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

Found 15,386 cases where Vaccine is COVID19 and Patient Died



Case Details

This is page 60 out of 154

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VAERS ID: 1535548 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-01
Onset:2021-08-03
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, 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: 2021-08-01
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril for BP but had it under control
Current Illness: none
Preexisting Conditions: none
Allergies: Azithromycin, Bactrim
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: sudden death


VAERS ID: 1535603 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-02-15
Onset:2021-06-29
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


VAERS ID: 1535608 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Unknown  
Location: Northern Mariana Islands  
Vaccinated:2021-04-21
Onset:2021-07-02
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Gun shot wound, Haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: GUNSHOT WOUND, HEMORRHAGE


VAERS ID: 1535895 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-17
Onset:2021-04-01
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Brain scan abnormal, Death, Haemorrhage intracranial
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Brain scan
CDC Split Type:

Write-up: Brain Bleed, Hemorrhage (Intracranial Hemorrhage). Death


VAERS ID: 1535913 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-07
Onset:2021-06-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Squamous cell carcinoma of lung
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-20
   Days after onset: 43
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized on 6/7/2021 for severe protein-calorie malnutrition and received the first dose of covid vaccine while hospitalized. Patient received second dose on 6/30/2021. Patient presented to the ED and was subsequently hospitalized on 7/4/2021 for squamous cell carcinoma of right lung. She died on 7/20/2021.


VAERS ID: 1535996 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-18
Onset:2021-08-02
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 - / IM

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

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

Write-up: Covid 19 Pfizer, Lot # EL3247 #2 obtained 02/08/2021. Client died August 2, 2021.


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: 1536023 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-17
Onset:2021-03-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   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: Metoprolol Lasix potassium Coreg Atorvostatin Albuterol
Current Illness:
Preexisting Conditions: CAD, CHF, ESRD, Valvular heart disease, diabetes
Allergies: sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died at home of an apparent heart attack, was not rescesitated and did not make it to hospital


VAERS ID: 1536025 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-24
Onset:2021-04-30
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Antiphospholipid syndrome, Autopsy, Biopsy kidney abnormal, Blood culture negative, Blood lactic acid increased, Condition aggravated, Culture negative, Culture urine negative, Death, Dizziness, Endotracheal intubation, Haemoglobin decreased, Hypertension, Immunoglobulin therapy, Lactic acidosis, Lung opacity, Mechanical ventilation, Multiple organ dysfunction syndrome, Plasmapheresis, Pneumonia, Renal replacement therapy, SARS-CoV-2 test negative, Transfusion, Vasculitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Vasculitis (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, slow fe 142 mg daily, levothyroxine 125 mcg
Current Illness: antiphospholopid antibody, Lupus anticoagulant pos, homozygous MTHFR, obesity, anemia
Preexisting Conditions: see 11
Allergies: none
Diagnostic Lab Data: Extensive- UMMC 5/9-5/26/2021 for acute hypoxic respiratory failure and AKI requiring CRRT. Pt had repeated neg Covid testing. Blood urine and sputum cultures neg. Had plasma exchange, IVIG and transfusion to support dropping hgb despite no bleeding site found. 5/25 developed increased lactic acidosis, decreasing BP and hgb 3.3. Transferred to comfort care.
CDC Split Type:

Write-up: Six days after her first vaccine patient became lightheaded. She presented to Hospital where she was found to have bilateral pneumonia with ground glass opacities, AKI and severe hypertension-systolic BP 200. She was admitted and began a steady downhill course intubated 5/5/21. Transferred to another hospital and seen by multiple specialists. On ventilator with kidney support. Repeated cultures negative for bacterial infection although pressors needed to maintain BP. Kidney biopsy showed vasculitis. Patient died with catastrophic multiorgan failure 5/26/21. Autopsy lists cause of death as pneumonia complicated by antiphospholipid Syndrome.


VAERS ID: 1536043 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-11
Onset:2021-07-19
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death from Covid-19


VAERS ID: 1536077 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-01
Onset:2021-08-02
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benzonatate 200 mg TID for cough, furosemide 20 mg q day, glipizide 5 mg BID, metformin1000 mg BID, pantoprazole 40 mg q day, spirinolactone 50 mg q day
Current Illness:
Preexisting Conditions: adenocarcinoma
Allergies: iodinated radiocontrast dyes
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1536142 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-01
Onset:2021-08-06
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Heart failure, atrial fiobrillation
Allergies: hyudrocodone, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital on 7/20/21 with respiratory congestion, dry cough and rhinorrhea after positive COVID test on 7/15. Resulted in acute hypoxic respiratory failure with death 8/6/21.


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: 1536208 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-31
Onset:2021-08-08
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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: 2021-08-08
   Days after onset: 0
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: Diabetes, Hypertension
Allergies: Codeine
Diagnostic Lab Data: COVID-19 positive
CDC Split Type:

Write-up: Admited to hospital on 8/7. Expired 8/8


VAERS ID: 1536214 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-01
Onset:2021-08-03
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Sepsis
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), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke, Sepsis, and Death


VAERS ID: 1536241 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-01
Onset:2021-03-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 130
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: COPD, CAD, DM TYPE 2, HLD, HYPOTHYROID, HX OF SUPRAGLOTTIC CANCER, STAGE 3B CKD, OA, CVA, CHEST PAIN
Preexisting Conditions: COPD, CAD, DM TYPE 2, HLD, HYPOTHYROID, HX OF SUPRAGLOTTIC CANCER, STAGE 3B CKD, OA, CVA, CHEST PAIN
Allergies: UNKNOWN
Diagnostic Lab Data: COVID POSITIVE PCR/NAAT 8/4/2021
CDC Split Type:

Write-up: COVID PNEUMONIA DEATH 8/6/2021


VAERS ID: 1536271 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-08-06
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death
SMQs:, 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: 0
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, CAD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. passed from COVID19 Pneumonia on 8/6/2021


VAERS ID: 1536315 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-11
Onset:2021-08-06
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / IM

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

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

Write-up: FULLY VACCINATED CASE DECEASED 8/6/21


VAERS ID: 1536337 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-14
Onset:2021-08-05
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / SYR

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

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

Write-up: FULLY VACCINATED DECEASED


VAERS ID: 1536432 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-04-12
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Fatigue, Headache, Intensive care, Malaise, Mechanical ventilation
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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 73
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisose, amLODIPine (amLODIPine), Breo Ellipta 200-25 MCG/INH Inhalation Aerosol Powder Breath Activated, clonazePAM (clonazePAM), ACETAMINOPHEN TAB, ALBUTEROL-IPRATROPIUM 2.5-0.5 MG/3 ML, Cyclobenzaprine, dilTIAZe
Current Illness: COPD, Oteoarthritis, Supraventiricular tachycardia, LPR, Hypertension,
Preexisting Conditions: COPD, back Pain,
Allergies: None
Diagnostic Lab Data: On 06/12 she was ambulanced to the ER where they did tests, she was then transported via ambulance to Fargo ND, ICU where she had countless testing, procedures, ect. She was put on a ventilator and sedated. I can not possible name them all here. They couldn''t hardly sustain her life, and keep her alive so they airflighted her to Abbott Northwestern in Minneapolis MN. On her 2nd day there she had cardiac arrest and died. In total I think it was about 12 days in ICU. 8 on the ventilator. I can not go over all the details here because the browser keeps timing out and I am forced to start over. This is my third time filling this out. Please reach out for more information please.
CDC Split Type:

Write-up: March 18 2021 my mom received her first Pfizer vaccine followed by her second on 4/03/2021. After she received it she started having an overall feeling of not well. Tired, fatigue, headache, and complained to her doctor on multiple occasions. Since 12/09/2020 she had only went to the doctor one time on 02/08/2021. After the first dose until her death she had gone to her doctor many times, on 03/30, 04/01, 04/21, 04/28, 05/25. That may not be a complete list of every visit.


VAERS ID: 1536441 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-15
Onset:2021-03-03
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW5318 / 2 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3267 / 1 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Parkinson's disease, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (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: 2021-06-08
   Days after onset: 96
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: Tramadol, vitamin d,
Current Illness: parkinson, diabetes, cancer
Preexisting Conditions: 4 seizures unknown origin in prior 18 months
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The only chemical change to my father in 2021 were the 2 injections. He had had seizures of unknown origin 4 times in the prior 18 months. A little over 2 weeks later he had a seizure. It was thought to be dehydration or lack of food. He was given a water bottle and we started watching his food intake. He had 4 seizures in 2 weeks. He had another 4 the week after, then they came everyday. More often, longer durations, and more powerful. He passed away on June 8, 2021 cause of death ruled to be parkinsons.


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: 1536521 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-10
Onset:2021-06-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Ramipril Simvastatin Januvia Glimepiride Melatonin Gabibentin .81 Aspirin Warfarin Sotalol Colazapen
Current Illness: None
Preexisting Conditions: Mitral & Aorta valve replacement (mechanical)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely sick & Died on 06/14/2021


VAERS ID: 1536899 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Coma, Confusional state, Death, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 4
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: I am not sure of what types but he was on blood thinners, type 2 diabetic and other health issues
Current Illness:
Preexisting Conditions: Type 2 diabetic several stints and pacemaker
Allergies: unknown
Diagnostic Lab Data: None as I know of . To be honest any healthcare person we talked to or dealt with played off the fact he was just given the vaccine before death. Which I am also frustrated with the fact no autopsy performed which given the information we gave the nurses etc doesn''t make sense to me
CDC Split Type:

Write-up: 1 -2 days after the first dose he started getting confused . 3rd day we admitted him to the hospital . At one point they thought or were testing about his brain bleeding . Roughly after 4 days in the hopsital his body crashed he was in a coma and then died roughly 14 days after the injection on March 24, 2021. He died of an acute intracerebral hemorrhage which we were told he had a blood clot then stroke


VAERS ID: 1536906 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-02-01
Onset:2021-02-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure med Synthroid Glaucoma med Xanax
Current Illness: Congestive heart failure
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1537187 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-28
Onset:2021-04-15
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, 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: 2021-04-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: flecainide 50mg 2x daily, metoprolol succinate 25mg 0.5 tablets daily, albuterol, tylenol, wellbutrin 300mg daily, busPIRone 30mg 2x daily, advil, synthroid 88mcg daily, nasacort
Current Illness: none
Preexisting Conditions:
Allergies: Dilaudid, latex, percocet ,nuts
Diagnostic Lab Data: Emergency room treatment and death. Postmortem Exam report 04/23/2021
CDC Split Type:

Write-up: Pt died on April 15, 2021 of cardiac arrest.


VAERS ID: 1540347 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-10
Onset:2021-08-02
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19 pneumonia, Death, Dyspnoea, SARS-CoV-2 test positive, Urinary tract infection
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), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: MENTAL,OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, IMMUNOCOMPROMISED CONDITION, CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD)
Preexisting Conditions: MENTAL,OTHER CHRONIC DISEASES, CARDIOVASCULAR DISEASE, IMMUNOCOMPROMISED CONDITION, CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD)
Allergies: UNKNOWN
Diagnostic Lab Data: + Rapid Test on 8/3/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient. Case was admitted after daughter found Dad on the floor was previously being treated for a UTI -- Transported to the ED as he had Difficulty breathing -- during hospital start was treated for COVID Pneumonia -- was treatment at hospital and discharged 8/6 -- 8/7 Returned to ED w/Acute Respiratory Distress -- Daughter was by bedside declined Mechanical Inc -- pt. expired 3 hrs later. Patient was fully vaccinated with Pfizer on 2/17 and 3/10.


VAERS ID: 1540381 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-07-28
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   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: Colon Cancer, Metastatic adenocarcinoma, Underweight, Malnutrition, Hyponatremia, Acute respiratory Failure.
Preexisting Conditions: Colon Cancer, Metastatic adenocarcinoma, Underweight, Malnutrition, Hyponatremia, Acute respiratory Failure.
Allergies:
Diagnostic Lab Data: Covid PCR Test
CDC Split Type:

Write-up: Patient Death


VAERS ID: 1540391 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-22
Onset:2021-05-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   Days after onset: 47
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED and was subsequently hospitalized for cellulitis of foot within 6 weeks of receiving COVID vaccination. She died on 7/12/2021.


VAERS ID: 1540406 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-01-07
Onset:2021-08-07
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / IM

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: 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:

Write-up: Client was fully vaccinated for covid-19, date of death 08/07/2021, cause of death complicatons of covid-19


VAERS ID: 1540494 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-05-24
Onset:2021-08-04
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CHF, HTN, supraventricular tachycardia, transient cerebral ischemia,
Allergies: sulfa abx
Diagnostic Lab Data: Positive COVID test on 8/4/21
CDC Split Type:

Write-up: Patient test positive for COVID at the nursing home where she lives on 8/4/21. Received casirivimab and imdevimab monocolonal antibodies on the same day. Pt arrived unresponsive at the ER 8/8/21 and expired.


VAERS ID: 1540547 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-16
Onset:2021-08-04
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 4
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: Acute hypoxic respiratory failure, Shock, Covid 19, Acute renal failure, Atrial fibrillation with RVR, Acute exacerbation of obstructive pulmonary disease, Elevated INR, Alpha -1- antitrypsin deficiency, diabetes, abnormal chest x-ray, lupus, DVT prophylaxis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Died


VAERS ID: 1540561 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-06-23
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 43 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Acute respiratory Failure, Covid 19, COPD exacerbation, HTN, Sepsis, DN2, Atrial Fibrillation
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute respiratory Failure, Covid 19, COPD exacerbation, HTN, Sepsis, DN2, Atrial Fibrillation. Patient Died.


VAERS ID: 1540687 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-04
Onset:2021-08-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: seizure disorder
Preexisting Conditions: Hypertension
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found in cardiac arrest at his residence. Brought into the emergency department by ems in cardiac arrest. No return of spontaneous circulation. Pronounced dead at 0746.


VAERS ID: 1540952 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-04
Onset:2021-08-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Public       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: 2021-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel, guanfacine, fluoxetine, lisinopril, omeprazole, ondansetron, naltrexone
Current Illness:
Preexisting Conditions: Anemia, morbid obesity, hypertension, alcoholism
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest resulting in death


VAERS ID: 1540970 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-01
Onset:2021-08-03
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, 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), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 + test on 7/28/21
CDC Split Type:

Write-up: Tested positive for COVID-19 on 7/28/21, admitted to the hospital on 8/3/21 with a date of death of 8/8/2021 via cardiac arrest.


VAERS ID: 1541088 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-27
Onset:2021-08-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient died on 08/09/2021


VAERS ID: 1541117 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-23
Onset:2021-07-30
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Ageusia, COVID-19, Death, Delirium, Dyspnoea, Intensive care, Muscular weakness, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRN, Albuterol 2 puff Q6H Prn, Aspirin 81 mg QD
Current Illness:
Preexisting Conditions: Morbid obesity, Diabetes, Hypertension, Congestive heart failure, Obstructive sleep apnea, Pulmonary Hypertension, fibromyalgia, psoriasis, history of breast cancer.
Allergies: Penicillins (Rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA Patient received Pfizer Vaccines on 3/5/2021 and 3/23/2021. Presented to urgent care on 7/24 and had a positive COVID test, started on azithromycin and benzonatate. Patient presented to ED on 7/30 with fever, dyspnea, myalgia, loss of taste, muscle weakness. Patient was initially admitted to the medical floor, on 4 L nasal cannula, but quickly escalated to high-flow nasal cannula and was then transferred to the ICU. The patient required high levels of oxygen and also developed delirium, as well as had acute kidney injury. Patient was treated with dexamethasone, terbutaline, remdesivir. In discussion with the patient''s primary medical decision makers, including the patient''s husband and son, the patient/s status was made a do not attempt resuscitation, but may continue the treatments. The patient was transferred to the medical wards on high levels of oxygen 60 L and 90% FiO2. Unfortunately, the patient continued to decompensate and passed away the evening of 8/3/2021. Additional information for Item 9: Atorvastatin 10 mg QD, Azithromycin 250 mg QD, Benzonatate 100 mg TID prn, Cholecalciferol 1000 units QD, Furosemide 40 mg QD, MagOx QD, Metoprolol 25 mg QD, Mycolog cream BID.


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: 1541629 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-02-09
Onset:2021-03-16
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM 9810 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   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: DEATH. My wife was in excellent health with no heart issues when she awoke five weeks after her second Pfizer shot feeling "like a load of bricks was on her chest". She was transported by ambulance to the Hospital Emergency Room around 11 am on March 16, 2021. She was monitored closely and after a couple of hours, the attending folks said they didn''t think it was a heart issue per fine blood work and full time EKG hook up. They were looking at GI possibilities and wanted to keep her overnight, do a couple more tests in the morning and then send her home. She stayed in an ER bay because there were no regular beds available. We made plans for the next morning and I left her around 8 pm and drove home. Around 2:50 am on the 17th, I received a phone call that she had a massive coronary event. The were able to bring her back one time momentarily, but then she passed away within a few minutes. I''m submitting this report because of the general belief that older women have heart attacks all the time. However, though she felt a heavy chest pressure, twelve plus hours in an ER bay couldn''t find any issues. She may have had some coronary inflammation that may have been exacerbated by the vaccine but I and we will never know. Nevertheless, this was sudden and unexpected and five weeks after her second vaccine dose and it seemed appropriate to toss it in your data pile. Thanks.


VAERS ID: 1542057 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-15
Onset:2021-07-06
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Bacteraemia, Blood culture, Central venous catheterisation, Computerised tomogram, Culture urine, Death, Disease recurrence, Dyspnoea, Gait inability, Pain, Pemphigoid, Peripheral swelling, Ultrasound scan
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium supplements, vitamin D3
Current Illness: Bullous Pemphilgoid
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Admitted to hospital 7/9/21 CT scans, urine/ blood cultures, ultrasounds, Moderna 006C21A 2nd dose given at hospital 7/13/21 Central line placement 7/12/21
CDC Split Type:

Write-up: Extremely painful recurrence of bulbous phemphigoid covered most of body. 3.5 weeks after initial vaccine. Required hospitalization 3 times and admission to rehab twice. Unable to walk, difficulty breathing, swollen legs, 2nd hospital. Unable to speak or walk 3rd hosp, ended in death/ bacteremia.


VAERS ID: 1542093 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-07-14
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   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: CARDIAC ARREST


VAERS ID: 1542094 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-07-18
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESPIRATORY ARREST


VAERS ID: 1542096 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-31
Onset:2021-01-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain oedema, Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CVA WITH SEVERE CEREBRAL EDEMA


VAERS ID: 1542098 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-30
Onset:2021-01-20
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DROWNING


VAERS ID: 1542100 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-01-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PRESSUMED CARDIAC DEATH


VAERS ID: 1542102 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-31
Onset:2021-02-05
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: 1542103 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-18
Onset:2021-02-12
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EPILEPSY


VAERS ID: 1542104 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-02-13
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1542106 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-02-27
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIAC ARREST


VAERS ID: 1542107 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-03-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIOPULMONARY ARREST


VAERS ID: 1542108 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-03-28
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocardial Infarction


VAERS ID: 1542109 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-04-16
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


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: 1542837 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-04-23
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

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

Write-up: SEVERE HYPOTENSION WITH CARDIAC ARREST


VAERS ID: 1542839 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-05-01
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute coronary syndrome
SMQs:, Myocardial infarction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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:

Write-up: ACUTE CORONARY SYNDROM


VAERS ID: 1542842 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-05-04
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIAC ARREST


VAERS ID: 1542843 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-05-10
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC DEATH


VAERS ID: 1542844 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-05-13
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

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

Write-up: CARDIAC ARREST


VAERS ID: 1544928 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-05-16
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       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: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: AMI


VAERS ID: 1544932 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-05-18
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Urosepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UROSEPSIS


VAERS ID: 1544937 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-05-24
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIAC ARREST


VAERS ID: 1544941 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-25
Onset:2021-05-29
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dehydration
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 4
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: DEHYDRATION


VAERS ID: 1544943 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-22
Onset:2021-05-29
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: REFRACTORY RESPIRATORY FAILURE


VAERS ID: 1544945 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-05-31
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CVA
CDC Split Type:

Write-up: None stated.


VAERS ID: 1544951 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-28
Onset:2021-06-10
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ALTERED MENTAL STATUS


VAERS ID: 1544952 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-06-16
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RESPIRATORY FAILURE


VAERS ID: 1544953 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-06-24
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


VAERS ID: 1544962 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-27
Onset:2021-06-26
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pulse absent, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-26
   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: PULSELESS VENTRICULAR FIBRILLATION


VAERS ID: 1544965 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-06-28
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiopulmonary failure
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIOPULMONARY FAILURE


VAERS ID: 1544970 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-07-01
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       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: 2021-07-01
   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:

Write-up: AMI


VAERS ID: 1544973 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-07-03
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SEPSIS


VAERS ID: 1544977 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-09
Onset:2021-07-07
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

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

Write-up: CARDIOPULMONARY ARREST


VAERS ID: 1544982 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-25
Onset:2021-07-08
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIOPULMONARY ARREST


VAERS ID: 1544986 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-11
Onset:2021-07-09
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SUDDEN CARDIAC ARREST


VAERS ID: 1544990 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-07-10
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MYOCARDIAL INFRACTION


VAERS ID: 1544991 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-07-17
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Sepsis
SMQs:, Sepsis (narrow), Opportunistic infections (broad)

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

Write-up: SEPSIS


VAERS ID: 1545011 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-30
Onset:2021-07-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cardiac failure, Congestive cardiomyopathy, Death, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sacubitril/Valsartan 24-26mg Carvedilol 3.125 mg Valcyclovir Z Medications: Sacubitril/Valsartan 24-26mg Carvedilol 3.125 mg Valcyclovir Zoloft 50mg Adderall 20mg XR Adderall 10mg IR. PMH: 2021 depression on Zoloft, 2009 ADHD on Adderall
Current Illness: none reported
Preexisting Conditions: anxiety, depression, ADHD, LBBB w/long QT 2018, positive HPV 2015 2017, G2P1A1
Allergies: NKDA
Diagnostic Lab Data: Requested pathology draw any blood for an antineuclocapsid antibody, and MPC death 3/28/2021 1255pm: presents to, MD and PA: earlier in week c/o feverish and fatigue x1day and positive exposure. No SOB, CP, n/v/d, wheezing or weakness. VSS, Tests: negative influenza A/B Ag, negative SAR-CoV-2 Antigen. Sent home, isolate 10 d post exposure. Condition Good (found in health summaries) 7/6/2021 c/o CP with SOB and skipped heart beats prn with exertion, climbing stairs for last several months. Had elevated BNP in Jan 2021 in ER, EKG shows LBBB and LAE?.has history of prolonged QT from 2018 seen by cardiology w/echo that also had LBBB with septal wall motion abnormality. Event monitor ordered 7/6/21 and referred to cardiology. 7/23/21: cardiology eval reports 1.5 years of exertional SOB, CP at rest and sensation skipped beats. ECHO obtained today revealed Grade III Diastolic Dysfunction with an EF of 15%, and left atrial hypertrophy, severely reduced from prior ECHO in 2018. As patient is clinically euvolemic, no signs of decompensated HF, will start ARB/Neprilysin inhibitor and Beta-blocker today. Will give time to see if EF recovers, if not she qualifies for biventricular pacing with QRS at 150msec. DIAGNOSIS: NEW onset heart failure: Stage B NYHA II of undetermined etiology -Entresto 24-26mg BID, uptitrate to max dose -BMP at 2 weeks, monitor K levels -Coreg 3.125mg BID, uptitrate to max tolerable dose -Pt to go facility 7/26/2021: Seen staff: dx dilated cardiomyopathy ? had ER of 15% recently diagnosed, MD not says not vaccinated to Covid yet and was "recommended that she get vaccinated as a COVID infection could potentially cause more cardiac trouble." Labs ordered SARSCOV2 AB I8/11/2021: has no family contact information - working through agent below. No further information on where/what agency gave the Pfizer vaccine. (info found in database) AUTOPSY results not available at time of VAERS entry. Dr. did not see any evidence that this patient''s death was related to the vaccine, but it is worth submitting anyway. DO
CDC Split Type:

Write-up: Death less than 24 hr after receipt of Pfizer #1 covid vaccine: 43 yo reportedly received her first Pfizer covid vaccine on 7/2302021. Her agent received a call from Staff to inform her of this sudden death. She was reportedly found on her couch deceased on Friday evening, 30 JUL 2021 and law enforcement had her transferred to a Funeral Home pending determination on Autopsy and Family wishes. Presumed cause of death is Heart Failure with Autopsy pending for etiology of Dilated Cardiomyopathy and death. Patient had 1.5 yr hx of dyspnea on exertion, intermittent chest pain at rest, and palpitations. She was evaluated here for a LBBB and long QT in 2018. Echo at the time was normal and she was cleared. BP: 118/72; HR: 71; RR: 16; T: 98.6 ?F (37 ?C); HT: 66 in (167.64 cm); WT: 155 lbs (70.31 kg); SpO2: 98%; BMI: 25.02; BSA: 1.795 square meters; Tobacco Use: Yes; What type of tobacco product?: menthol; Amount of tobacco product used per day: 2 per day;


VAERS ID: 1545170 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-08-06
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

Administered by: Public       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: 2021-08-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine #1 Moderna 02/04/2021 lot # 029K20A Pt died of cardiac arrest on 08/06/2021


VAERS ID: 1545175 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-22
Onset:2021-08-10
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS A COVID-19 BREAKTHROUGH CASE THAT EXPIRED ON 8/10/2021. NEARLY 5 MONTHS AFTER COMPLETING SERIES. HEALTH DEPARTMENT WAS NOT THE VACCINATING FACILITY BUT WE ARE THE REPORTING FACILITY.


VAERS ID: 1545180 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-08-09
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   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: Pt on hospice
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose #1 Moderna 01/25/2021 lot # 029K20A Pt died in hospice care on 8/9/2021


VAERS ID: 1545276 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-06
Onset:2021-08-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Decreased appetite
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: Acetaminophen, Aricept, Megestrol Acetate Suspension, Mirtazaine, Multivitamin-Mineral tab, Namenda, Polyethylene Glycol, Prostat Liquid
Current Illness: PROTEIN-CALORIE MALNUTRITION, DEMENTIA, HYPERTENSION
Preexisting Conditions: HYPERTENSION, DEMENTIA
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident noted with loss of appetite on 8/8/21 and resident expired on 8/10/21


VAERS ID: 1545319 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-08-02
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

Administered by: Unknown       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: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose #1 03/07/2021 Moderna lot # 032M20A Pt died of cardiac arrest 8/2/2021


VAERS ID: 1545487 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-05
Onset:2021-07-27
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Blood gases, COVID-19, Chest X-ray, Chest pain, Condition aggravated, Cough, Death, Dyspnoea, Emphysema, Endotracheal intubation, Epistaxis, Fatigue, Hyperglycaemia, Hypogeusia, Hypoxia, Infection, Insomnia, Laboratory test, Mechanical ventilation, Muscle spasms, Nasal dryness, Oxygen saturation decreased, Pyrexia, Refusal of treatment by patient, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amitriptyline (ELAVIL) 10 MG Oral Tablet Take 3 tablets by mouth nightly at bedtime. 9/23/20 amLODIPine (NORVASC) 10 MG Oral Tablet TAKE 1 TABLET BY MOUTH EVERY DAY 9/24/20 aspirin 81 MG Tablet Delayed Release Take by mouth daily.
Current Illness:
Preexisting Conditions: No date: Actinic keratosis No date: Angiopathy No date: Basal cell carcinoma No date: Cancer (CMS-HCC: 12) No date: Chronic renal disease, stage III No date: Coronary heart disease No date: Dermatitis No date: Diabetes mellitus Comment: Type 2 No date: Elevated transaminase level No date: Fatty liver No date: GERD (gastroesophageal reflux disease) No date: Hyperlipidemia No date: Hypertension No date: Insomnia No date: OSA on CPAP No date: Peripheral polyneuropathy No date: Psoriasis No date: Restless leg No date: Sleep apnea No date: Squamous cell carcinoma of skin No date: Thyroid disease Comment: Hypothyroidism No date: Vitamin D deficiency
Allergies: ? Kenalog [Triamcinolone] - Rash Only ointment he has severe reaction too. ? Latex - Rash
Diagnostic Lab Data: (COVID-19), NAA FLU-RSV-SARS NAAT Collected: 07/26/21 1151 - confirmed positive CORONAVIRUS (COVID-19), NAA Collected: 07/27/21 2235 - confirmed positive
CDC Split Type:

Write-up: Patient was hospitalized due to breakthrough covid-19 infection on 7/27/21 with complaints of shortness of breath, nonproductive cough, daily fevers, decrease taste, chest pain when coughing, and fatigued. Patient completed the Pfizer vaccine series in February. Patients condition worsened over hospital course and he was pronounced deceased on 8/09/21 @21:55. Below information is copied from progress note on 8/08/21: 7/30/21: Patient has had no new issues overnight. He remains on HFNC + NRB 80L/100% maximum support, refusing bipap. Educated on importance of utilizing bipap, still refusing. Sats remain mid 80s. 8/1: No acute events overnight. Tol slow wean of HFNC. Bipap overnight. Hemodynamically stable. 8/2: No acute events overnight. On FFB overnight 85% 12/8. Was reportedly in chair most of the day yesterday on HFNC 70%/70l with stable sats. Hemodynamically stable. No fevers. 8/3:Patient sitting up in chair , on HFNC, nostrils bloody and with dry mucus. Requesting to be placed on regular diet with no restrictions. Uneventful night. 8/4: Sats upon intial exam this AM by this provider were 77%. Pt had just transferred bed to chair with HFNC and NRB. Sats slow to recover but with NRB, slowly improved to 89%. Pt states that he slept poorly last night and this AM upon getting up had trouble with severe left thigh cramp. Was given Robaxin, pain med, warm pack to thigh and is better now. Added Melatonin to HS meds prn to help with sleep. Additional aspart given for hyperglycemia. 8/5: no events overnight. Patient remained on BIPAP with no issues. 8/6: Pt required BIPAP d/t decreasing O2 sats to low 80s on HFNC. 8/7: Intubated last night for hypoxemia refractory to FFB 100%. Currently stable sats on APRN 100%, PH 30. Sub cut emphysema to neck. AM CXR, ABG, and labs pending. TF ordered. Wife notified of intubation- she was diagnosed with covid at same time as husband. She will contact her son who has been fully immunized and no current covid s/s. 8/8: patient remained intubated and sedated on ventilator overnight. APRV PH 24, 95% fiO2


VAERS ID: 1545589 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-06
Onset:2021-07-28
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown. Medication on hospital admission. pravastatin 0.5 tab Daily pantoprazole 40 mg Daily Singulair 10mg Q PM losartan -hydrochlorothiazide 100 mg-12.5 mg Daily ropinirole 0.5 mg Daily Metoprolol 50 mg ext release Daily Cardizem 120 mg
Current Illness: Unknown
Preexisting Conditions: History of: A-Fib, Breast cancer, C-Diff, Colitis, Depression, GERD, Irritable Bowel Syndrome, Restless Leg Syndrome, Sleep Apnea, HTN, CHF, Pacemaker
Allergies: Bee stings, morphine, Opiates
Diagnostic Lab Data: Positive Covid19SARS2RTPCR on 7/25/21. Chest x-ray on admission indicated possible CHF or bilateral Pneumonia.
CDC Split Type:

Write-up: Pt admitted to hospital on 7/25/21 with shortness of breath, which turned out to be positive for Covid-19. Pulmonology was consulted and patient was started on dexamethasone, remdesivir, baricitinib, as well as Tocilizumab. Started on vapotherm O2 with Fi02 of 100 %. Despite aggressive measures patient condition deteriorated. Family made patient a do not resuscitate, and patient expired on 7/28/21.


VAERS ID: 1545621 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-02-17
Onset:2021-02-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Condition aggravated, Confusional state, Death, Headache, Laboratory test
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin also known as Warfarin- anticoagulant - the doctor was concerned about this medication with possible adverse events with the vaccine
Current Illness: no
Preexisting Conditions: He had a stroke about 3 or 4 years previously and still had residual effects from the stroke, including aphasia.
Allergies: no
Diagnostic Lab Data: Per his daughter he had lots of labs and medical test done.
CDC Split Type: vsafe

Write-up: The day after the vaccination, 02/18/2021, He was having headaches and confusion and it got worse over the weekend. On 02/21/2021 he went to the ER and was told he had bleeding in his brain. They stopped Coumadin and the bleeding stopped. He was in the hospital in town for less than a week and was transferred to Nursing and Rehab . On 03/12/2021- he had a major stroke and he went back to the hospital and came home for hospice, and died on 03/20/2021.


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: 1546116 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-17
Onset:2021-03-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 69
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trospium 20mg Simvastatin 10mg Lisinopril 5mg Kyolic Calcium
Current Illness: No
Preexisting Conditions: Anemia Low weight
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Continuous Weakness until death


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: 1548292 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Diarrhoea, Nausea, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (had COVID in December 2020.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed away; Arm hurt bad; She could barely eat/drink; She could barely do anything; Diarrhea; Nausea; Vomiting; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Passed away) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 (had COVID in December 2020.) in December 2020. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Jan-2021, the patient experienced PAIN IN EXTREMITY (Arm hurt bad), DECREASED APPETITE (She could barely eat/drink), ASTHENIA (She could barely do anything), DIARRHOEA (Diarrhea), NAUSEA (Nausea) and VOMITING (Vomiting). On 24-Jan-2021, PAIN IN EXTREMITY (Arm hurt bad), DECREASED APPETITE (She could barely eat/drink), ASTHENIA (She could barely do anything), DIARRHOEA (Diarrhea), NAUSEA (Nausea) and VOMITING (Vomiting) had resolved. The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications were not reported. Treatment information was not reported. Most recent FOLLOW-UP information incorporated above includes: On 06-Aug-2021: Death event added.; Sender''s Comments: This case refers to a 73-year-old female patient with a history of COVID-19 infection one month prior to receiving mRNA-1273 who died after unknown duration after the vaccination. Based on the current available information and temporal association between the use of the product mRNA-1273 and the remaining events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1548970 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-20
Onset:2021-01-28
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Malaise, Sudden death, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   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: Crestor, Prolia, Aspirin, Levothyroxine
Current Illness:
Preexisting Conditions: Thoracic artery aneurysm, hyperparathyroidism, hypothyroidism, mild cognitive impairment
Allergies: PCN, Sulfa, Terbinafine
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was not feeling well - vomiting, chest and upper back pain for a few hours prior to visit. Died suddenly while workup in progress


VAERS ID: 1548975 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-08-09
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

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: 2021-08-09
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated, covid-19 death


VAERS ID: 1548984 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-23
Onset:2021-08-07
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data: 8/7/2021 COVID-19SRSCoV2 RT-PCR LIAT: Detected
CDC Split Type:

Write-up: Patient was hospitalized with due to COVID-19 after being fulling vaccinated. Patient expired on 8/10/2021


VAERS ID: 1549018 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-08-01
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Hypoxia, Lethargy, Mental status changes, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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: 2021-08-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor, citalopram, Lasix, glimepiride, Januvia
Current Illness:
Preexisting Conditions: CKD, hypertension, DM, dementia
Allergies: NKDA
Diagnostic Lab Data: Tested positive for COVID-19 on 7/28/2021 at facility.
CDC Split Type:

Write-up: Admit 8/1/2021 From facility. tested positive for COVID 7/28/2021 at facility. Day of admit 02 sat 81% and facility called daughter to notify pt. was going to be taken to the ER. For EMS patient''s oxygen dropped as low as 57% and patient was lethargic, and patient arrives to the ER non-rebreather. On my examination patient is oriented x1 and further history is limited due to altered mental status. The onset was 4 days ago. The course/duration of symptoms is worsening. The character of symptoms is COVID 19, hypoxia. Transferred to hospice 8/2/2021 and expired 8/4/2021.


VAERS ID: 1549046 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-07-24
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Death, Endotracheal intubation, General physical health deterioration, Mechanical ventilation, Muscular weakness, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, Ultram, Zyloprim, Amitriptyline, Vit D, ferrous sulfa, Prozac, Prinivil, multivitamin, naprosyn, Vit B
Current Illness: unknown
Preexisting Conditions: DM, HTN, OSA, morbid obesity, hypothyroidism
Allergies: no known allergies
Diagnostic Lab Data: SARS COV2 COVID PCR 07/24/2021
CDC Split Type:

Write-up: Admitted 07/24/07/27 for weakness in legs, found to have O2 sat of 50% on room air. COVID test positive on 7/24 and pt diagnosed with acute hypoxemic respiratory failure due to COVID-19 . She was also found to be in acute renal failure. Pt was intubated, placed on vent and started on CRRT. She received Moderna vaccine, 2nd dose on May 15, 2021. On admission, pt denied any shortness of breath, body aches, headache, fever or chills. Patient condition deteriorated. was made comfort care on 7/27 and expired 7/27/21.


VAERS ID: 1549114 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-02-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA/039K20A / UNK RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral thrombosis, Cerebrovascular accident, Dizziness, Fatigue, Illness, Ischaemic stroke, Pain, Vision blurred
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 107
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 101 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: None
Allergies: Penicillin Aspirin Tylenol
Diagnostic Lab Data: Hospital has this information
CDC Split Type:

Write-up: After the shot, sick, tired, aches and pains for two - three days. Day 3 - 5 Dizziness, blurred vision. Day 5 went to the hospital, ER found sign of stroke. Day 7 saw a neurologist, was told that a stroke occurred, but was not sure if it was new or old. Day 12, massive Ischemic Stroke followed by multiple hemorrhages. The Clot left a 10mm hole in the left side of the brain.


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: 1549185 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-20
Onset:2021-08-09
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 RA / SYR

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

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

Write-up: FULLY VACCINTED CASE DECEASED 8/9/21


VAERS ID: 1549208 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-28
Onset:2021-02-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Death, Echocardiogram abnormal, Ejection fraction decreased, Left ventricular failure, Myocardial infarction, Troponin I increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 188
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaZOLAMIDE , Aspirin, Azopt 1 % Ophthalmic Suspension, Cent
Current Illness:
Preexisting Conditions: Diabetes mellitus type II Hypertension Hyperlipidemia CKD stage II/III Nephrolithiasis Hypothyroidism Erectile dysfunc
Allergies: Iopidine, Betimol, Pilocarpine, Timilol; Timolol-Brimon-Dorzol
Diagnostic Lab Data: Troponin I of 0.77 on 2/10/2021 (roughly 8 days after symptoms started); echocardiogram on 2/11/2021 with an ejection fraction of 20-25%
CDC Split Type:

Write-up: The patient suffered a myocardial infarction complicated by systolic heart failure and, over the course of 6 months led to cardiac arrest and death.


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