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

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



Case Details

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VAERS ID: 1523231 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-01-07
Onset:2021-01-24
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray, Death, Intensive care, Pneumonia, Sepsis, Septic shock
SMQs:, Toxic-septic shock conditions (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: He had already taken his first round of chemotherapy - he was on chemotherapy medication. He was on a whole host of other drugs.
Current Illness: He started his first chemo treatment on December 31st and then he had a second chemo treatment on January 21st. He had one treatment prior and one round of treatment after vaccination.
Preexisting Conditions: Stage 4 Non Hodgkin''s Lymphoma - November 2020 - diagnosed with
Allergies: No
Diagnostic Lab Data: Chest x-ray, they did every test in the world for him.
CDC Split Type: vsafe

Write-up: Unrelated to vaccine: He had community acquired pneumonia; sepsis and septic shock. Went by ambulance to ER and that evening they got him to ICU room. I think they were administering strong antibiotic. He was in the hospital three days. Came home on Jan 27th. We started hospice on Jan 29 and he passed on February 23rd.


VAERS ID: 1523234 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-05-14
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M202A / UNK UN / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Dyspnoea, Oedema, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   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: Aspirin, Cardia XT, lasix, ferrous sulfate, potassium chloride, ropinirole
Current Illness:
Preexisting Conditions: Afib,mitral regurg, HTN, prostate cancer, hiatal hernia, iron def enemia, ostwoarthritis, B12 deficiency, amaurosis fugax, SOB, low BP
Allergies: unk
Diagnostic Lab Data: Covid + 5/14/2021
CDC Split Type:

Write-up: presented ED on 5/14/21 - O2 in 60''s., SOB, cough lower body edema, dx with covid pneumonia


VAERS ID: 1523257 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-30
Onset:2021-08-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: DIABETES, CHEST PAIN, PULOMONARY EDEMA
Preexisting Conditions: DIABETES, HYPERTENSION, FIBROMYALGIA, ANXIETY, ASTHMA, HYPERLIPIDEMIA
Allergies: AMLODIPINE, ASPARTAME PHENYLALANINE, CARVEDILOL, CITALOPRAM, LISINOPRIL, METHADONE, PENICILLIN, SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT DID NOT COMPLAIN ABOUT ANY SIDE EFFECT. HOWEVER, DAUGHTER REPORTED THAT PATIENT WAS FOUND DEAD AT HER HOUSE LAST NIGHT 08/02/21


VAERS ID: 1523422 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-07-20
Onset:2021-08-02
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 7/20/2021 Client received Janssen COVID 19 vaccine in a long term care facility. 8/2/2021 Client died at long term care facility 8/3/2021 Coordinator received email notification of client''s death


VAERS ID: 1524928 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: BMI; Result Unstructured Data: Test Result:greater than 40; Test Name: COVID test; Result Unstructured Data: Test Result:Died of COVID
CDC Split Type: USPFIZER INC202100958483

Write-up: Died of COVID; Died of COVID; BMI greater than 40; This is a spontaneous report received from a contactable physician communicated to a sales representative. A 23-year-old female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for Injection), first dose as dose 1 single and second dose as dose 2 single, both via an unspecified route of administration on an unspecified date for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Event took place after use of product. The patient experienced died of COVID, BMI greater than 40 on an unspecified date. The events drug ineffective and covid-19 assessed as serious (death, medically significant) and while for other was non-serious. The patient underwent lab tests and procedures which included body mass index: greater than 40, COVID test: died of covid on unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of the events drug ineffective and covid-19 was reported as fatal and while for other was unknown. Reporter does not wish to be contacted for follow-up. No follow-up attempts are possible, information about lot/batch number cannot be obtained.; Sender''s Comments: (Based on plausible dose -event relationship post vaccination and no other alternate explanation the causal role of BNT162B2 cannot be excluded for the reported LOE events) The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Died of COVID; Died of COVID


VAERS ID: 1525590 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-26
Onset:2021-07-26
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Exposure to SARS-CoV-2, 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: 2021-08-04
   Days after onset: 9
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: Specimen Collection Date: 7/26/21 Specimen Source: nasal swab Test Performed: SARS-CoV-2 Result: Positive Lab
CDC Split Type:

Write-up: No sx. Tested due to being a resident of a long term care facility where there was a current outbreak due to a staff member testing positive during routine testing.


VAERS ID: 1525599 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-07-26
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, 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: 2021-08-04
   Days after onset: 9
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: C. Diff
Preexisting Conditions: multiple co-morbidities
Allergies:
Diagnostic Lab Data: Specimen Collection Date: 7/26/21 Specimen Source: nasal swab Test Performed: SARS-CoV-2 N gene Resp Ql NAA+probe Result: Positive Lab: Exact Sciences Laboratories
CDC Split Type:

Write-up: No sx. Tested due to being a resident of a long term care facility where there was a current outbreak due to a staff member testing positive during routine testing.


VAERS ID: 1525661 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-08
Onset:2021-06-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No.
Current Illness: No.
Preexisting Conditions: No.
Allergies: No.
Diagnostic Lab Data: No.
CDC Split Type: vsafe

Write-up: Brain nauseum.


VAERS ID: 1525685 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-13
Onset:2021-05-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bladder catheterisation, Blood pressure abnormal, Blood pressure fluctuation, Blood test, Body temperature decreased, Chest X-ray, Cough, Foaming at mouth, Hypothermia, Irritability, Lethargy, Loss of consciousness, Magnetic resonance imaging, Pain, Peripheral coldness, Pneumonia, Renal failure, Renal injury, Sepsis, Ultrasound scan, Urinary retention
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), 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) (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), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hostility/aggression (broad), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 74 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Donetezil 10 mg at bedtime, Fluid pill furofemide 40 mg at breakfast, Isosorbide Mononitrate 30 mg, insulin levemir in flex pin long active insulin, losartan 25 mg in am, potassium cl 20 meq at breakfast, once a week insulin Trulicity, Flom
Current Illness:
Preexisting Conditions: Diabetes, High blood pressure , stroke 2008 and 2010
Allergies:
Diagnostic Lab Data: Ultrasounds, MRI, chest Xrays, bloodwork dilatin shots for pain
CDC Split Type: vsafe

Write-up: Friday night I woke up he was foaming in the mouth, I sat him up and elevated him and cleaned him up I called 24 hour doctor line. The doctor recommended going to er. We stayed home, He was coughing and seemed irritated. Breakfast he seemed fine very lathargic, no fever, lost conciousness and I called paramedics . The paramedics could not get his body tempature 80. I waited when I got to the hospital 4 hours later and went to his room thay had a heat machine and thermal blanket on him, he was concious but looked like he was going to sleep, his blood pressure started going up and down and up and down. He was very cold to touch. He had a cough and they were given him 2 types of antibiotics to help clear up pnemonunia which then damaged his kidney and he got septisis . They had to use an ultrasound to get ivy and foley in because of fluid. Physical therapy had to get him in and out of bed. Doctors said they had done everything they could do and sent him rehab before sending him to hospice. He was Hypothermic, kidney failure and sepsis.


VAERS ID: 1525780 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-05-16
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pulmonary embolism, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, venous (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: 2021-07-29
   Days after onset: 74
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 Other pulmonary embolism without acute cor pulmonale Unspecified convulsions


VAERS ID: 1525789 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-07-02
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELDZ61 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - Acute renal failure, unspecified acute renal failure type


VAERS ID: 1525795 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-04-20
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 101
Permanent Disability? No
Recovered? No
Office Visit? Yes
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 I26.99 - Other pulmonary embolism without acute cor pulmonale J18.9 - Pneumonia, unspecified organism


VAERS ID: 1525804 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-03-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death, Malignant melanoma, Rash, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Skin malignant tumours (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 140
Permanent Disability? No
Recovered? No
Office Visit? Yes
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 rash following vaccination sepsis N17.9 - Acute kidney failure, unspecified multiple mylenoma


VAERS ID: 1525940 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-07-21
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Dysphagia, Dyspnoea, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: 2021-08-01
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HYPERTENSION
Allergies: UNKNOWN
Diagnostic Lab Data: POSITIVE PCR FOR COVID-19 AND ABNORMAL CXR
CDC Split Type:

Write-up: TO ER ON 7/21/21 WITH SHORTNESS OF BREATH AND DYSPHAGIA. POSITIVE PCR TEST FOR COVID-19. HAD MONOCLONAL INFUSION IN THE ER AND WAS HOSPITALIZED INTO THE ICU. DIED ON 8/1/21. WAS FULLY VACCINATED WITH THE MODERNA VACCINE. DOSE 1-2/22/21 AND DOSE 2-3/23/21.


VAERS ID: 1525967 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-12
Onset:2021-07-09
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, 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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   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: Death summary from medical records indicates COVI-19 viral pneumonia and acute hypoxemic respiratory failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admission due to covid and death was due to covid+19. ER visit on 7/8 and complained of weakness. Diagnosed with covid on 7/7 by her physician. Death summary from medical records indicates COVI-19 viral pneumonia and acute hypoxemic respiratory failure


VAERS ID: 1525971 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-06-23
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes type 2, HTN, cardiovascular disease, renal disease, lung disease, PAD, MI, immunocompromised, former smoker, anxiety, impaired physical mobility, blind,
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received vaccine on 2/12/2021 and 3/12/2021. He was admitted to the hospital on 6/23/2021 and passed away on 6/29/2021.


VAERS ID: 1525977 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-27
Onset:2021-07-28
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 181602 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: HTN, MI, TIA
Allergies: NKA
Diagnostic Lab Data: Positive by PCR for COVID-19 on 7/24/21
CDC Split Type:

Write-up: Pt experienced a syncopal episode which prompted a hospital visit on 7/12/21. Pt tested negative by PCR for COVID-19 on 7/18/21 and positive by PCR for COVID-19 on 7/24/21. Pt passed away on 7/28/21.


VAERS ID: 1525985 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-07-04
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-20
   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: HTN, heart transplant, cardiovascular disease, renal disease, lung disease, oxygen therapy, immunocompromised, AMS, delirium
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received vaccines on 2/12/2021 and 3/12/2021. He was admitted to the hospital on 7/4/2021 and passed away 7/20/2021.


VAERS ID: 1526026 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-04-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 97
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: Amlodipine 2.5 mg Daily Aspirin 81mg Daily Atorvastatin 20mg Daily Metformin 500mg Twice a day Tamsulosin 0.4mg Daily Tolterodine ER 4mg ER Daily in the evenings
Current Illness: BPH HTN Hypercholesterolemia Lipoma long head of biceps rupture neoplasm of bladder OSA PAD Type 2 DM without complication muscle pain hemospermia hydroureter somatic dysfunction of sacroiliac joint
Preexisting Conditions: See above
Allergies: Azithromycin--rash (mild) Ciprofloxacin--lightheadedness/confusion (moderate to severe) Codeine--dizziness Hydralazine-dizziness, moderate Nitrile gloves
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary Embolism 7/20 presented to ED with right sided pain which he had for about 2 weeks. Denies any hx of trauma. Did admit to moving furniture but did not recall an injury. D/C''d with chest wall pain and given Ultram 50mg 1 tab q 4hrs qty= 7. on 7/26 he presented to ED with symptoms of PE and was dx''d with acute PE He was declared deceased on 7/29/21


VAERS ID: 1526036 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-07-27
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal X-ray, Acute kidney injury, Chest X-ray, Computerised tomogram head, Computerised tomogram thorax, Condition aggravated, Cough, Death, Dyspnoea, Metabolic encephalopathy, Polymerase chain reaction positive, Toxicity to various agents, Viral infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: oxygen, albuterol, dexamethasone, doxycycline, famotidine, mer
Current Illness: COVID-19 pneumonia,sepsis, respiratory acidosis, met. encephal
Preexisting Conditions: COPD, chronic hypoxic respiratory failure, history of breast cancer s/p R mastectomy, CKD state IIIa
Allergies: codeine, penicillins, tetanus toxoids
Diagnostic Lab Data: chest xray 7/27/21 and 8/2/21 abd xray 8/2/21 Head ct without contrast 8/2/21 chest ct without contrast 7/27/21
CDC Split Type:

Write-up: Presented to ED on 7/27/21 with shortness of breath and non-productive cough. POC PCR positive on 7/27/21. Previous recent hospitalization 7/7-7/11 for acute metabolic encephalopathy, acute kidney injury, theophylline toxicity. Palliative care in place. Died 8/3/21 Hospitalized 8 days at Health care


VAERS ID: 1526049 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-03-12
Onset:2021-04-12
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorthiazide and hyperthyroid medications
Current Illness: Grave?s disease
Preexisting Conditions: Grave?s disease, pre hypertensive, prediabetic
Allergies: unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My dad had a cardiac arrest one month after his second vaccine. He had complained of severe indigestion for 6-8 hours within 2 days of his second dose and refused medical attention for it. The day he passed he did not verbalize any complaints.


VAERS ID: 1526134 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-07-15
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Limb injury, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (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: 19
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Brilinta, Tylenol. aspririn,
Current Illness: HTN, CHF, CAD, PVD, GERD, Acute Mi, Liver failure,hypoxia, nicotine addiction, leg wound, altered mental status
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: POS Covid screening 7.17 after returning to ER for altered mental status changes
CDC Split Type:

Write-up: Came to ER 7.15.2021 for leg wound


VAERS ID: 1526275 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-15
Onset:2021-04-21
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92106 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral, Asthenia, Blood test, Cardiovascular function test, Computerised tomogram, Death, Dysstasia, Feeling abnormal, Gait inability, Malaise, Muscular weakness, X-ray limb
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 74
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: Synthroid.Eloquest,Vit D.Multi Vit,nose spray for bloody noses.
Current Illness: always has had high blood pressure.Has afib with heart.Started having nose bleeds in Jan.At 97 was starting to weaken a bit.
Preexisting Conditions: none
Allergies: Sulfa, highly sensitive to many meds.
Diagnostic Lab Data: when she went to the hospital she had Xrays cat scan of back legs etc Also had a CAt scan of the brain to make sure it was not a stroke.All kinds of blood tests cardio tests.
CDC Split Type:

Write-up: My Mom received her 2 shots at the same facility.The 1st shot no reaction the second shot she was in bed sick for 3 days.She did recover but seemed to feel very weak after that second shot.She kept saying she did not feel right.On April 21 her legs buckled she could not stand or walk.We put her back to bed and at 7 her legs buckled again.She was taken by ambulance to hospital where she stayed for 7 days .She was then transferred to another hospital for PT for 21 days.She never was able to stand or walk again.Neither of these facilities could say why it was a mystery.She was transferred to a nursing home because she could not stand or walk on May 24.She continued to go downhill and on July 4th she passed away.I cannot help but wonder if it was not this second shot.


VAERS ID: 1526316 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-04-23
Onset:2021-08-01
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 RA / IM

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

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM2, HTN, SUD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death of unknown reason


VAERS ID: 1526319 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-22
Onset:2021-02-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Back pain, Burning sensation, Cardiac failure, Death, Dyspnoea, Gait inability, General physical health deterioration, Malaise, Memory impairment, Pain, Rash, Thinking abnormal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 28
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: Victim went to bed immediately upon returning from the facility. He did not eat dinner because he was not feeling well. The next day he did not wake up until after noon and found he could no longer walk. He reported his legs burning as if they were on fire. He began to break out in a painful rash over two thirds of his body. He had pain in his back that would come and go. The burning pain in his body was intermittent and he was able to use a walker after a few days but he never recovered his strength like he was before he was vaccinated and he deteriorated further everyday and then began to exhibit memory and thinking problems. 29 days after the shot he became so weak he could not catch his breath and was taken to the emergency room and died within minutes after being put on the examination table. Cause of death was listed as heart failure. Prior to receiving the vaccine he was energetic and put in a full day everyday of home maintenance, gym workouts and exercise classes. He regular drove to social events and breakfast events and had not been sick with the flu for several years.


VAERS ID: 1526341 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-28
Onset:2021-05-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 - / IM

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

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

Write-up: Patient expired 19 days after receiving her first shot of Moderna. Patients family is convinced the shot killed her and wants it reported. patient has a history of vasculitis. Primary provider believes the vaccine could have contributed to her death. Patient was on the transplant list and was told it was a requirement to receive this shot.


VAERS ID: 1526509 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-05-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aortic aneurysm, Aortic aneurysm rupture, Arteriosclerosis, Asthenia, Autopsy, Back pain, Cardio-respiratory arrest, Death, Hypertensive heart disease, Hypotension, Nausea, Retroperitoneal haematoma, Syncope, Tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Complained of nausea, vomiting, weakness one hour after injection followed by syncopal episode and severe back pain. Became hypotensive and tachycardic in ER followed by cardiorespiratory arrest. Autopsy performed next day showed ruptured abdominal aortic aneurysm with large retroperitoneal hematoma. Cause of death was massive retroperitoneal hemorrhage due to ruptured abdominal aortic aneurysm due to hypertensive and atherosclerotic cardiovascular disease.


VAERS ID: 1526529 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-19
Onset:2021-07-31
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Lethargy, Malaise
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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: amlodipine, aspirin, atenolol, baclofen, Symbicort, bupropion, citalopram, clopidogrel, insulin, lamotrigine, pantoprazole, solifenacin, Incruse Ellipta
Current Illness:
Preexisting Conditions: Type 2 diabetes, stage 2 COPD, CKD stage 3, portal venous hypertension, diabetic peripheral neuropathy, long term 24/7 oxygen use, hypertension, GERD, coronary artery disease, smoker - 3-5 cigarettes daily,
Allergies: tamoxifen citrate, amoxicillin, codeine, penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Became lethargic and had malaise, called 911 and could only be heard breathing on the line. When EMS arrived, she was deceased.


VAERS ID: 1526730 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C219 / 2 UN / SYR

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

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

Write-up: My mother complained of chest pressure and shortness of breath breath while at work numerous times to her co-workers. Her fellow employees reported having her sit down until she said she was feeling better. The very next day she did a short 4 hour shift at work came home and was found dead by her husband in the front yard of her home.


VAERS ID: 1528238 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-23
Onset:2021-06-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Apnoea, Myocardial infarction, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Emotional suffering (His wife had a stroke 20 years ago and it effected her emotions. She could only laugh or be mad); Heart attack (Verbatim: Heart attack This was eight years ago.Her capillaries were small. The veins to he heart were small.); Kidney disorder (Verbatim: Kidney Problems); Lung disorder NOS; Schizophrenia (Verbatim: Schizophrenia); Stent placement (Patient had 7 stents around her heart. Her capillaries were small. The veins to he heart were small.); Stroke (Verbatim: Stroke Occurred 20 years ago)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100965284

Write-up: Heart attack and lungs filled with water; Heart attack and lungs filled with water; Stopped breating; This is a spontaneous report from a contactable consumer. A 52-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in left arm on 23Jun2021 (Batch/Lot number was not reported) as dose 2, single for covid-19 immunisation. Medical history included stroke occurred 20 years ago, kidney problems, heart attack eight years ago, patient had 7 stents around her heart, her capillaries were small, The veins to her heart were small, asthma, schizophrenia, stated lungs were bad, had a stroke 20 years ago and it affected her emotions. She could only laugh or be mad. Concomitant drug were unspecified. Patient was on a lot of them. The patient had first shot of BNT162B2 on 31May2021 in left arm for COVID-19 Immunization and she started crying. The patient experienced heart attack and lungs filled with water (death, hospitalization) on Jul2021 with fatal outcome, stopped breating (hospitalization) on 28Jun2021 with outcome of unknown. The patient was hospitalized for 3 days. The patient died in Jul2021. It was unknown whether autopsy done. The clinical course was reported as follows: Caller on the line who mentioned he was a PCA, clarified as a patient care attendant for his wife. He is calling about the Pfizer Shot, the vaccination, clarified as to prevent COVID, the COVID Shot. He stated his wife died due to the shot. He mentioned he has no avenue to go down. No direction. He stated he is upset no research has been done form people who died from the shot, or information from it causing one to have a heart attack, lungs filling with water, or weakening the immune system. He later clarified this is what happened to his wife. Caller stated he feels that his wife died from the COVID shot, but he is not a scientist and has no way of proving that. He wants someone to call him and tell him. Caller clarified the patient''s cause of death. He stated the death certificate has she passed away due to heart attack due to lungs filling with water and she could not be resuscitated. They tried for two hours. Caller stated he does not know the exact date patient passed away, it is all packed up. It was either 02Jul 2021 or 03Jul2021. He confirmed the heart attack and lungs filling with water occurred on the date she passed away. Caller explained, he wanted to explain what he saw. After she first got the shot she started crying. He mentioned his wife had a stroke 20 years ago and it affected her emotions. She could only laugh or be mad. Patient''s mother and father had passed away within three months of each other and she could not even cry then. Caller stated after patient got the shot she started crying and did not know what was going on. He mentioned she was close to menopause and he thought it was just menopause going on. It was all day, every day, she was crying. Then after the second shot a few days later patient stopped breathing. The paramedics were called who provided a breathing treatment. Patient was taken to the hospital and was there for three days. They could not figure out what was wrong. They did work-ups. Patient was in ICU. Then she crashed. They started CPR. Patient''s lungs filled up with water, patient had a heart attack, and she stopped breathing. Caller clarified patient had the issues with breathing and stopped breathing initially like on 28Jun2021. Then patient was taken to the hospital. Stated patient''s health was never like us. However, he kept her not sick. He was good at his job. However, when patient was sick he would take patient to the hospital or the doctor''s to find out what is going on. When sick she was in the hospital, when she was fine she was home. No vaccines administered on same date of the pfizer suspect. Confirmed none were given on the same date. The paramedics were called, patient was taken to hospital and was admitted to ICU due to patient stopped breathing. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Heart attack; Lungs filled with water


VAERS ID: 1528254 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-03-23
Onset:2021-03-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Drug reaction with eosinophilia and systemic symptoms, SARS-CoV-2 test
SMQs:, Severe cutaneous adverse reactions (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CO-DIOVAN; VITAMIN D3; GINKGO BILOBA; COLLAGEN; MELATONIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension; Joint disorder; Tinnitus; TMJ syndrome
Allergies:
Diagnostic Lab Data: Test Date: 20210428; Test Name: covid test; Test Result: Negative
CDC Split Type: USPFIZER INC202100971223

Write-up: Post-vaccine auto-immune reaction, organ failure (DRESS syndrome); This is a spontaneous report from a contactable consumer. An 81-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiration date not provide) on 23Mar2021 12:00 at age of 81 years old as single dose on left arm via an unspecified route of administration for COVID-19 immunization. Relevant medical history included hypertension, temporomandibular joint syndrome, tinnitus and joint discomfort. On 02Mar2021 at 12:00 PM at 81 years old, on Left arm the patient received first dose of BNT162B2 for COVID-19 immunization. Concomitant medications included hydrochlorothiazide, valsartan (CO-DIOVAN), vitamin D3, ginkgo biloba, collagen and melatonin. It was informed that on 29Apr2021 the patient died after developing a severe allergic auto-immune reaction, diagnosed as DRESS Syndrome, started on 24Mar2021 09:00. The adverse event result in emergency room visit and physician office visit. It was mentioned that patient was hospitalized 13 days due to the event and was treated with high-dose of cortico-steorids, antibiotics. It was also informed that It took a lot of effort by several doctors, and ultimately the intervention of a premiere infectious disease expert in another location, on 18Apr2021, to make a definitive diagnosis and to confirm it was a reaction to the Pfizer COVID vaccine. (as reported). The doctors tried but failed to save him, and he died on 29Apr2021 (as reported). The patient underwent a SARS-CoV-2 test (Blood test) on 28Apr2021 which resulted negative. An autopsy was not performed. Serious criteria was fatal, life-threatening and hospitalization. The event [Post-vaccine auto-immune reaction, organ failure (DRESS syndrome)] occurred in a country different from that of the reporter. This may be a duplicate report if another reporter from the country where the event occurred has submitted the same information to his/her local agency. Information on the lot/batch number has been requested. Follow-up (20May2021): This follow-up is being submitted to notify that the lot/batch number is not available despite the follow-up attempts made. Follow-up attempts have been completed and no further information is expected. Amendment: This follow-up report is being submitted to amend previously reported information: updated the reporter''s country.; Reported Cause(s) of Death: Post-vaccine auto-immune reaction, organ failure (DRESS syndrome)


VAERS ID: 1528255 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Idaho  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xeljanz
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100972826

Write-up: blood clots in her lungs; This is a spontaneous report from a contactable consumer or other non hcp from a Pfizer sponsored program. A 86-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection), dose unknown via an unspecified route of administration on an unspecified date in 2020 (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation; tofacitinib citrate (XELJANZ), route of administration, start and stop date, batch/lot number and dose were not reported for an unspecified indication. The patient medical history and concomitant medications were not reported. The reporter stated that his neighbor was taking Xeljanz and got the COVID 19 vaccine (unknown manufacturer) and died from blood clots in her lungs. She died on an unspecified date and the family was blaming Xeljanz. The patient was diagnosis with blood clots about a month ago. She got COVID Vaccine around Christmas 2020. She was in hospital for 5 days with blood clots. The reporter inquired if vaccine cause blood clots. Seriousness of the event was reported as death and hospitalization. The action taken in response to the event for tofacitinib citrate was not applicable. The outcome of the event was fatal. It was not reported if an autopsy was performed. Follow-up attempts are needed. Information on the lot/batch number is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1528593 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-21
Onset:2021-05-21
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 17
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: Vaccinated patient, tested positive and was admitted with COVID on 5/21/2021. Patient passed away on 6/7/2021.


VAERS ID: 1528612 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-15
Onset:2021-06-12
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 40 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, metoprolol
Current Illness: none
Preexisting Conditions: distant history of breast cancer and hypertension
Allergies: sulfa antibiotics
Diagnostic Lab Data: 6/24 initiation of apixaban 7/13 apixaban + aspirin 7/18 off apixaban and started on warfarin
CDC Split Type:

Write-up: Moderna Vaccine given 3/15/21 and 4/12/21. Developed spontaneous renal infarct 6/12/21., placed on apixaban. Had acute CVA 6/24/21, unknown cause with no arrhythmia, negative hyper coagulable work up, and no evidence of recurrence of malignancy. 7/13/21 with new DVT was started on aspirin in addition to apixaban and 7/18/21 another CVA occurred. Was started on warfarin. 7/29/21 develop cerebral hemorrhage and passed.


VAERS ID: 1528618 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-05-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Exposure to SARS-CoV-2, Functional gastrointestinal disorder, General physical health deterioration, Pneumonia, SARS-CoV-2 test positive
SMQs:, Gastrointestinal nonspecific inflammation (narrow), 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: 2021-05-20
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumococcal Vaccine
Other Medications:
Current Illness: Bowel issues
Preexisting Conditions:
Allergies: Amoxicillin, Azithromycin, Bactrim (sulfamethoxazole-trimethoprim) Clarithromycin, Codeine, Doxycycline, Levofloxacin, Levothyroxine, Loratadine, OxyContin, Penicillin, Pneumococcal Vaccine
Diagnostic Lab Data: COVID Positive PCR - 5/3/2021
CDC Split Type:

Write-up: This case was hospitalized 4/6 due to bowel issues. Exposed and developed symptoms in hospital. Eventual transfer to hospice d/t decline in part d/t pneumonia symptoms. COVID Positive PCR - 5/3/2021


VAERS ID: 1528695 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-11
Onset:2021-05-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Communication disorder, Death, Feeding disorder, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   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: Chronic Kidney disease, stage 5, recent UTI, pyelonephritis.
Preexisting Conditions: chronic back pain from lumbar herniated disc, COPD, DM type 2, coronary artery disease.
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The patient became unresponsive on the day after the vaccine, was unable to communicate or eat and died 6 days later.


VAERS ID: 1528841 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-31
Onset:2021-06-27
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 BREAKTHROUGH CASE THAT EXPIRED APPROXIMATELY THREE MONTHS AFTER COMPLETING VACCINATION SERIES.


VAERS ID: 1528852 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-03
Onset:2021-07-29
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID -19 BREAKTHROUGH CASE THAT EXPIRED FOUR MONTHS AFTER COMPLETING COVID VACCINATION SERIES.


VAERS ID: 1528864 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-08-02
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Condition aggravated, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, ecotrin, tenormin, apresoline, hydrodiulil, coumadin, zocor
Current Illness:
Preexisting Conditions: DVT, CID, A fib, CHF, CKD, anemia Leukocytosis,
Allergies:
Diagnostic Lab Data: POS covid swab 8.2.21
CDC Split Type:

Write-up: Came to EC for CHF was put on hospice during admission


VAERS ID: 1528874 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-15
Onset:2021-01-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Agitation, Anxiety, Cardio-respiratory arrest, Chest discomfort, Chills, Computerised tomogram, Cyanosis, Death, Endotracheal intubation, Fall, Feeling abnormal, Full blood count, Hyperhidrosis, Intensive care, Pyrexia, Renal function test, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (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), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dopamine, Atorvastatin, Aspirin, Atenolol
Current Illness: Urinary Tract Infection
Preexisting Conditions: Parkinson''s disease, heart disease
Allergies:
Diagnostic Lab Data: CBC, Renal panel, CT
CDC Split Type:

Write-up: Patient went to the medical center for appointment with primary care for blood work and to receive the COVID-19 vaccine. When he returned home with his wife, he started feeling bad. He took a nap and woke up with sweat and chills. Patient''s wife attempted to call his PCP and the Medical Center with no success and transported patient to the local Emergency Department. There it was discovered he had a fever and he was admitted for possible urinary tract infection. Overnight, while in his room he became agitated and had a sense of impending doom. Per his wife, he grabbed his chest and turned blue, falling to the bed. A code blue was called and CPR was performed. He was intubated and put on some sedation. He was transferred to the ICU. After a couple days of a poor prognosis he was put on comfort care or hospice. He passed away on January 24, 2021


VAERS ID: 1528880 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-08-02
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9810 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Death, Pneumonia
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC) J18.9 - Pneumonia due to infectious organism, unspecified laterality, unspecified part of lung


VAERS ID: 1528889 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-07-30
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - Multifocal pneumonia


VAERS ID: 1528901 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-02-17
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death, Dyspnoea, Gastrointestinal haemorrhage
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 167
Permanent Disability? No
Recovered? No
Office Visit? Yes
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 shortness of breath N17.9 - AKI (acute kidney injury) K92.2 - Gastrointestinal hemorrhage, unspecified gastrointestinal hemorrhage type


VAERS ID: 1528939 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-06-03
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FeroSul, Vanicream, Glucophage, Vit C, Cozaar, Flomax, Prilosec, Maxitrol, Ditropan, aspirin, Lipitor, Zoloft, Nizoral, Risperdal, Systane, Tylenol, Desyrel
Current Illness:
Preexisting Conditions:
Allergies: Seasonal
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1528947 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-05-31
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-31
   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: Prilosec, Zofran, Ativan, Generlac, Tylenol, Roxanol, Celexa, Dulcolax
Current Illness:
Preexisting Conditions:
Allergies: Statins, Aspirin, Compazine, Diagnostic X-ray material, Penicillin''s, Prochlorperazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 05/31/2021.


VAERS ID: 1528952 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-02
Onset:2021-06-18
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CVO224 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-06
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes mellitus, chronic lymphocytic leukemia
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 NAAT test on 6/18/2021
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 - received dose #1 of Moderna on 2/2/2021 and dose #2 of Moderna on 3/2/2021 tested positive via NAAT on 6/18/2021. Client was hospitalized for COVID-19 and died on 7/6/2021


VAERS ID: 1528988 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-07
Onset:2021-01-27
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Gangrene, Refusal of treatment by patient, 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: 2021-04-14
   Days after onset: 76
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 325mg 2 PO q 12 PRN; Calcium tablet 600mg PO BID; Multi-vitamin PO Daily; Vitamin D 1000 IU BID; amlodipine 5mg PO Daily; Plavix 75mg PO daily; Lotrisone cream to right foot BID; levothyroxine 100mcg PO daily; lovastatin 10mg PO HS;
Current Illness: Gangrene of right foot
Preexisting Conditions: ICD 10 codes: U07.1; I73.9; M62.81; R26.2; R41.841; Z74.1; I99.8; I96; R52; I10; E03.9; J30.9; Z79.02; F32.9; E78.5
Allergies: aspirin. caffeine, cephalosporines, esomeprazole, iodinated diagnostic agents, Keflex, Nexium, septra, soap, sulfa antibiotics, trimethoprim
Diagnostic Lab Data: Antigen COVID Positive 4/11/2021 PCR COVID Positive 4/13/2021
CDC Split Type:

Write-up: Gangrene of right foot with refused treatment No symptoms of COVID Date of death 4/14/2021


VAERS ID: 1529110 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-08-02
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death on 8/2/2021


VAERS ID: 1529159 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
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: Dementia, brain hemorrhage, death


VAERS ID: 1529227 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-03
Onset:2021-08-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A214A / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pravastatin, allopurinol, benzonatate, levothyroxine, fluconazole, metoprolol, duoneb updraft, lasix, xanax, prednisone, acetylcysteine, eliquis
Current Illness:
Preexisting Conditions: copd, chf, severe aortic stenosis, dyslipidemia, sleep apnea, hypothyroidism, OA, thrush, cachexia
Allergies: codeine, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: rec''d vaccination 8/3/21, was tested for covid as part of building wide sweep 8/4/21, facility was notified at approx 1500 on 8/5/21 that PCR test was positive code blue was in progress when facility rec''d notification of positive test result- code called at approx 1430 on 8/5/21


VAERS ID: 1529248 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-04
Onset:2021-08-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Patient had cold symptoms for 1 week prior to vaccination
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the emergency room one day following being vaccinated in cardiac arrest. Patient is deceased.


VAERS ID: 1529585 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-05-29
Onset:2021-07-05
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529596 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-01-15
Onset:2021-02-11
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529599 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-01-21
Onset:2021-02-18
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529725 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Agonal respiration, Arteriosclerosis coronary artery, Autopsy, Coronary artery thrombosis, Malaise, Myocardial rupture, Pericardial haemorrhage, Resuscitation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Accidents and injuries (narrow), Other ischaemic heart disease (narrow), Respiratory failure (narrow)

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

Write-up: Sent home from work early complaining of feeling unwell one day after receiving vaccine. Witnessed agonal breathing while sitting in chair that same afternoon. Resuscitation unsuccessful. Autopsy showed hemopericardium due to ruptured myocardial infarct due to coronary artery thrombosis due to coronary artery atherosclerosis. No evidence of anaphylaxis or myocarditis.


VAERS ID: 1529868 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-02-15
Onset:2021-02-18
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   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:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1529871 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-03-10
Onset:2021-04-07
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1530068 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-19
Onset:2021-03-24
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6027 / 2 RA / IM

Administered by: Private       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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 12
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke on March 24, 2021. Widespread blood clots discovered on April 3rd, 2021. Death on April 5th, 2021.


VAERS ID: 1530474 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-07-31
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   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:
Current Illness: Disease progression NOS
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210805373

Write-up: DIED; This spontaneous report received from a consumer concerned an female of unspecified age and ethnicity. The patient''s height, and weight were not reported. The patient''s concurrent conditions included underlying disease. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 31-JUL-2021, the patient died of unknown cause. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20210805373-covid-19 vaccine ad26.cov2.s -Death. This event(s) is considered un-assessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1530586 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood grouping, 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: Test Name: Blood type; Result Unstructured Data: Test Result:AB Negative
CDC Split Type: USPFIZER INC202100953049

Write-up: patient died after receiving the 1st dose of the vaccine; This is a spontaneous report from a non-contactable consumer (patient''s sister) via a Pfizer sponsored program. A male patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Batch/Lot number was not reported) via an unspecified route of administration on an unspecified date as dose 1, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that the patient died after receiving the 1st dose of the vaccine on an unspecified date. The patient underwent lab tests and procedures which included blood grouping: AB negative 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. No further information is expected.; Reported Cause(s) of Death: patient died after receiving the 1st dose of the vaccine


VAERS ID: 1531269 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: 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: 2021-07-01
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: USJNJFOC20210808115

Write-up: CONFIRMED COVID-19 INFECTION; SUSPECTED VACCINATION FAILURE; This spontaneous report received from a patient concerned a male of unspecified age, race and ethnicity unknown. 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 not reported, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. It was reported that on an unspecified date, the patient experienced confirmed covid-19 infection, suspected Vaccination Failure. On an unspecified date in Jul-2021, the patient died from confirmed covid-19 infection. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of Suspected Vaccination Failure was not reported. This report was serious (Death).; Sender''s Comments: V0-20210808115-covid-19 vaccine ad26.cov2.s-Confirmed 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). 20210808115-covid-19 vaccine ad26.cov2.s-Suspected Vaccine 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: CONFIRMED COVID-19 INFECTION


VAERS ID: 1531540 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-22
Onset:2021-05-26
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: 2021-07-29
   Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benefiber QD, Lovastatin 20 mg QD, Meloxicam 15 mg QD, MVI,
Current Illness:
Preexisting Conditions: COPD, Hx of sinusitis, Hyperlipidemia, Hx NSCLS, Osteoporosis, Enlarged prostate, obesity, aortic valve sclerosis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTECH COVID-19 Vaccine EUA Patient received Pfizer COVID Vaccines on 1/29/2021 and 2/22/2021. Patient presented to ED on 7/16/2021 with worsening shortness of breath for the last few days. Admit diagnosis of Pneumonia due to COVID-19. Patient was treated with remdesivir daily (7/16 - 7/20), IV steroids, and Tocilizumab 800 mg x2 doses (7/20&21). Patient expired on 7/29/2021.


VAERS ID: 1531545 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-08
Onset:2021-07-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       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: Unknown
Current Illness: Morbidly Obese, COPD, CHF, Diabetes, Peripheral Vascular Disease
Preexisting Conditions: Morbidly Obese, COPD, CHF, Diabetes, Peripheral Vascular Disease
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient was found dead in his home on 07/27/2021.


VAERS ID: 1531639 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-05
Onset:2021-07-24
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Patient was on oxygen 24/7 before hospitalization and COVID test.
Allergies: Dextromethorphan
Diagnostic Lab Data: Tested positive for COVID on 07/30/2021
CDC Split Type:

Write-up: 07/24/2021 Patient was admitted to Hospital, with microplasma pneumonia and breathing difficulties.


VAERS ID: 1531784 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-07-17
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Asthenia, Balance disorder, COVID-19, Chills, Cough, Death, Dyspnoea, Lung opacity, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), 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), 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: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira 40mg/0.4ml QOD, citalopram 10mg QD, Folic acid 1mg QD, Furosemide 20mg QD, oxybutynin 5mg BID, sumatriptan 50mg PRN, topiramate 50mg BID, Tumeric root extract 500mg QD
Current Illness:
Preexisting Conditions: Stage 2 CKD, Hypertension, Seropositive erosive RA, DISH, Hx of breast cancer, Hyperlipidemia, Immunosupression due to drug therapy
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTECH COVID-19 Vaccine EUA Patient received Pfizer COVID Vaccines on 3/09/2021 and 4/06/2021. Patient presented to ED on 7/17/2021 with 2 week history of increasing shortness of breath and cough with associated chills, weakness and unsteadiness on her feet.Admit diagnosis acute hypoxic respiratory failure due to COVID-19. Upon admission, CTA showed a nonocclusive segmental PE and ground-glass opacities. Patient was treated with IVF, Rocephin, Zithromax, Decadron 6mg (10 days), a heparin drip, and remdesvir (5 days). Patient expired on 7/28/2021.


VAERS ID: 1531963 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-15
Onset:2021-02-11
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaemia, Biopsy bone marrow, Biopsy lung, Blood test, Bronchopulmonary aspergillosis, Chest X-ray, Computerised tomogram, Pneumonia, Pulmonary embolism, Thrombocytopenia
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 41 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Glioblastoma
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Multiple chest x-rays, CT scans, lung biopsies, blood draws, bone marrow biopsy from February 13, 2021 through April 23, 2021
CDC Split Type:

Write-up: Began on February 11, 2021: thrombocytopenia, anemia, pneumonia, multiple pulmonary embolisms, pulmonary aspergillosis pneumonia


VAERS ID: 1532004 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-05
Onset:2021-02-15
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test normal, Bradycardia, Death, Electrocardiogram abnormal, Troponin normal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levothyroxine, carvedilol, renavite (prescription vitamins)
Current Illness: Wegener''s granulomatosis - stable; Hashimoto''s Thyroiditis - stable; no cardiac disease - normal EKG in December 2020
Preexisting Conditions: Wegener''s granulomatosis - stable on renal dialysis three times per week; no significant pulmonary disease; Hashimoto''s Thyroiditis - stable
Allergies: none
Diagnostic Lab Data: EKG showed atrial fibrillation. Basic blood labs were normal, normal troponin.
CDC Split Type:

Write-up: 11 days following COVID vaccine #2, patient died within 15 hours on February 16, 2021, of sudden, new onset atrial fibrillation leading to bradycardia unresponsive to atropine and oxygen. Patient had been seen by primary care doctor in December 2020 for Medicare annual wellness exam and had a normal EKG and heart exam; moderate hypertension well controlled. No other history of cardiac disease or arrhythmias, no angina, no dyspnea, no cyanosis. All renal dialysis parameters had been stable since starting on thrice-weekly dialysis in 2017. No history of preceding illness or vaccine reactions. No fever, no rash, no GI symptoms, no change in consciousness (clear mental status), no asymmetry of face/arms/legs. All medications administered by caregiver who is daughter and MD.


VAERS ID: 1532021 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-05-26
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, Mental status changes, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   Days after onset: 61
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benefiber QD, Lovastatin 20 mg QD, Meloxicam 15 mg QD, MVI,
Current Illness:
Preexisting Conditions: Type 2 diabetes, Stage 3 CKD, BMI 40.0-44.9
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA Patient received Janssen Vaccine on 4/30/2021. Presented to ED on 7/9/2021 with Altered Mental Status and Shortness of Breath. Admitted with Respiratory failure. Patient admitted 7/9/21 for COVID-19 pneumonia. Intubated 7/10 and completed treatment with decadron and remdesivir daily (7/9 - 7/13). Treated with ceftriaxone and azithromycin. Patient expired on 7/26/2021.


VAERS ID: 1532026 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-22
Onset:2021-07-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthritis, Asthenia, Condition aggravated, Death, Dyspnoea, Pain, Rash, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 100 mg 1 daily omeprazole 20 mg caps 1 2x daily prazosin 1 mg caps 1 at bedtime methtrexate 2.5 mg 4 once a week aripiprazole 5 mg 1 daily ambiem 10 mg tabs 1 at bedtime meloxicam 7.5 mg tabs 1 daily Imdur Isosorbide Mononit 3
Current Illness: hearts issues COPD IBS
Preexisting Conditions: hearts issues COPD IBS
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: it made her arthritis flare up. She was having issues breathing and catching her breath. She had swelling and a rash, weakness, pain and the worse is she passed away on Sunday July 25, 2021.


VAERS ID: 1532040 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-17
Onset:2021-06-24
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Other       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: Unknown
Current Illness: None known
Preexisting Conditions: Chronic alcohol use, asthma, chronic pain
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Vaccinated at a location on 5/17/2021, staff mentioned her obituary June 24th, 2021 and was concerned of her death so close to her vaccination date.


VAERS ID: 1532064 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-08-04
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, 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: 2021-08-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Past medical history of HTN, DM, CKD.
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case had COVID vaccines x 2. Last vaccine given at HCF on 2/12/21. Case presented to ED on 7/24/2021 with covid like symptoms. Postitive test for COVID 19 and was admitted to another HCF on 7/24/2021. He expired at that facility on 8/4/21.


VAERS ID: 1532154 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-06-04
Onset:2021-06-21
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER ER8734 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast feeding, Death of relative
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins
Current Illness: Appendicitis - Surgery for ruptured appendix April 23, 2021
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: Countless tests and labs at Hospital
CDC Split Type:

Write-up: On July 17, my baby passed away. I had been breastfeeding my 6 week old baby at the time that I received the first Pfizer vaccine on June 4, 2021. He became very sick with a high fever about 2 weeks after I got the first Pfizer vaccine on June 21. He was treated for 2 weeks with IV antibiotics for a supposed bacterial infection. However, they never found any specific bacteria, and called his diagnosis culture-negative sepsis. At the end of his hospital stay he tested positive for rhinovirus. After the 14 day course of antibiotics, he was home for one week, but exhibited strange symptoms (e.g. swollen eyelid, strange rashes, vomiting). I took him back to the hospital on July 15, where he presented with what they called an atypical Kawasaki disease. He passed away shortly thereafter from clots in his severely inflamed arteries. I am curious if the spike protein could have gone through the breast milk and caused an inflammatory response in my child. They say Kawasaki disease presents very similarly to the Multi-System Inflammatory Syndrome in children that they are seeing in post Covid infections. (My baby also had unusual birth circumstances, as he was born at 37 weeks, triggered by a maternal appendicitis.) However, if they know that antibodies go through the breastmilk as a good thing, then why wouldn''t the spike protein also go through the breastmilk and potentially cause problems.


VAERS ID: 1532167 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-05-12
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002CIA / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   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: Insulin
Current Illness: None
Preexisting Conditions: Type 1 Diabetes
Allergies: None
Diagnostic Lab Data: Autopsy conducted. The coroner listed the cause of death as the hemorrhaging cerebral hemangioma. He was not aware that the patient had received the vaccine prior to his death.
CDC Split Type:

Write-up: The patient died of a hemorrhaging cerebral hemangioma 3 weeks after getting the vaccine.


VAERS ID: 1532192 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-10
Onset:2021-06-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Myocardial infarction, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   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: None
Current Illness: N/A
Preexisting Conditions: Kidney Issues
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting, Heat Attack & Death


VAERS ID: 1532890 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-28
Onset:2021-07-31
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Ammonia increased, Anion gap decreased, Blood calcium decreased, Blood chloride normal, Blood creatine increased, Blood glucose normal, Blood lactic acid increased, Blood magnesium increased, Blood potassium normal, Blood pressure abnormal, Blood sodium decreased, Blood urea increased, Brain injury, Brain oedema, Carbon dioxide normal, Computerised tomogram head abnormal, Condition aggravated, Death, Depressed level of consciousness, General physical health deterioration, Glomerular filtration rate decreased, Haematemesis, Haematocrit decreased, Haemoglobin increased, Hypertension, Intensive care, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume normal, Oesophageal variceal ligation, Oesophageal varices haemorrhage, Oesophagogastroduodenoscopy abnormal, Oxygen saturation decreased, Packed red blood cell transfusion, Platelet count decreased, Platelet transfusion, Pupil fixed, Red blood cell count decreased, Red cell distribution width increased, Transfusion, Unresponsive to stimuli, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   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: None listed
Current Illness: Chronic Active Hepatitis C
Preexisting Conditions: Alcoholic Cirrhosis Chronic Active Hepatitis C Hypertension Esophageal Varices
Allergies: NKDA
Diagnostic Lab Data: Labs from 8/3/21: WBC 15.93, RBC 3.34, Hgb 10.4, Hct 29.0, MCV 86.8, MCH 31.1, MCHC 35.9, RDW 15.2, RDWSD 47.1, Platelets 67, Ammonia 132. Lactate 5.0, Magnesium 2.33, Sodium 132, K 3.6, Cl 101, CO2 25, Anion gap 6, BUN 59, Creat 1.4, GFR Non-Af.Am 40, Glucose 135, calcium 6.8 (these are only labs I have at this point in time)
CDC Split Type:

Write-up: Patient received vaccine on 7/28/21 at clinic. Presented to ER on 7/31/21 after vomiting large amount of bright red blood 1 hour PTA. She was admitted to ICU, required 8 units PRBSx, 3 units FFP, and 1 unit platelets with poor response in Hgb and Hct. Required pressors up to maintain BP. EGD revealed bleeding varices which were banded. On ICU day 2 patient became increasingly acidotic and began to desaturate. Oxygenation improved with increased sedation and 2 additional units PRBC. On ICU day 3 patient became hypertensive, pressors were stopped. There was acute change in LOC with decreased responsiveness to painful stimuli and nonreactive pupils. Head CT showed severe diffuse cerebral edema c/w hypoxic brain injury. Patient continued to deteriorate and decision made for compassionate extubation. Pateint expired at 2110.


VAERS ID: 1533998 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210810431

Write-up: DIED; BLOOD CLOT; This spontaneous report received from a consumer concerned a female of unspecified age, race and ethnicity. The patient''s weight, height and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown expiry: unknown) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. No concomitant medications were reported. On an unspecified date, the patient had blood clot and died. The patient died from unknown cause of death and blood clot. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. On an unspecified date, the patient died and the outcome of blood clot was fatal. This report was serious (Death).; Sender''s Comments: V0:20210810431-Covid-19 vaccine ad26.cov2.s-Death, Blood Clot. 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; BLOOD CLOT


VAERS ID: 1534123 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, SARS-CoV-2 antibody test
SMQs:, COVID-19 (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: Test Name: Antibody; Test Result: Negative
CDC Split Type: USPFIZER INC202100970230

Write-up: passed away; This is a spontaneous report from a contactable consumer. A female patient of an unspecified age received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date as single dose, and dose 1 via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. As reported, caller was a patient who stated he and his wife received the Pfizer COVID vaccine, and were vaccinated in Jan2021 and Feb2021. Caller was inquiring about the antibody testing, as he and his wife had one done. Caller wanted to know why he and his wife tested negative for antibodies. Caller was concerned because his sister who had both the Pfizer COVID vaccine shots passed away and she showed not having any antibodies. The patient died on an unspecified date. An autopsy was not performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away


VAERS ID: 1534137 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / -

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 INC202100978617

Write-up: I want to report a death from a Pfizer vaccine; This is a spontaneous report from a contactable consumer (patient''s wife). A 60-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot Number: EN6207) as dose 1, single; via an unspecified route of administration on an unspecified date (Batch/Lot Number: EN6204) as dose 2, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient died from the Pfizer vaccine on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: I want to report a death from a Pfizer vaccine


VAERS ID: 1534138 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
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 INC202100978632

Write-up: They have thousands of deaths, including her mother; This is a spontaneous report from a non-contactable consumer (patient''s daughter). A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The consumer stated they have thousands of deaths, including her mother (the patient). 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. No further information is expected.; Reported Cause(s) of Death: They have thousands of deaths, including her mother


VAERS ID: 1534143 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
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 INC202100985229

Write-up: passed away, after taking Covid shots; This is a spontaneous report from a contactable consumer. A female patient of an unspecified age received bnt162b2 (BNT162B2, Lot number was not reported), via an unspecified route of administration on an unspecified date as dose 2, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously received the first dose of bnt162b2 on unspecified date as single dose for COVID-19 immunization. The patient passed away, after taking Covid shots on an unspecified date. Cause of death was unknown. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: passed away, after taking Covid shots shots


VAERS ID: 1534144 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
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 INC202100985462

Write-up: My mom would still be alive today if she hadn''t been given the jab.; This is a spontaneous report from a Pfizer-sponsored program. A non-contactable consumer reported for a female patient (mom) that: A female patient of an unspecified age received bnt162b2 (BNT162B2), dose number unknown via an unspecified route of administration on an unspecified date (at an unspecified age of vaccination) (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient died on an unspecified date. The course of events was as follows: My mom would still be alive today if she hadn''t been given the jab. 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: My mom would still be alive today if she hadn''t been given the jab.


VAERS ID: 1534147 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Illness
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 INC202100985867

Write-up: This vaccine got my grandfather sick and now he s no more; This is a spontaneous report from a Pfizer sponsored program based on information received from a Consumer about the grandfather. A male patient of an unspecified age received bnt162b2 (BNT162B2) unknown dose number, 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 medical history and concomitant medications were not reported. The patient became sick and 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: Sickness


VAERS ID: 1534150 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-07
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 INC202100986086

Write-up: died after 4hours of receiving it; This is a spontaneous report from a Pfizer sponsored program received 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''s medical history and concomitant medications were not reported. The reporter mentioned that a family member (the patient) who received the Pfizer Covid-19 vaccine died after 4hours of receiving it. 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. No further information is expected.; Reported Cause(s) of Death: died after 4hours of receiving it


VAERS ID: 1534654 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-07
Onset:2021-04-12
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Diarrhoea, Fatigue, Feeling abnormal, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Type 2 Diabetes
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started feeling bad the day following the injection. Tired, diarrhea, nausea. Death - Died on 4/12/21 at approximately 5:00 AM


VAERS ID: 1534807 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-26
Onset:2021-07-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK AR / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Immediate post-injection reaction, Intensive care, Malaise, Mechanical ventilation, SARS-CoV-2 test negative, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My uncle received the vaccine on 26 july. He immediately became unwell and by 1 august, he had lost over 15 lbs. He was admitted to ICU when conditions did not improve. He was put on a breathing machine because he was unable to breathe. His covid test was negative and doctors said it was nothing transmittable. He died early next next morning.


VAERS ID: 1534829 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-26
Onset:2021-08-05
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LW0178 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Autopsy = embolism
CDC Split Type:

Write-up: Death from blood clot


VAERS ID: 1534934 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-28
Onset:2021-01-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / UNK AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal distension, Death, Ocular hyperaemia, Pemphigoid
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (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: 2021-04-12
   Days after onset: 72
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Divalproex 125mg, Levothyroxin 88mcg, Pantoprazole 40mg, Shingrix 50mcg, Solifenacin 10mg, Acetaminophe 325mg, Vitamin D3 25mcg, Vitamin B-12 1000mcg
Current Illness: Dementia
Preexisting Conditions: Dementia
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bullous Pemphigoid, eye redness (serious), swollen stomach, death


VAERS ID: 1535013 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-17
Onset:2021-05-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic dissection, Aortic valve replacement, Death, Electroencephalogram, Gaze palsy, Infarction, Magnetic resonance imaging head abnormal, Mental status changes, Muscle rigidity, Muscle twitching, Muscular weakness, Partial seizures, Seizure, Tremor, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 59
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, ellipta, klonopin, lexapro, allegra, flonase, lortab, singulair, multivitamin, prilosec, compazine
Current Illness:
Preexisting Conditions: HTN,OSA,CKD
Allergies: gabapentin, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 5/22/21 he was taken emergently to the operating room and underwent repair of Type A aortic dissection with replacement of ascending aorta with re-suspension of his aortic valve. Post op he developed new onset right arm and right sided facial twitching along with right arm weakness. Neurology was consulted for focal motor status epilepticus and he was loaded on Keppra and started on Vimpat. EEG and MRI brain ordered. MRI revealed small foci of acute infarcts in the left occipital and right temporal lobes which may be embolic in etiology. He was initially very slow to wake up and follow commands appropriately. This improved over a number of weeks. By day of discharge on 6/21 to acute rehab, his right arm and facial twitching had completely resolved. He was alert, oriented X 3. His right arm continued to have slow return of function with fine motor skills. 6/22, patient reportedly had a 1 hour episode of AMS, witnessed by wife and daughter, in which his eyes rolled back into his head. He was arousable and answered simple questions. He had no associated tremors, shaking, rigidity. This resolved with an episode of emesis and patient was back to baseline within minutes of vomiting. 6/23, patient had another episode described as "generalized seizure" involving upper and lower extremities last several seconds followed by multiple focal seizures including only UEs. Was readmitted on 6/24 and was discharged on 7/16/21. He subsequently passed away on 7/19/21


VAERS ID: 1535017 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-09
Onset:2021-06-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin and h/o HTN medication. He was found dead at home due to cardio pulmonary hypertension. He was having symptoms of feelings flush and short of breath after the 2nd dose of Moderna vaccine
Current Illness: diabetic, hypertension
Preexisting Conditions: h/o etoh abuse, diabetic and h/o foot ulcer
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: C/O feeling short of breath & flushed at times. Unsure if he went to his primary doctor for a follow up. He was found deceased at home by his daughter


VAERS ID: 1535066 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-13
Onset:2021-07-04
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-08-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Intestinal perforation, Sepsis
SMQs:, Gastrointestinal perforation (narrow), Ischaemic colitis (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 23
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 known at the time of vaccination but he had a sudden and violent bowel perforation leading to sepsis and death.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Perforated bowel that was sudden and caused sepsis.


VAERS ID: 1535195 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-10
Onset:2021-06-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Death, Influenza like illness
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: diabetes insipidus
Allergies: Tree nuts
Diagnostic Lab Data: Examined by the Office of the Chief Medical Examiner on June 15, 2021.
CDC Split Type:

Write-up: Patient experienced flu-like symptoms and an upset stomach and died 60-72 hours later. Immediate cause of death is still pending further study.


VAERS ID: 1535217 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-25
Onset:2021-05-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 UN / SYR

Administered by: School       Purchased by: ?
Symptoms: Condition aggravated, Confusional state, Creutzfeldt-Jakob disease, Death, Extrapyramidal disorder, Feeling abnormal, Headache, Locked-in syndrome, Lumbar puncture abnormal, Memory impairment, Motor dysfunction, Myoclonus, Pyramidal tract syndrome, Speech disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad), Opportunistic infections (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Lumbar pucture, 07/12/2021 result, CJD.
CDC Split Type:

Write-up: After 2nd dose of Pfizer 4/25/21, by 5/6/2021 complaining of severe headache and showing major symptons of something neurologically wrong- extreme memory fog, confusion, headache.Was hospitalized on 5/31 for about 10 days after a 911 call complaining of a headche. Released in a worsened state. Spent 10 days at home, regressing daily. On 06/19/2021 hospitalized again, doing tests eliminating possibilities.Rapidly regressing, unable to speak full sentences, Myoclonus, loss of motor skills, Pyramidal & extrapyramidal symptoms as well as akinetic mutism. After 3 weeks undiagnosed, on 07/12/2021 LP results confirmed positive for CJD. Was released to hospice on 07/19/2021 and death on 07/22/21.


VAERS ID: 1535278 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Anal incontinence, Autopsy, Fatigue, Feeling abnormal, Pain, Secretion discharge, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: (OTC) allergy medication; (OTC) arthritis pain reliever
Current Illness: Unknown
Preexisting Conditions: Type II diabetes
Allergies: Unknown
Diagnostic Lab Data: Autopsy 4/8/2021
CDC Split Type:

Write-up: "brain fog," blurred vision, extreme mucous, body aches, fatigue, bowel incontinence


VAERS ID: 1535282 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-04-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Condition aggravated, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid medication (unknown details); "multiple blood pressure medications" (unknown details)
Current Illness: Increased coughing/wheezing started PRIOR to vaccination. Was being treated for a sinus infection. SOB worsened post vaccination. Unknown adverse event date due to these circumstances.
Preexisting Conditions: Thyroid disorder (details unknown), Tobacco use (2-3 packs/day)
Allergies: None known
Diagnostic Lab Data: Autopsy 4/15/2021
CDC Split Type:

Write-up: Increased SOB


VAERS ID: 1535284 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-27
Onset:2021-04-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: Lisinopril 20mg - Take 1 Tablet PO, 1x Daily Hydrochlorothyazide 50mg - Take 1 Tablet PO, 1x daily at Bedtime Simvastatin 20mg - Take 1 Tablet PO, 1x Daily in evening Norco 7.5/325mg - Take 1 Tablet PO, 4x Daily q6 PRN Metformin 500mg - Tak
Current Illness: Unknown
Preexisting Conditions: Hypertension, diabetes, obesity, moderate alcohol use
Allergies: Unknown
Diagnostic Lab Data: Autopsy 6/18/2021
CDC Split Type:

Write-up: Cough, congestion


VAERS ID: 1535351 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-06
Onset:2021-08-01
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / IM

Administered by: Pharmacy       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: 2021-08-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tabletTake 500 mg by mouth every 6 hours as needed for Pain. --albuterol 90 mcg/puff inhalerInhale 2 puffs into the lungs every 6 hours as needed for Wheezing. --Ascorbic Acid (VITAMIN C) 1000 MG tabletT
Current Illness: ? Aortic insufficiency ? Aortic stenosis ? Ascending aorta dilation ? Asthma ? Benign prostatic hyperplasia ? Bilateral carotid artery disease ? Cerebrovascular accident ? Chest pain ? Chronic interstitial cystitis ? COPD (chronic obstructive pulmonary disease) ? COPD with acute exacerbation 1/6/2021 ? Coronary artery disease ? ED (erectile dysfunction) ? History of emphysema ? Hypertension ? Hypoxemia dependant to supplimental oxygen ? Left bundle branch block ? Obesity ? OSA (obstructive sleep apnea) ? Pacemaker ? Pneumothorax 1996 ? Pulmonary fibrosis mild ? S/P CABG x 5 ? Stroke 4/2014 left sided deficits, ambulates without a cane or walker ? Urinary urgency 08/2010 Cystoscopy/Bladder
Preexisting Conditions: See #11
Allergies: Lidocaine, Sulfa, Pennicillins, Latex
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 (COVID-19) in Specimen with probe detection (SARS Coronavirus 2) Ordered Test Codes: 94309-2 /2019nCoV Status: Final Accession Number: 1574473 Specimen Source: Other Specimen Site: Specimen Collection Date/Time: 2021-07-30 00:00:00.0
CDC Split Type:

Write-up: Patient was vaccinated with 2 doses Pfizer Covid-19 vaccine in January and February of 2021, and was hospitalized for Covid (8/1/21) and subsequently died of Covid pneumonia on 8/4/21.


VAERS ID: 1535468 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-15
Onset:2021-07-23
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral venous sinus thrombosis, Coagulation factor V level abnormal, Endotracheal intubation, Epilepsy, Factor V Leiden mutation, Magnetic resonance imaging head, Palliative care, Seizure, Superior sagittal sinus thrombosis
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 9
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levetiracetam 1000mg BID, levothyroxine 137 mcg
Current Illness: None
Preexisting Conditions: Obesity, hypothyroidism
Allergies: Flonase (dizziness), prednisone (confusion)
Diagnostic Lab Data: Single R506Q Factor V Leiden mutation on hypercoagulable panel, which I don''t think is significant. Otherwise, the pt did not have another reason (recent cranial surgery, dehydration, etc) to have this.
CDC Split Type:

Write-up: Patient developed cerebral venous sinus thrombosis (superior sagittal vein) and a large right occipito-parietal intracerebral hemorrhage. He developed epilepsy ~ a month prior to his presentation and there was a possible meningioma seen on a prior MRI - he was started on levetiracetam and had a follow-up appt but had his hemorrhage first. The patient had a seizure upon arrival and was intubated. Ultimately, we have pursued palliative care this afternoon.


VAERS ID: 1535508 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-04-10
Onset:2021-04-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESPIRATORY FAILURE


VAERS ID: 1535518 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-02-15
Onset:2021-04-23
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Drowning
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

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

Write-up: DROWNING


VAERS ID: 1535520 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-01-16
Onset:2021-04-28
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


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