and began vomiting that evening.
Current Illness: IMMUNOCOMPROMISED CONDITION, CHRONIC LIVER DISEASE
Preexisting Conditions: IMMUNOCOMPROMISED CONDITION, CHRONIC LIVER DISEASE
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient. The patient is fully vaccinated and the second dose of Pfizer. Date of second vaccine was listed as 05/08. Case began new medication, began vommiting 6/25. Got tested for COVID-19, tested +,. The patient was is in end stage liver disease awaiting a transplant and was tested as part of routine testing for weekly paracentesis. The patient''s wife reports that he began three new medications on 6/24 and began vomiting that evening. Patient was admitted after testing positive because the test caused him to miss his paracentesis procedure and has no other symptoms. Patient is listed as having died from COVID-19, end stage liver failure, and liver cirrhosis.


VAERS ID: 1522766 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-28
Onset:2021-07-24
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram abdomen, Computerised tomogram abnormal, Condition aggravated, Diverticulum, Dyspnoea, Hepatic enzyme increased, Hypertension, Productive cough, SARS-CoV-2 test positive, Spinal compression fracture, Tachycardia
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Hypertension (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), 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: 2021-07-31
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol loratadine Advar Remeron Prilosec Zoloft
Current Illness: none known
Preexisting Conditions: COPD HTN Large granular lymphocytic leukemia Type 2 diabetes
Allergies: Dilaudid aspirin sulfa drugs
Diagnostic Lab Data: Upon presentation to the emergency department he was tachycardic and hypertensive with otherwise normal and stable vitals. She was saturating well on 4 L oxygen nasal cannula, increased from baseline 3L. COVID-19 testing was positive, and liver enzymes were elevated. Chest x-ray showed atelectasis without focal consolidation in CT abdomen and pelvis showed no acute pathology and a T8 compression fracture and chronic diverticulosis as incidental findings.
CDC Split Type:

Write-up: a 80 y.o. female with a past medical history of CLL, chronic obstructive pulmonary disease on 3 L oxygen at baseline, chemotherapy-induced pancytopenia, transfusion dependent anemia, iron overload, and type 2 diabetes who presented to Hospital on 0724/2021 with increased shortness of breath and productive cough and was admitted for COVID pneumonia.


VAERS ID: 1522879 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-07-27
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 7
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: Covid19 antigen test positive on 07/31/2021
CDC Split Type:

Write-up: Cough, Fever, Muscle Aches


VAERS ID: 1522892 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-20
Onset:2021-08-01
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: PENICILLIN, SULAMETHOXAZOLE
Diagnostic Lab Data: 7/26/2021 COVID = DETECTED AT CLINIC
CDC Split Type:

Write-up: 7/26/2021 TESTED FOR COVID AT CLINIC RESULTS = DETECTED. 7/28/2021 PATIENT ADMITTED TO HOSPITAL FOR COVID PNA 8/1/2021 PATIENT DIED.


VAERS ID: 1522949 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-26
Onset:2021-07-27
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, Cardiac arrest, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Continuous positive airway pressure, Death, Dyspnoea, Hypoxia, Intensive care, Lung infiltration, Mechanical ventilation, Oxygen saturation decreased, Productive cough, Pulmonary embolism, SARS-CoV-2 test positive, Tachypnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clarinex-D 24 hours, Nasacort, Percocet 5/325 PRN, Ecotrin 325, Pravastatin 40 mg.
Current Illness: DJD, Hyperlipidemia, Obesity, Sinus Problems
Preexisting Conditions:
Allergies: Codeine, Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully Covid-19 vaccinated at the end of February. On 07/16/2021 patient tested positive with Covid-19. Patient admitted on 07/27/2021 ICU with shortness of breath, productive cough and O2 % on 86%. CXR on 07/27/2021 shows bilateral infiltrate''s. patient was hypoxic and tachypneic. 07/31/2021 patient become more shortness of breath and was put on CPAP high flow and CT of the chest was done showing PE. Patient was put on Heparin drip. Patient decompensated on 08/02/2021, was connected to MV and went to cardiac arrest, patient pass at 09:57 on 08/02/2021.


VAERS ID: 1522982 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-07-25
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   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: Eliquis, Cozaar, Zyloprim, Deltasone, Toprol
Current Illness:
Preexisting Conditions:
Allergies: Cortisone, Penicillin''s, and Diltiazem
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/25/2021.


VAERS ID: 1523005 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-07-28
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Roxanol, Ativan
Current Illness:
Preexisting Conditions:
Allergies: Fosamax, Ibandronic acid, penicillin, sulfa drugs, lactose, alendronic acid, chicken meat, food, hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/28/2021.


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=58&PERPAGE=100&VAX=COVID19&DIED=Yes

Government Disclaimer on use of this data


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