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

Found 988 cases where Vaccine is COVID19 and Manufacturer is JANSSEN and Patient Died



Case Details

This is page 6 out of 10

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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data: Autopsy found high levels of atherosclerotic plaque
CDC Split Type:

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


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

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

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

Write-up: Dead


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 61
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210710773

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


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

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

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

Write-up: None stated.


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

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

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

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


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

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

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

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


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

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: colace and famotidine
Current Illness:
Preexisting Conditions: ilieus , GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS, PARKINSON''S DISEASE, QUADRIPLEGIA, NONTRAUMATIC INTRACEREBRAL HEMORRHAGE
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

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


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

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

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

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


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

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

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

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


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

Administered by: Other       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210724474

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


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

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

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

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


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

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

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

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


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

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

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

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


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

Administered by: Senior Living       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Bedridden, COVID-19, Dyspnoea exertional, Oedema, SARS-CoV-2 test positive, Unresponsive to stimuli, Urinary incontinence, Weight decreased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: end stage CHF, Atrial Fib, Diabetes, Renal Cell cancer - one kidney removed.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine, aspirin, atorvastatin, lisinopril, metformin, Tresiba flextouch U-100, Vitamin D3
Current Illness:
Preexisting Conditions: Type 2 diabetes, essential hypertension, body mass index $g30 - obesity, hypertriglyceridemia, substance abuse
Allergies: NKDA
Diagnostic Lab Data: Drug screen for amphetamine, methamphetamin, delta-9 carboxy THC, Delta-9 THC, creatinine, sodium, potassium, chloride, urea nitrogen
CDC Split Type:

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


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

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

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

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


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

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

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

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


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

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Cerebrovascular accident, Death, Pulmonary embolism, Right ventricular failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

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

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


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

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no health problems
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210731688

Write-up: PATIENT PLACED ON VENTILATOR; DEATH; COVID PNEUMONIA; This spontaneous report received from a consumer via a company representative via social media concerned a 49 year old female of unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient had no health problems. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry unknown) dose was not reported, administered in late APR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. In late APR-2021, on the night of vaccination, the patient experienced flu like symptoms. She was hospitalized and was in intensive care unit (ICU) (date unspecified), she never got better from flu like symptoms. It was claimed that the patient had Covid pneumonia. On an unspecified date, patient experienced sever lung damage and lung complications, and the patient was placed on ventilator. On 02-MAY-2021, the patient died from unknown cause of death It was unknown if the autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on 02-MAY-2021, and the outcome of covid pneumonia and patient placed on ventilator was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, and Life Threatening).; Sender''s Comments: V0 -20210731688-Covid-19 vaccine ad26.cov2.s-Death, Covid Pneumonia, Patient placed on ventilator. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1489530 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210732113

Write-up: PASSED AWAY; This spontaneous report received from a consumer via a company representative via social media concerned a 5 decade old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported, expiry date: unknown) dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient passed away due to vaccination. The cause of death was unknown. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210732113-COVID-19 VACCINE AD26.COV2.S-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 30 days after receiving the vaccination, patient passed away due to blood clots and being sepsis.


VAERS ID: 1497692 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USJNJFOC20210741198

Write-up: DEATH; STROKE; This spontaneous report received from other health professional via a company representative from social media concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, frequency 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced stroke. On an unspecified date, the patient died from unknown cause of death. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of stroke was not reported. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to 20210740986 and 20210740726.; Sender''s Comments: V0: This social media received cased concerns a patient of unspecified age, gender, and ethnicity who had a "stroke" and died from an unspecified cause on unspecified date after receiving. No other pertinent details reported. Information is very limited in this case. The information available precludes a complete and meaningful assessment; hence, the causality is considered unclassifiable due to insufficient information.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1500185 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-06-30
Onset:2021-07-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   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: Gabapentin, Lovastatin, Paradaxa, metoprolol , Vitamin D,
Current Illness: Rheumatoid Arthritis, pre diabetic, slight hypertension. My mother was bedridden the last 6 mos of her life. She passed three days after the jab! S
Preexisting Conditions: My mother was bedridden the last 6mos of her life! She had rheumatoid arthritis(bone on bone) she was in severe pain & was given pain relievers as well. January 23rd , 2021.She was rushed to the hospital for severe stomach pain, she was admitted & was in there & rehab until March 11,2021
Allergies: Allergic to pennicilin
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother passed away 3 days after jab on July 4, 2021


VAERS ID: 1500569 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210743441

Write-up: SUSPECTED COVID-19 INFECTION; COMPLICATION FROM VIRUS; This spontaneous report received from a patient via a company representative via social media concerned an 8 decade old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient died on sunday from suspected covid-19 infection after he had been hospitalized (date unspecified) due to complications from the virus. It was reported that the patient had received vaccine, but he contracted the virus five days after the his shot before he was fully protected. it was reported that the patient was vaccinated, but he was vaccinated too late. It was not effective yet. It was stated that the patient wanted to get vaccinated, but did not get around to it for a while, and unfortunately did not get around to it until it was too late. The patient was not connected to any outbreak and he was exposed to the virus by a community member. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of suspected covid-19 infection on an unspecified date, and the outcome of complication from virus was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0- 20210743441-Covid-19 vaccine ad26.cov2.S- Suspected Covid-19 infection , Complication from virus. 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: COVID INFECTION AFTER VACCINATION/COMPLICATION FROM VIRUS


VAERS ID: 1502013 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-20
Onset:2021-04-21
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, Intensive care, Pulseless electrical activity, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lasix, omeprazole, prednisone, bactrim, mycophenolate
Current Illness: autoimmune ILD on chronic O2, HTN, DM, CKD, anxiety
Preexisting Conditions: autoimmune ILD on chronic O2, HTN, DM, CKD, anxiety
Allergies: meperidine, morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: developed COVID after vaccine, sx onset 4/21/21, hospitalized 4/24-4/27, treated with remdesivir and steroids, improved, then readmitted 5/2/21 with respiratory failure, required ICU admission 5/21/21, intubated, PEA arrest, passed away 5/24/21.


VAERS ID: 1504860 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: over 80 years old patients had underlying health issues.
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210741034

Write-up: DEATH; SUSPECTED COVID 19 INFECTION; This spontaneous report received from a company representative via Manufacturer on 16-JUL-2021 concerned multiple patients. Initial information was processed along with the additional information received on 21-JUL-2021. The patient''s height, and weight were not reported. Two patient''s over 80 years old had underlying health issues, and pre-existing medical conditions of other 8 patient''s were not reported. The patient''s received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose, 1 in total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, two patient''s over 80 years old died from an unknown cause after being hospitalized, and eight patients also required hospitalization (hospitalization date unspecified). All patient''s had contracted the virus more than two weeks after being fully vaccinated. The cases are confirmed with a positive test COVID-19 (coronavirus disease) (confirmatory test was not reported) (suspected covid 19 infection). Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of suspected covid 19 infection was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged). This report was associated with product quality complaint, 90000186727.; Sender''s Comments: V0 20210741034-COVID-19 VACCINE AD26.COV2.S-Death and suspected covid 19 infection. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1504869 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210746676

Write-up: DEATH; This spontaneous report received from a patient concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin were not reported)1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210746676-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1505007 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse event, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient was healthy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210745184

Write-up: DEATH; FEEL SIDE EFFECTS/SYMPTOMS; This spontaneous report received from a consumer concerned a 49 year old male an unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient was healthy. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown; expiry date: Unknown) dose, start therapy date were not reported 1 total administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date (1 day after receiving vaccine), the patient experienced side effects/symptoms. Four day later, he passed away. It was not reported, if the autopsy was performed or not. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of feel side effects/symptoms was not reported. This report was serious (Death). This case is linked to 20210608311 (same reporter).; Sender''s Comments: V0 - 20210745184-Covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1505319 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-06
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Death, Dementia, Neuropsychiatric symptoms
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Urinary tract infection, Dementia
Preexisting Conditions: Arrhythmia, Benign prostatic hypertrophy, hyperlipidemia, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cause of death not documented. Significant comorbidities include dementia with neuropsychiatric behaviors including anxiety.


VAERS ID: 1507809 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210747770

Write-up: DEATH; This spontaneous report received from a consumer concerned multiple patients of unspecified age, sex, race and ethnic origin. The weight, height, and medical history of patients were not reported. The patients 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. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patients died from unknown cause of death. The autopsy details were not provided. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210747770-Covid-19 vaccine ad26.cov2.s -Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


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

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Cardiac arrest, Condition aggravated, Death, Dyspnoea, Intensive care, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad)

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

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


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

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

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

Write-up: Patient died.


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

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

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

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


VAERS ID: 1511577 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210756409

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes but the medication is unknown
Current Illness:
Preexisting Conditions: Diabetes, Minor stroke
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


VAERS ID: 1517885 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Dementia, MS, COPD, hx CVA and nephrolithiasis w/ureteral stent
Allergies:
Diagnostic Lab Data: Positive PCR SARS-CoV-2 result from NP specimen collected 7/31/2021.
CDC Split Type:

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


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

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram abdomen, Computerised tomogram abnormal, Condition aggravated, Diverticulum, Dyspnoea, Hepatic enzyme increased, Hypertension, Productive cough, SARS-CoV-2 test positive, Spinal compression fracture, Tachycardia
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Hypertension (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol loratadine Advar Remeron Prilosec Zoloft
Current Illness: none known
Preexisting Conditions: COPD HTN Large granular lymphocytic leukemia Type 2 diabetes
Allergies: Dilaudid aspirin sulfa drugs
Diagnostic Lab Data: Upon presentation to the emergency department he was tachycardic and hypertensive with otherwise normal and stable vitals. She was saturating well on 4 L oxygen nasal cannula, increased from baseline 3L. COVID-19 testing was positive, and liver enzymes were elevated. Chest x-ray showed atelectasis without focal consolidation in CT abdomen and pelvis showed no acute pathology and a T8 compression fracture and chronic diverticulosis as incidental findings.
CDC Split Type:

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, Cozaar, Zyloprim, Deltasone, Toprol
Current Illness:
Preexisting Conditions:
Allergies: Cortisone, Penicillin''s, and Diltiazem
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 1536019 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-23
Onset:2021-08-07
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   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: Acetazolamide, aspirin, cholecalciferol, clonidine, clopidogrel, Cosopt, Trulicity, Zetia, furosemide, isosorbide, labetalol, Levemir, lisinopril/hctz, nifedipine, Novolog, pantoprazole, sertraline
Current Illness:
Preexisting Conditions: CAD, hypertension, VCA, diastolic heart failure, GERD, Diabetes, CKD3, neuropathy, hyperlipidemia, venous stasis,
Allergies: Diphenoxylate
Diagnostic Lab Data: Covid-19 detected 7/26/21 vial laboratory PCR testing.
CDC Split Type:

Write-up: Contracted Covid-19. Died after 12 days in hospital


VAERS ID: 1536189 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-02
Onset:2021-08-06
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Alcohol poisoning, COVID-19, Coma, Coma scale abnormal, Craniocerebral injury, Death, Endotracheal intubation, Loss of consciousness, SARS-CoV-2 test positive, Subarachnoid haemorrhage, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 2
Permanent Disability? Yes
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:
Allergies:
Diagnostic Lab Data: Coronavirus test performed: 08052021 - POSITIVE
CDC Split Type:

Write-up: Pt founds unresponsive and transferred to the hospital. Pt was intubated after being given Narcan with no response. Pt was GCS 3 at the scene. Medical History of alcoholism, frequent falls and CAD, Hep C, etc. Pt Neurosurgery was consulted due to SAH and admitted to the trauma service. DX: Acute alcohol intoxication; Coma; TBI with loss of consciousness; Traumatic subarachnoid hemorrhage. COVID + on admission. Pt expired on 8/8/2021.


VAERS ID: 1536481 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-06-17
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 402A21A / N/A LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s caretaker, called today on 08/09/21 to request us to submit a report that patient passed away on June 17th due to major stroke, which is believed to be linked to the Janssen Covid Vaccine.


VAERS ID: 1541119 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-10
Onset:2021-07-10
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 105031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Angiogram abnormal, Arthralgia, Aspiration, Bile output abnormal, COVID-19, Computerised tomogram abdomen abnormal, Computerised tomogram neck, Computerised tomogram thorax abnormal, Death, Dyspnoea, Extravasation, Gastrointestinal tube insertion, Haematoma, Perforation, Pneumonia, SARS-CoV-2 test positive, Urinary system X-ray, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (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: 2021-08-06
   Days after onset: 27
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: Acetaminophen prn, Amiodarone 200 mg QD, Apixaban 2.5 mg BID, Calcium Carbonate 1250 mg BID, Carvedilol 3.125 mg BID, Cholecalciferol 25 mcg QD, Voltaren gel TID prn, Famotidine 20 mg BID, Fluticasone nasal 2 sprasy QD, Furosemide 20 mg QD,
Current Illness: Hematoma right thigh
Preexisting Conditions: Hypertension, A-fib, GERD, Restless leg syndrome, Vitamin D Deficiency, Depression w/ anxiety, Chronic hyponatremia,
Allergies: Corticotropin (Throat swelling)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA Patient received Janssen Vaccine on 3/10/2021. Presented to ED on 7/10/2021 with hip pain of two weeks in duration. CT Angiogram showed a right inguinal hematoma and active extravasation and was medically managed. Patient subsequently developed shortness of breath and pneumonia and treated with 7 days of cefepime. Patient tested positive for COVID-19 using the Cepheid GeneXpert platform on 7/30/2021, which was the anticipated day of transfer to skilled nursing facility. On 8/4 she developed abd pain prompting KUB whihc showed SBO but patient deferred NG tube.Later she had CT chest neck and abd which showed worsening PNA with aspiration of bowel content and SBO and poss oropharyngeal perforation. Patient did agree after detailed discussion with family about CT findings and IR able to place NG tube but shortly after she began throwing up bile and needing high flow oxygen. She was not able to maintain oxygen saturation and family changed her status to AND, and she expired on 8/6 at 0415 AM.


VAERS ID: 1542111 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-06-10
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hemoglobin decreased
Preexisting Conditions: Comments: On 26-MAY-2021, the nurse had made a home visit. The patient was checked by physician on 10-JUN-2021 and blood sample was taken.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210815166

Write-up: ACUTE MYOCARDIAL INFARCTION; This spontaneous report received from a consumer concerned a 70 year old male. The patient''s height, and weight were not reported. On 26-MAY-2021, the nurse had made a home visit. The patient was checked by physician on 10-JUN-2021 and blood sample was taken. The patient''s labs showed that he had very low levels of haemoglobulin. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, 1 total, administered on 10-JUN-2021 11:00 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. At 11:00 PM on 10-JUN-2021, the patient started throwing up, grabbed his chest, and fell over. He received immediate medical attention and time of death was announced at 12:10 AM on 11-JUN-2021. The physicians said cause of death was due to acute myocardial infarction. After the patient''s death, reporter had received a phone call from doctor asking to take patient right away to the hospital as his labs showed that he had very low levels of hemoglobulin. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died from acute myocardial infarction on 11-JUN-2021. This report was serious (Death).; Sender''s Comments: V0:20210815166-COVID-19 VACCINE AD26.COV2.S-Acute myocardial infaraction. 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: ACUTE MYOCARDIAL INFARCTION


VAERS ID: 1542115 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210815346

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer via a company representative via social media concerned multiple (3) patients. The patients` weight, height, and medical history were not reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) frequency 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients experienced blood clots and died from blood clot. It was unknown whether the autopsy was done or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20210815346-Covid-19 vaccine ad26.cov2. s- Blood clots. 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: BLOOD CLOT


VAERS ID: 1545923 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-15
Onset:2021-06-07
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 038C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram abnormal, Death, Deep vein thrombosis, Gastrointestinal necrosis, Intestinal resection, Portal vein thrombosis, Surgery, Visceral venous thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Ischaemic colitis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   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: History of DVT and recently diagnosed colon cancer.
Preexisting Conditions: Coronary artery disease, DVT, anemia
Allergies:
Diagnostic Lab Data: CT abdomen and pelvis showed extensive portal and femoral thrombosis on 6-9-2021.
CDC Split Type:

Write-up: Patient presented 3 weeks after vaccination with massive bilateral femoral and portal visceral thrombosis. Taken to surgery and resected dead bowel. Thrombosis progressed and patient died after 2 days.


VAERS ID: 1547474 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Obesity; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210817359

Write-up: PASSED AWAY; COVID-19; This spontaneous report received from a physician concerned a 75 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: type 2 diabetes, and considered obese. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported, 1 total for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date in JUL-2021 (a month prior to this report), the patient had covid-19 was sent home from the hospital with no treatment and told to quarantine. He was seemingly getting better, but after a few days his condition worsened and the ambulance would not pick him up. The patient decided and tried himself to sleep, but unfortunately on 09-AUG-2021, he passed away in sleep. The patient died from unknown cause of death on 09-AUG-2021. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient passed away on 09-AUG-2021, and the outcome of covid-19 was not reported. This report was serious (Death).; Sender''s Comments: V0: 20210817359-COVID-19 VACCINE AD26.COV2.S.- Passed away. This event is considered unassessable. The event has a unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1549143 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-16
Onset:2021-06-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A2A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (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: 2021-07-25
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREDNISONE 10MG LOSARTAN 25MG DOXYCYCLINE MONO 100MG ALPRAZOLLAM 0.5MG SYMBICORT 160/4.5MCG HYDROCHLOROTHIAZIDE 25MG LIOTHYRONINE25MCG
Current Illness:
Preexisting Conditions: COPD HYPERTENSION
Allergies: CLARITHROMYCIN LEVOFLOXACIN AUGMENTIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PASSES AWAY ON 7/25/21 OF UNKNOWN CAUSE BUT HAD PERICARDITIS


VAERS ID: 1550081 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210815363

Write-up: BLOOD CLOTS IN BRAIN; This spontaneous report received from a patient via a company representative concerned a female of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, 1 total, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. Two weeks later on an unknown date in MAR-2021, the patient experienced blood clots in brain and died from blood clot in her brain. It was reported that, the plug was pulled after one week. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: This spontaneous report received from a patient via a company representative concerned a female of unspecified age and ethnicity, who experienced blood clots in brain two weeks after receiving Janssen Covid-19 vaccine Ad26.COV2.S. It was reported that, the plug was pulled after one week. The patient died from blood clots in brain. It was unspecified if an autopsy was performed. The patient''s height, and weight were not reported. No past medical history, concurrent conditions, and concomitant medications were reported. Information is limited in this case, and the occurrence of blood clots in brain could represent background incidence of such events in the general population. Hence, the relationship to the vaccination is considered unclassifiable. Additional information has been requested.; Reported Cause(s) of Death: BLOOD CLOT IN BRAIN


VAERS ID: 1550084 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-12
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: USJNJFOC20210818401

Write-up: DEATH; BLOOD CLOTS; This spontaneous report received from a consumer via social media concerned multiple patients (6 or 7) with unspecified race and ethnicity. The patient''s weight, height, and medical history were not reported. The patients 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. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients experienced blood clots and died from unknown cause of death. It was unspecified if was an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of blood clots was not reported. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to 20210818227, 20210818107, 20210817805 and 20210818021.; Sender''s Comments: V0: 20210818401 -covid-19 vaccine ad26.cov2.s- death, Blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1555771 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210815127

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19; This spontaneous report received from a company representative on behalf of a health care professional concerned a male patient of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date after vaccination, the patient experienced suspected covid-19 (suspected clinical vaccination failure). On an unspecified date in AUG-2021 (same week of this report), the patient was hospitalized and was intubated. The duration of hospitalization was not specified. On an unspecified date in AUG-2021 (same week of this report), the patient died of covid-19. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of suspected clinical vaccination failure and suspected covid-19 on AUG-2021. This report was serious (Death, and Hospitalization Caused / Prolonged). This case was associated with the Product Quality Complaint number 90000188817.; Sender''s Comments: V0: 20210815127- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Suspected COVID-19. 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). 20210815127- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.; Reported Cause(s) of Death: COVID-19


VAERS ID: 1559265 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol 100 MG, Anastrazole 1mg, atorvastatin 20mg, vitamin D, Lasix 20mg, lantus, Levaquin 500mg, synthroid 25mg, melatonin 5mg, omeprazole 20mg, trugenta, coreg, Eliquis 2.5mg, glipizide, iron 325mg
Current Illness: pneumonia
Preexisting Conditions: Primary Diagnosis is: PNEUMONIA, UNSPECIFIED ORGANISM, ACUTE ON CHRONIC SYSTOLIC (CONGESTIVE) HEART FAILURE, PULMONARY FIBROSIS, UNSPECIFIED, ACUTE AND CHRONIC RESPIRATORY FAILURE, UNSPECIFIED WHETHER WITH HYPOXIA OR HYPERCAPNIA, HYPOTHYROIDISM, UNSPECIFIED, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, UNSPECIFIED ATRIAL FIBRILLATION, CHRONIC KIDNEY DISEASE, UNSPECIFIED, DIVERTICULOSIS OF INTESTINE, PART UNSPECIFIED, WITHOUT PERFORATION OR ABSCESS WITHOUT BLEEDING CHF Diabetes
Allergies: none
Diagnostic Lab Data: none per family request
CDC Split Type:

Write-up: Patient c/o sudden onset of headache to family and suddenly passed away immediately following statement made that she had a headache


VAERS ID: 1577472 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USJNJFOC20210810396

Write-up: BRAIN HAEMORRHAGING; BLOOD CLOT; This spontaneous report received from a consumer who reported hearing a news report which concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total administered, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced brain haemorrhaging and blood clot. On an unspecified date, the patient died from brain hemorrhage and blood clot. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of brain haemorrhaging and blood clot on an unspecified date. This report was serious (Death).; Sender''s Comments: V0: 20210810396- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Brain haemorrhaging, Blood clot. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BRAIN HEMORRHAGE; BLOOD CLOT


VAERS ID: 1577475 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient was very healthy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210818781

Write-up: DIED FROM THE VACCINE; This spontaneous report received from a consumer via a company representative concerned a male of unspecified age. The patient''s height, and weight were not reported. The patient was very healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, after vaccination patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0-20210818781-COVID-19 Vaccine AD26.COV2.S-Died From The Vaccine. This event(s) is considered un-assessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1577653 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-10
Onset:2021-07-24
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180892 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization for COVID19 7/24/21 and death 08/02/2021


VAERS ID: 1577966 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-15
Onset:2021-08-14
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Dyspnoea, Intensive care, Mechanical ventilation, Resuscitation, Tachypnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to ICU on 8/13/21 on noninvasive ventilation. Patient repeatedly verbalized she did not want to be intubated. Overnight, increasing oxygen needs and AVAPS increased to fio2 100% and epap 14. She had increased work of breathing and tachypnea with respirations up to 50s and oxygen saturations 79-85%. This morning, monitor alarmed asystole and RN called code blue and initiated CPR with bag valve mask. Monitor tech advised patient was normal sinus rhythm and then ventricular standstill just prior to arrest. Multiple rounds of CPR with epinephrine administered, unfortunately we were not able to regain pulse. Patient was not intubated in honor of her wishes. Resuscitation attempts stopped, and time of death called at 09:18; may she rest in peace.


VAERS ID: 1578437 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-07-21
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, kidney disease, DM, breast ca, colon ca
Allergies: NKA
Diagnostic Lab Data: COVID test, CXR
CDC Split Type:

Write-up: admission to hospital with COVID symptoms that resulted in death


VAERS ID: 1578504 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-14
Onset:2021-05-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, COVID-19, Death, Dyspnoea, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 51
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: UNK
Current Illness: UNK
Preexisting Conditions: diabetes mellitus, hypertension
Allergies: UNK
Diagnostic Lab Data: COVID-10 PCR positive 06/03/2021
CDC Split Type:

Write-up: weakness, SOB, Abdominal cramps, nausea and vomiting starting 5/28/2021. admitted to the hospital required breathing assistance. tested positive for COVID-19 06/03/2021, died 7/18/2021


VAERS ID: 1578516 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-04
Onset:2021-07-28
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN AD26 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Death, Dyspnoea, Mental status changes, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PENICILLIN
Diagnostic Lab Data: COVID TEST, CXR
CDC Split Type:

Write-up: ALTERED MENTAL STATUS, SHORT OF BREATH


VAERS ID: 1578963 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-28
Onset:2021-07-24
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: diabetes, psoriasis
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Unexplained death. Patient was found dead near his front door with car keys still in his hand. Pacemaker had recently been checked and was working fine, so it was not a heart attack.


VAERS ID: 1582506 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-09
Onset:2021-07-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute hepatic failure, Acute left ventricular failure, Angiogram cerebral abnormal, Brain death, Brain herniation, Brain oedema, Cardiac failure, Cardiogenic shock, Computerised tomogram head abnormal, Death, Distributive shock, Echocardiogram abnormal, Endotracheal intubation, Gastrointestinal haemorrhage, Haematemesis, Hyperammonaemia, Hyperventilation, Intensive care, Intracranial pressure increased, Laboratory test, Lactic acidosis, Mental status changes, Multiple organ dysfunction syndrome, Pupil fixed, Respiratory distress
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   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: ferrous sulfate
Current Illness: post partum - c section 2/27/21 nothing else
Preexisting Conditions: none 7/15/21 admitted to Medical Center ICU with acute liver failure without hepatic coma
Allergies: none
Diagnostic Lab Data: 7/15/21 - The patient was admitted as a transfer from a HCF with acute liver failure of unknown etiology on 7/15/2021. On arrival, she had altered mental status with respiratory distress and coffee ground emesis. She was promptly intubated for airway protection. A GI bleed was suspected, thus she was started on octreotide and protonix gtts and IV ceftriaxone. An a-line, dialysis line were placed. An orogastric tube was placed and there was no acute GI bleeding thereafter. Labs demonstrated severe lactic acidosis, severe hyperammonemia and acute renal failure, thus CVVH was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory and cardiogenic shock. Cardiac echo demonstrated acute systolic and diastolic heart failure with reduced EF, however no intervention was recommended by cardiology due to multiorgan failure. CT brain on 7/15 demonstrated diffuse brain edema and mild cerebellar tonsillar herniation. Neurosurgery was consulted and bolt placement was performed. ICPs were consistently elevated $g100s. Repeat CT brain demonstrated worsening cerebral edema and herniation. By the evening of 7/15, her pupillary exam became fixed and dilated despite being on maximum pentobarbital therapy, propofol to decrease ICP, head of bed 45 degrees+ all times, mannitol, and mild hyperventilation for cerebral edema and elevated ICPs. Once CVVH was initiated, though, mannitol and hypertonic saline were not treatment options, as the CVVH clears the medication quickly. The patient was listed for OLT that afternoon but later determined to not be a candidate due to her worsening neurological status. She had a change in pupil exam suggestive of worsening herniation (pupils became fixed/dilated) and CT confirmed worsening herniation. ICPs remained 120+ despite triple pressor support in effort to maintain CPP (without success). A diagnostic cerebral angiogram was performed on 7/16 due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family, the patient became DNR. The family elected to discontinue supportive measures on 7/18. The patient was pronounced dead at 9:22 AM.
CDC Split Type:

Write-up: vaccine given 7/9/21 patient admitted to local Hospital then transferred to another Hospital and finally transferred to a final Medical Center ICU 7/15/21 with liver failure


VAERS ID: 1586886 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-12
Onset:2021-03-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN AD26 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN
Allergies: codeine, cipro, oxycodone
Diagnostic Lab Data: cxr covid test
CDC Split Type:

Write-up: hospitalization resulting in death


VAERS ID: 1587137 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-04-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN AD26 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: whipple, COPD, pancreatitis
Allergies: abilify, ambien, iodine, lithium, shellfish
Diagnostic Lab Data: covid test, CXR
CDC Split Type:

Write-up: signs and symptoms of covid- hospitalization and death


VAERS ID: 1587255 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-16
Onset:2021-08-05
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

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

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: Lipitor, Toprol, sodium bicarbonate, Cozaar, Lexapro, Lasix, Aldactone, Glucophage, Buspar, Klor-Con, Remeron, Mag Oxide, aspirin, Calcium 600-D, Pyridoxine
Current Illness:
Preexisting Conditions:
Allergies: Bactrim, Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/05/2021


VAERS ID: 1591271 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-18
Onset:2021-07-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, gabapentin, lamotrigine, nicotine lozenge, quetiapine, aspirin
Current Illness: Chest ache/dizzy, HTN, HLD, COPD, GERD, Colon polyps, MGUS, cognitive symptoms, depression, tobacco use
Preexisting Conditions: Chest ache/dizzy, HTN, HLD, COPD, GERD, Colon polyps, MGUS, cognitive symptoms, depression, tobacco use
Allergies: bupropion, buspirone, mirtazapine
Diagnostic Lab Data: Cause of death not documented. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Significant comorbidities include HTN, hyperlipidemia, COPD, GERD, prolonged QT interval, and history of polypectomy.
CDC Split Type:

Write-up: Cause of death not documented. The ADR did not occur at the time of the administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Significant comorbidities include HTN, hyperlipidemia, COPD, GERD, prolonged QT interval, and history of polypectomy.


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