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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 61 out of 154

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VAERS ID: 1549226 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-22
Onset:2021-05-17
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest X-ray abnormal, Chills, Cough, Death, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Fatigue, Headache, Nausea, Pneumonia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, HTN, Cardiovascular disease
Allergies: Unknown
Diagnostic Lab Data: Abnormal CXR - diagnosis of pneumonia Abnormal EKG - unknown etiology
CDC Split Type:

Write-up: Death - Symptom onset date 04/24/21 to include chills, loss of taste/smell, headache, fatigue, cough, SOB, nausea, vomiting and diarrhea.


VAERS ID: 1549276 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-12
Onset:2021-02-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Death, Decreased appetite, Fatigue, Mobility decreased, Sepsis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was extreme tire from the moment that she got home after the vaccine. no appetite to eat. I have to help her get up from bed. We call the doctor twice. We thought the doctor know the answer. The doctor said it is normal. As the days pass by, the condition got worse. She ate less and less. One the fourth day evening, she kept on calling my name. That was unusual. She probably not feeling well. One the fifth day morning, She seems very confused. That same morning. We call ambulance to take her to hospital. Two day later, she passed away. Doctors said it is blood inflection.


VAERS ID: 1549402 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-03-03
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 160
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was seen in the ED and hospitalized multiple times after second dose of vaccine, tested positive for COVID on 2/22/2021. Patient passed away on 8/11/2021


VAERS ID: 1549423 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-27
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 - / -

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

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

Write-up: Patient death within 60 days of receiving a COVID vaccine


VAERS ID: 1549424 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 169
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: Shingles
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clot to heart death


VAERS ID: 1549429 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-16
Onset:2021-07-20
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Death, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization and death COVID-19 PNEUMONIA, ACUTE KIDNEY INJURY, HYPOXIC RESPIRATORY


VAERS ID: 1549456 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-29
Onset:2021-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized multiple times and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1549498 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-08-06
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, COVID-19, Death, Hypotension, Lethargy, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to acute inpatient hospital from Rehab for new diagnosis COVID-19 with lethargy without hypoxia on 8/6/21. Patient had a sudden event with bradycardia hypotension suspected MI. Patient was DNR DNI. Patient expired 8/9/21


VAERS ID: 1549500 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-27
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized multiple times and died within 60 days of receiving a COVID vaccine series


VAERS ID: 1549543 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-01-15
Onset:2021-04-23
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20 / 1 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Infection, 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: 2021-05-16
   Days after onset: 23
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: Acetaminophen, artificial tears, Dulcolax, Peridex mouthwash, Insulin, Versed, Afrin
Current Illness:
Preexisting Conditions: Rheumatoid arthritis, early stage renal cell cancer, history of prostate cancer, hypertension, dyslipidemia, GERD, fatty liver, hashimoto''s hyperthyroidism
Allergies: Lactulose, infliximab
Diagnostic Lab Data: (+) PCR on 04/23/2021
CDC Split Type:

Write-up: Breakthrough Covid.


VAERS ID: 1549564 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-07-16
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Oxygen saturation decreased, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: chronic kidney and cardiac disease, hypertension, on immunosuppressive therapy for Myelofibrosis
Allergies: UNK
Diagnostic Lab Data: COVID-19 PCR positive 7/16/2021
CDC Split Type:

Write-up: Week, wheezing, cough. low O2 saturations admitted to the hospital where he later died


VAERS ID: 1549612 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-07-29
Onset:2021-07-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

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

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: None on record
Current Illness: Unknown
Preexisting Conditions: DM HTN
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dealth


VAERS ID: 1549649 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-02
Onset:2021-02-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / N/A UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Death, General physical health deterioration, 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: 188
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: COPD, Leukemia, Obstructive sleep apnea, GERD
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident tested positive for COVID-19, on 8/9/2021. He declined quickly and passed away on 8/10/2021.


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

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

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

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


VAERS ID: 1550084 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210818401

Write-up: DEATH; BLOOD CLOTS; This spontaneous report received from a consumer via social media concerned multiple patients (6 or 7) with unspecified race and ethnicity. The patient''s weight, height, and medical history were not reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients experienced blood clots and died from unknown cause of death. It was unspecified if was an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of blood clots was not reported. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to 20210818227, 20210818107, 20210817805 and 20210818021.; Sender''s Comments: V0: 20210818401 -covid-19 vaccine ad26.cov2.s- death, Blood clots. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1553645 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-10
Onset:2021-08-10
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute chest syndrome, Blood creatinine increased, Blood lactic acid increased, Blood potassium decreased, Bradycardia, Bronchoscopy abnormal, COVID-19, Cardio-respiratory arrest, Chest X-ray abnormal, Coma scale abnormal, Computerised tomogram head normal, Death, Endotracheal intubation, General physical health deterioration, Haemoglobin decreased, Heart rate decreased, Hypertriglyceridaemia, Mental status changes, Occult blood positive, Oxygen saturation decreased, Pneumonia staphylococcal, Pulmonary oedema, Pulse absent, Respiratory failure, Resuscitation, SARS-CoV-2 test positive, Sickle cell anaemia with crisis, Sputum culture positive, Transfusion, Unresponsive to stimuli, Vaginal haemorrhage, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Dyslipidaemia (narrow), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient is a 36 y.o. female with a past medical history notable for Hemolytic anemia on Rituxin monthly, Follows with Dr., chronic pain, depression, hypertension, migraines, sickle cell disorder, and thyroid disease who presents as a transfer from ER due to sickle cell crisis. Patient presented to ER with AMS, family reported finding patient unresponsive at home this am. Per record GCS was 5-7 when EMS arrived. Her sats were in the 60s. Patient was found to have a fentanyl patch which she is prescribed. She did not appear to be improving. She was subsequently intubated. She was somewhat difficult to oxygenate. Bronchoscopy showed copious edema bilaterally. Chest x-ray showed diffuse pulmonary edema. Her hemoglobin was found to be 4.9. She was noted to have some vaginal bleeding. Occult blood testing was positive. Per report patient''s pulse bradied down into the 30s. It was unclear if she had a pulse so CPR was started. She quickly regained ROSC. Her heart rate improved to the 90s. She was given 1 unit of blood, started on propofol and epinephrine. Creatinine was 1.2. Potassium was 3.2, and it was replaced. WBC 10,Initial head CT scan was nondiagnostic due to limited patient cooperation. Repeat CT head was negative for acute abnormality. Patient was started on cefepime. She was transferred here for higher level of care. She is subsequently being transferred to another facility for further evaluation. On arrival here patient is intubated, sedated on propofol, in no distress. Vital signs stable. Patient tested positive for COVID-19. Started on Decadron and remdesivir. Critical care consulted. Has developed hypertriglyceridemia. Additionally, sputum culture growing MSSA consistent with superimposed MSSA pneumonia. Patient on cefepime. Patient had general worsening of her condition with worsening respiratory issues. On the night of 810, patient coded multiple times. Family visually made the decision to make patient DNR. Hemoglobin dropped consistent with acute chest syndrome. Lactic acid was greater than 18. Patient coded 1 more time and expired early this morning.


VAERS ID: 1553728 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-15
Onset:2021-06-15
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Congestive cardiomyopathy, Death
SMQs:, Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   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: Tylenol and Ibuprofen
Current Illness: No
Preexisting Conditions: No
Allergies: Allergic to peas
Diagnostic Lab Data: Autopsy done after death.
CDC Split Type:

Write-up: There were no signs or symptoms. Patient received his last Covid19 vaccine on 5/13/21. He passed away on 06/15/2021. The diagnosis on the autopsy report shows that he died from Dilated Cardiomyopathy. There was no evidence of trauma and a clean toxicity report. He has no previous diagnosed health problems.


VAERS ID: 1553784 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-12
Onset:2021-08-02
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-08-13
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: Acute respiratory distress syndrome, Endotracheal intubation, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: patients family has said patient was not truthful about getting vaccinated, patient reported vaccination on admit
Preexisting Conditions: bilat pneumonia, chronic heart failure, a fib multivessel arterial disease
Allergies: none
Diagnostic Lab Data: respiratory support for ards, intubation, respiratory failure.
CDC Split Type:

Write-up: possible breakthrough case on 8/2 if patient indeed was fully vaccinated last April


VAERS ID: 1553959 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-05
Onset:2021-03-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 159
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Arthritis, Tachycardia
Allergies: Cipro, Fentanyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital on 7/23/2021. Intubated on 8/1. Expired 8/12


VAERS ID: 1553967 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-04-19
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 94
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: chronic lung disease, Sjogren''s disease, high blood pressure
Allergies: unk
Diagnostic Lab Data: Positive COVID-19 PCR 4/21/2021
CDC Split Type:

Write-up: experienced dyspnea, diarrhea, nausea, vomiting Associated with a long term care facility


VAERS ID: 1554013 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-18
Onset:2021-08-09
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 - / -

Administered by: Unknown       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: Patient died on August 9, 2021.


VAERS ID: 1554115 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-08-13
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249, EL9269 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Pulseless electrical activity
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), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   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: Anxiety, Arthritis, Cancer (squamous cell carcinoma forehead), HTN, Kidney stones, non Hodgkin''s Lymphoma, post-polio syndrome, stage 3 severe COPD,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse entered room patient was in PEA CODE BLUE called and patient expired on 8/13/2021


VAERS ID: 1554249 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-28
Onset:2021-08-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Syncope, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: moderna vaccine
Current Illness: no known illnesses
Preexisting Conditions: no known medical conditions
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clot resulted in a stroke; was leaving a checkup with the doctor when she collapsed. August 3rd 4:30pm; passed away 7 hours later at 11:30pm.


VAERS ID: 1554322 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-27
Onset:2021-08-02
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 8
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: Case was vaccinated with covid vaccine on 5/6/21 & 5/27/21. Was admitted to Medical Center on 8/2/2021 with chest pain and shortness of breath. Tested positive for COVID 19. Case expired at Medical Center on 8/10/21.


VAERS ID: 1554378 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-10
Onset:2021-08-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: death 8/13 @12:09
Other Medications: no know home meds
Current Illness: pts live in girlfriend was dx with covid 19 on 8/3 per contact tracer documented that pt was experiencing mild sx at time of intial tracing.
Preexisting Conditions:
Allergies: Fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1554434 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-25
Onset:2021-07-24
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, Asthma, Benign prostatic hyperplasia, COVID-19, COVID-19 pneumonia, Cardiac arrest, Cardio-respiratory arrest, Computerised tomogram head normal, Condition aggravated, Confusional state, Death, Decreased appetite, Dehydration, Delirium, Dementia, Dyspnoea, Endotracheal intubation, Heart sounds abnormal, Infection, Intensive care, Magnetic resonance imaging normal, Mental status changes, Psychotic disorder, Pulse absent, Resuscitation, Rhonchi, SARS-CoV-2 test positive, Schizoaffective disorder bipolar type, Sepsis, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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 (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROAIR HFA;VENTOLIN HFA) 108 (90 BASE) MCG/ACT inhaler Inhale 1-2 puffs every 4 to 6 hours as needed. Information, Historical amLODIPine (NORVASC) 10 MG Oral Tablet Take 1 tablet by mouth daily. 4/28/20 ARIPiprazole (AB
Current Illness:
Preexisting Conditions: Anemia ? Asthma ? Dementia ? Diabetes mellitus ? Glaucoma ? Hypertension ? Schizophrenia
Allergies: Lisinopril
Diagnostic Lab Data: SARS-COV-2, NAA, Detected 07/25/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received the Pfizer vaccine (2nd dose in series) on 03/25/2021. Hospitalized from 07/24/21 - 08/13/21 (death). Below is copied from his discharge (death) summary: Cause of Death Cardiac arrest Acute respiratory failure Discharge Condition: Expired Hospital Course: 87 y.o. male admitted on 7/24/2021 for evaluation of generalized weakness for the past day, loss of appetite, increased dyspnea. In the ED with diffuse rhonchi. Sats 88% on room air. Started on 5 L NC. Work up with COVID. Also AKI. Started on abx and steroid AMS and confusion Acute hypoxic respiratory failure on nasal cannula. COVID pneumonia, present on admission. Asthma exacerbation improved. Sepsis, now resolved, secondary to COVID. Acute kidney injury likely prerenal dehydration, resolved. Hypertension well controlled. Benign prostatic hypertrophy. Bipolar/schizophrenia. Delirium ? Psychosis vs dementia, improved. SI s/p mental health act 08/04. Patient had a very long hospitalization on the floor and in the ICU Treated with IV abx, IVF and all COVID treatment He was on HF but improved at some point and placed on RA then got worse again so abx restarted and speech reevaluated During the admission his mental status didn''t improve and he was on restraints to avoid self-harm Psych, neuro and pulm followed during the admission CTH no acute findings as well as MRI . Druing my round today around 11.15-11.20a found the patient to be unresponsive when I stepped in his room. Pulse ox wasn''t on his finger tried to place it but didn''t work so called RN but we couldn''t appreciate any pulse that time so we called code blue . Patient still unresponsive and very faint heart sounds on exam with no significant pulse . Code staff/ICU team responded. Compressions , respiratory support , epi given as well trial of intubation since the pateint still listed as FULL code, but unfortunately didn''t tolerate it and expired around 1138am Discussed in details with the staff Also called and discussed with his Care giver and empathy provided Patient has no family around and his care giver knows him and takes care of him for 20 years


VAERS ID: 1554435 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-06
Onset:2021-08-12
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acquired oesophageal web, Anticoagulant therapy, Bilevel positive airway pressure, Colonoscopy abnormal, Death, Dyspnoea, Endotracheal intubation, Fatigue, Gait disturbance, Gastritis, Haematochezia, Haemorrhoids, Intensive care, Mental status changes, Oesophagogastroduodenoscopy abnormal, Oxygen saturation decreased, Respiratory symptom, Supportive care
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Divalproex sodium, amlodipine, topiramate, thyroid desiccated, pantoprazole, hydrochlorothiazide-triamterene, gabapentin, tofacinitib, cevimeline, irbesartan, methocarbamol, metformin, gemfibrozil, rosuvastatin, celecoxib, trazodone
Current Illness: None that are known
Preexisting Conditions: HTN, HLD, DM2, Rheumatoid arthritis, chronic back pain, carotid disease status post left CEA, hypothyroidism
Allergies: Ciprofloxacin, doxycycline, penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose 1 and 2 of COVID vaccine on 2/6/21 and 2/27/21, respectively. On 8/4/21 the patient presented from home after progressive upper respiratory symptoms that began on 7/28/21. She states that about a week prior to admission she started having some generalized fatigue with progressively worsening shortness of breath to the point where it is difficult for her to ambulate. She checked her oxygen levels at home and they were low hence she presented to the ED today for further evaluation. On arrival she was found to be 82% on room air oxygen saturation. She had no recent nausea, vomiting or diarrhea. She stated that she has been occasionally seeing blood in her stools. She had an EGD April 2021 which showed some gastritis and Schatzki''s ring. She also stated that she had a colonoscopy 2 weeks prior to admission which according to the patient showed some hemorrhoids. Patient was started on remdesivir, Lovenox for prophylaxis of DVT, continued home blood pressure medications, as well as vitamins. Her inflammatory markers were trended. Since oxygen saturation deteriorated rapidly, patient was upgraded and was placed on Vapotherm 40 L 100% with as needed BiPAP. Patient was continued on IV steroids and remdesivir. Patient continued to decompensate while on Vapotherm, patient was requiring continuous BiPAP for several days and was unable to be weaned off of it. Patient''s mental status deteriorated as well. All attempts were made to reach family but had difficulty, supportive care medicine was involved as well. Her mentation began to further deteriorate and patient began to desaturate on BiPAP, necessitating intubation as per family''s wishes. Further goals of care discussion guarded family patient was made DNR. Patient''s family members came to hospital to see her, noted her again deconditioning discussed poor prognosis. Patient is then made comfort care as per family. Patient expired on 8/13/2021 at 4:18 AM.


VAERS ID: 1554444 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-04-20
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, Fatigue, Headache, Pneumonia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: 2021-06-26
   Days after onset: 67
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Lung CA
Preexisting Conditions: Obesity
Allergies: UNK
Diagnostic Lab Data: COVID-19 PCR positive 4/28/2021
CDC Split Type:

Write-up: Cough, dyspnea, fatigue, headache, pneumonia, chest pain and wheezing


VAERS ID: 1554791 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-03-18
Onset:2021-05-28
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Blood test, Cough, Death, Dyspnoea, Hypoxia, Pneumonia, Pneumonitis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 8
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: Synthroid Norvasc Metoprolol Omeprazole Keytruda Mirtazepine Benadryl Loratadine Metamucil
Current Illness: Metastatic melanoma (substantially improving)
Preexisting Conditions: Hypothyroidism Hypertension Acid reflux
Allergies:
Diagnostic Lab Data: Pulse oximeter 55, between May 31 - June 5th Blood work done at hospital, results unknown Hospital unable to perform CT scan of lungs due to inability of patient to lie flat for scan due to hypoxia
CDC Split Type:

Write-up: Pneumonia or Pneumonitis Weakness Severe hypoxia Cough Atrial fibrillation Dyspnea Death Progressed from ambulatory to death in 8 days


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

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

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

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


VAERS ID: 1558119 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-23
Onset:2021-07-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Other       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: 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: Postive COVID-19 test
CDC Split Type:

Write-up: Patient got diagnosed with COVID-19 within 24 hours of receiving first dose and was admitted to the hopistal and died on 08/11/2021


VAERS ID: 1558329 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-07-20
Onset:2021-08-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG tablet aspirin 325 MG tablet Fexofenadine HCl (ALLEGRA PO) fluticasone (FLONASE) 50 MCG/ACT nasal spray IBUPROFEN PO metoprolol (TOPROL-XL) 50 MG 24 hr tablet Omega-3 Fatty Acids (FISH OIL PO)
Current Illness: Digestive Laryngopharyngeal reflux (LPR) Respiratory Chronic sinusitis
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was found dead in the yard of his residence. He laid in the yard for a couple of days before he was discovered. No further information was provided by the family. His wife lives with him in the home; however, she is disabled and unable to provide any information.


VAERS ID: 1558346 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-07-16
Onset:2021-07-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Death, Fatigue
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: None performed
CDC Split Type:

Write-up: Was very tired and wanted to stay in bed from short time after receiving the vaccine. Experienced some chest pain. Was found deceased in house at night 14 days later.


VAERS ID: 1558466 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arterial occlusive disease, Autopsy, Death, Fatigue
SMQs:, Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluphenazine, Trihexyphenidyl, Duloxetine, Amlodipine
Current Illness: None
Preexisting Conditions: Schizophrenia, high blood pressure, high cholesterol
Allergies: None
Diagnostic Lab Data: Medical examination by medical examiners
CDC Split Type:

Write-up: Felt fatigued the day before adverse event, died in his sleep of arterial occlusion


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

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

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

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


VAERS ID: 1569053 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-03
Onset:2021-08-10
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Agitation, Asthenia, Atrial fibrillation, Back pain, Blood magnesium decreased, Blood phosphorus decreased, Blood potassium decreased, COVID-19, COVID-19 pneumonia, Cardiac arrest, Condition aggravated, Culture urine positive, Death, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Fall, Fatigue, Hypotension, Implantable defibrillator insertion, Infection, Infusion, Intensive care, Left atrial dilatation, Oxygen saturation decreased, Pain, Right ventricular enlargement, SARS-CoV-2 test positive, Staphylococcal infection, Tachypnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   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: apixaban (ELIQUIS) 5 MG aspirin 81 MG Tablet l atorvastatin (LIPITOR) 80 MG Tablet fentaNYL (DURAGESIC) 100 MCG/HR fluticasone (FLONASE) 50 MCG/ACT Suspension losartan-hydroCHLOROthiazide (HYZAAR) 100-12.5 MG Ta
Current Illness:
Preexisting Conditions: Abdominal hernia Chronic constipation Colon polyp GERD (gastroesophageal reflux disease) Heart attack Hyperlipidemia Hypertension
Allergies: Penicillins
Diagnostic Lab Data: SARS-COV-2, NAA, Detected on 08/10/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received the Pfizer vaccine (2nd dose in series) on 03/03/21. Hospitalized from 08/10/21 - 08/14/21 (death). Below is copied from patients discharge (death) summary: Hospital Course: Patient is an 84 year old man with a past medical history of Afib (on eliquis, metoprolol), HTN, HLD, MI admitted to the ICU for acute hypoxemic respiratory failure secondary to Covid-19 pneumonia. He presented to the ED after EMS was called for fall out of bed with generalized weakness, he denies hitting his head or LOC. He was satting 78% on EMS arrival and tachypneic, he had minimal improvement with NRB. In the ED he was found to be in Afib RVR to the 160s with hypotension, levophed was begun, he was cardioverted, and was begun on amiodarone infusion. The patient reports a 1 week history of generalized fatigue and shortness of breath without leg swelling or orthopnea. He was vaccinated in March with the Pfizer vaccine. He reports his cardiologist is at another facility and doesn''t remember his medications offhand but knows he takes Eliquis BID. 8/11: TTE ordered, not yet performed. K+, Mg, phos low and repleted. On HFNC + NRB 60L/92% satting high 80s/low 90s. Currently on amio drip. No other acute events. 8/12 Patient elected to be DNR/DNI yesterday. Urine culture growing $g100K Staph, started on Vanc/Cefepime while waiting sensitivity. Amio gtt changed to metoprolol. Patient endorsing soreness/back pain and states he uses Percocet and fentanyl patch outpatient. On HFNC + NRB 60L/95%, satting high 80s/low 90s past 24 hours. Echo performed shows EF 50-55%, impaired relaxation, moderately enlarged RV, moderately dilated LA, PASP 45 mm Hg. 8/13: Patient elected to rescind DNR/DNI 1 day ago. Became acutely agitated throughout the night and was removing HFNC stating that he "did not want to do this anymore". Started on precedex gtt and haldol prn for agitation. Pt w/ improved compliance w/ HFNC and able to maintain O2 saturation between 87-89%. 8/14: Patient now DNR/DNI, daughter at bedside while patient''s wife was again admitted to the hospital. Decision made to pursue compassionate wean. Started on Morphine infusion for comfort and to prevent air hunger. O2 saturation continually downtrending. Asystole at 1803, confirmed in 2 leads. No signs of life. Pronounced expired at 1803. Dr notified at 1806.


VAERS ID: 1570787 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-04
Onset:2021-03-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Completed suicide, Confusional state, Depressed mood, Depression, Fatigue, Hormone level abnormal, Overdose, Weight decreased
SMQs:, Suicide/self-injury (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug abuse and dependence (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (narrow), Medication errors (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-06
   Days after onset: 126
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol 50mg- lisinopril 10mg- simvastatin 20mg- zetia 10mg -ibuprofen 800mg (daily)
Current Illness:
Preexisting Conditions: hypertension - High cholesterol leg pain
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very healthy 70yr old man who sees his doctor regularly became tired, confused, depressed and lost weight suddenly. March and April tried to shake it off and thought he was just feeling his age. In May he went to his doctor who treated him for depression. He took an overdose of his anti depressant medication and was hospitalized (5/29/2021) Went to medical Center for treatment. They said he was on wrong anti depressant and changed his medication to Lexapro 5mg. On 7/6/2021 he committed suicide. He was being treated for a chemical imbalance. He did not have a chemical imbalance before the vaccine. He has had the same doctor for 10yrs. and has been on the same medications. No reason for depression. Best time of his life. I can not rule out or prove the vaccine played a major part in his death.


VAERS ID: 1573848 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-13
Onset:2021-08-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Internal haemorrhage, Oral discharge
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Collapsed esophagus.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Internal bleeding, purplish fluid began to ooze from her mouth on.


VAERS ID: 1573968 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Decreased appetite, Fatigue, Headache, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fatigue
Other Medications: Medication for Diabetes, High blood pressure, mental health
Current Illness: Diabetes, high blood pressure
Preexisting Conditions: Diabetes, high blood pressure, mental health
Allergies: n/a
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: My mother experienced fatigue, headache, arm pain, nausea, loss of appetite and passed away two days after second dose of Covid-19 Pfizer vaccine. *Please note: Hospital has patient listed with a 7/4/1945 birth date which was incorrect and never corrected. Birth certificate shows 7/5/1945 as correct date of birth.


VAERS ID: 1573981 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-04
Onset:2021-08-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: Unkown
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient has 1st dose of Pfizer vaccine documented on 8/4/2021. Per hospital notes, pateint recevied dose and has been short of breath since.


VAERS ID: 1573992 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-16
Onset:2021-04-28
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 80777-0273-99 / UNK UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Heart disease
Allergies: None
Diagnostic Lab Data: Awaiting death certificate
CDC Split Type:

Write-up: Death


VAERS ID: 1574001 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   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: Amlodipine, gababentin, zinc, pantoprazole, metoclopramide, thiamine, metoprolol, voltaren, oxycodone, humalog, aspirin, ferrous sulfate, vitamin C, santyl, betadine, symbicort, doxazosin
Current Illness: diabetes, hypertension, BPH, dysphagia, sepsis, enterocolitis due to C. Diff, hyperlipidemia, PVD, Cerebral infarction
Preexisting Conditions: diabetes, hypertension, BPH, dysphagia, sepsis, enterocolitis due to C. Diff, hyperlipidemia, PVD, Cerebral infarction
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 8/12/21 at 8:30 p.m. resident noted in bed alert and responsive. Resident noted talking to nurse. At 9:10 p.m., resident noted to be unresponsive by staff. CPR initiated. 911 arrived at 9:27 p.m. and was unsuccessful. Pronouncement of death at 9:30 p.m. Medical examiner deemed resident death as natural causes


VAERS ID: 1574026 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-24
Onset:2021-07-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Platelet count decreased, Thrombotic thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, apixiban, furosemids, gabapentin, leuprolide, pantoprazole, ondansetron, prednisone, spironalactone, tadalafil, treprostinil.
Current Illness: Pulmonary hypertension, scleroderma, myopathy, nicm, fsgs.
Preexisting Conditions: Pulmonary hypertension, scleroderma, myopathy, nicm, fsgs.
Allergies: Latex
Diagnostic Lab Data: Platelet count went from 277 to 16K/ul
CDC Split Type:

Write-up: Pt developed acute TTP ~3 weeks post dose and subsequently passed away.


VAERS ID: 1574074 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-10
Onset:2021-05-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A-1 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Anticoagulant therapy, Aspartate aminotransferase increased, Blood bicarbonate decreased, Blood bilirubin increased, Blood creatinine increased, Blood lactic acid, Computerised tomogram abdomen, Computerised tomogram liver, Computerised tomogram pelvis, Death, General physical health deterioration, Hepatic ischaemia, Intestinal ischaemia, Mesenteric vein thrombosis, Multiple organ dysfunction syndrome, Platelet count decreased, Portal vein thrombosis, Scan with contrast, Septic shock, Thrombectomy, Venogram, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   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: None
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia
Allergies: None
Diagnostic Lab Data: 5/26: CT abdomen and pelvis with contrast 5/27: CT 3 phase liver with and without contrast 5/28: IR venogram and thrombectomy lactate 10.1 ALT 3378 AST 3700 Bilirubin 4.0 Creatinine 3.03 WBC 25,000 Platelets 60 Bicarbonate 19
CDC Split Type:

Write-up: 69 year old male who presented with abdominal pain due to mesenteric venous thrombosis of the portal vein / superior mesenteric vein confluence. He was managed medically with therapeutic heparin anticoagulation, however he rapidly progressed in less than 24 hours despite medical therapy to having extensive superior mesenteric vein thrombosis and portal vein thrombosis causing bowel and liver ischemia with septic shock. He went to Interventional Radiology and underwent extensive thrombectomy, however he was too unstable to undergo surgery for resection of dead bowel and died secondary to septic shock and multi organ failure.


VAERS ID: 1574126 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-17
Onset:2021-08-01
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Computerised tomogram thorax, Death, Hyponatraemia, Legionella test, Procalcitonin increased, Staphylococcus test negative, Streptococcus test negative
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), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, alfornoterol, azithromycin, benzonatate, budesonide, calcium/vit d3, clonazepam, famotidine, furosemide, ferrous sulfate, guaifenesin, levothyroxine sodium, losartan potassium, morphine, omeprazole, PEG, prednisone, tiotropium br
Current Illness:
Preexisting Conditions: Hypothyroidism, COPD, HTN, CKD, GERD
Allergies: latex, natural rubber
Diagnostic Lab Data: CPTA neg for PE pro-cal was 0.79 MRSA DNA probe, Legionella and strep pneumo urine Ag were neg
CDC Split Type:

Write-up: -pt was found to have acute hypoxic respiratory failure secondary to COVID19 and severe hyponatremia - 8/6/21 pt received monoclonal antibodies but not a candidate for remdesivir d/t duration of symptoms -d/t minimal improvement symptoms, Palliative care was consulted. per family wishes pt was transitioned to inpatient hospice on 8/12/21 pt pronounced deceased at 1148 on 8/13/21


VAERS ID: 1574223 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-13
Onset:2021-05-19
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Chest X-ray abnormal, Computerised tomogram abnormal, Death, Dyspnoea, Intensive care, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   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: unknown
Current Illness: unknown
Preexisting Conditions: hypertension, hypothyroidism
Allergies: unkown
Diagnostic Lab Data: Patient had a negative PCR COVID test. However, the patient had an abnormal chest x-ray and CT scan that was distinctive for COVID.
CDC Split Type:

Write-up: The patient was admitted to Hospital on 5/19/2021. Patient was having shortness of breath. Patient was diagnosed with acute respiratory failure with hypoxia. Patient was admitted to the CCU. Patient died on 5/23/2021


VAERS ID: 1574282 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-08-09
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Diarrhoea, Dyspnoea, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, GERD, Hyperlipidemia, Asthma, HTN, IDDM, Stroke
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital with shortess of breath, cough, diarrhea, nausea, vomiting. While admitted increase in oxygen demands


VAERS ID: 1574401 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Biopsy, Biopsy muscle, Biopsy peripheral nerve, Biopsy pharynx, COVID-19, Death, Pain in extremity, Vasculitis
SMQs:, Vasculitis (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 179
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 127 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: arthritis rheumatoid, diabetes, high blood pressure
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Several biopsy throat, muscle and nerve
CDC Split Type:

Write-up: Several pain in her legs, hands, and arms. developed Several Vasculitis. Hospitalized for 4 months in pain. Acquired COVID in the hospital and died 5 days later.


VAERS ID: 1574415 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-10
Onset:2021-08-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Chest pain, Death
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   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, patient deceased.
Current Illness: Unknown
Preexisting Conditions: Unknown for sure. Was told that patient was overweight and had HTN
Allergies: PCN and SULFA drugs
Diagnostic Lab Data: Autopsy done on 8/14/21 per Medical Examiner''s office.
CDC Split Type:

Write-up: Called from Medical Examiner''s office that record of vaccination was needed on a deceased person. Upon talking to local Fire Chief states, "patient received Moderna COVID 19 vaccination on 8/10/21 complained of chest pain on 8/11/21 and deceased on 8/12/21. Fire Chief reports that patient was overweight and had hypertension.


VAERS ID: 1574423 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-22
Onset:2021-07-26
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: COPD, cardiovascular disease
Allergies: Unknown
Diagnostic Lab Data: COVID-19 PCR test positive on 7/26/2021
CDC Split Type:

Write-up: Client tested positive for COVID-19 via PCR on 7/26/2021 after being fully vaccinated. Pfizer vaccine dose #1 administered on 1/22/2021 lot#EL9262 and Pfizer vaccine dose #2 administered on 2/12/2021 lot# EN9581. Client died on 7/29/2021 cause of death as COVID-19 per Coroner''s office.


VAERS ID: 1574553 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-13
Onset:2021-03-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Dehydration, Ear, nose and throat examination abnormal, Endoscopy, Laryngoscopy, Malnutrition, Oral disorder, Oral lichen planus, Oropharyngeal pain, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 148
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 41 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? levothyroxine 25 MCG tablet ? B-D U/F PEN NEEDLE 31G X 5 MM Misc ? Forteo 600 MCG/2.4ML Solution Pen-injector ? midodrine (PROAMATINE) 10 MG tablet ? hydrOXYzine (ATARAX) 25 MG tablet ? metoPROLOL tartrate (LOPRESSOR) 25 MG tablet ? DULox
Current Illness: PERIPHERAL NEUROPATHY
Preexisting Conditions: 1. Autonomic dysfunction: moderate per auto lab testing. Mildly impr autonomic peripheral neuropathy. Mod impr cardiovagal and CV adrenergic function. Supine HTN with OH 2. Autonomic peripheral neuropathy: mild per auto lab testing in length-dependent pattern 3. Syncope and collapse 4. Chronic inflammatory demyelinating polyneuropathy: per hx, previously treated with IVIG, suggested per exam and hx 5. CNS demyelinating disease: clinical concern given the new/worsening symptoms 6. Small fiber neuropathy: per hx and exam-previously, now with findings indicating more than small nerve fiber involvement. 7. Migraine with aura and without status migrainosus, not intractable 8. Orthostatic lightheadedness: 10 min orthos with immediate OH systolically, -22 mmHg, HR increment +14 bpm, max HR 88 bpm, sat at 10 mins d/t sxs, on meds 9. Lumbar radiculopathy 10. Muscle weakness: worsened since LOV measurement, all limbs. Consider recurrent CIDP and possible CNS associated disease. Consider cervical and lumbar/lumbosacral radiculopathies. Possible early myelopathy without hyper-reflexia or lack of this findings due to peripheral nerve involvement. 11. Cognitive complaints 12. Hypohidrosis 13. Raynaud''s syndrome without gangrene 14. Other urinary incontinence 15. Hypovitaminosis D 16. Postlaminectomy syndrome of lumbar region 17. Abnormal sensory exam: PP reduction on all extremities and patchy reduction on trunk 18. History of Sjogren''s disease
Allergies: ? Norvasc [Amlodipine Besylate] HIVES ? Oxycontin [Oxycodone] Other (See Comments) Panic attacks after long term use ? Pseudoephedrine Other (See Comments) hallucinations ? Thiazide-Type Diuretics zaroxolyn caused nausea, diarrhea, hot flush ? Adhesive (Environmental) RASH adhesive tape ? Aspirin S/p gastric bypass ? Bumetanide VOMITING ? Celebrex [Celecoxib] RASH ? Cephalosporins rash and stomach upset ? Darvocet [Propoxyphene N-Apap] itching ? Demerol ANXIETY and PRURITUS ? Erythromycin GI UPSET ? Extract Of Poison Ivy Other (See Comments) ? Hydrochlorothiazide severe gastro problems ? Hydrocodone-Acetaminophen PRURITUS ? Metaxalone VOMITING ? Metoclopramide Hcl Other (See Comments) unsure ? Milk Intolerance (Food) GI UPSET Raw milk only, ok if within foods ? Monosodium Glutamate (Food Or Med) GI UPSET sever gastro problems ? Nsaids Other (See Comments) S/p gastric bypass ? Nuvigil [Armodafinil] depression ? Opioid Analgesics PRURITUS Itching- can take Vicodan if takes Benadryl with it ? Oxycodone-Acetaminophen HIVES ? Penicillins stomach upset and rash ? Pentazocine RASH ? Poison Sumac Extract Other (See Comments) ? Skelaxin [Skelaxin] GI UPSET ? Sulfa Antibiotics rash ? Trees Other (See Comments) ? Wasp Venom Protein Other (See Comments)
Diagnostic Lab Data: Laryngoscopy 3/29/2021 Upper endoscopy 4/6/2021
CDC Split Type:

Write-up: Patient has extensive history of autoimmune disorders. Received Moderna vaccine #1 on 3/13/21. Developed sore throat 3/15, progressing to oral lesions - went to urgent care on 3/22/21 and ED on 3/25/21 (diagnosed with stomatitis). Evaluated by ENT specialist 4/2/21 and diagnosed with oropharyngeal lichen planus. Was prescribed steroids. Hospitalized 4/2/21, 4/17/21, and 7/23/21 due to dehydration, malnutrition, and weakness. Patient opted for hospice care and died 8/10/21.


VAERS ID: 1574576 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-03
Onset:2021-05-20
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Chronic heart disease, Diabetes Mellitus, Severe obesity
Allergies: UNK
Diagnostic Lab Data: 5/23/2021 COVID-19 PCR positive
CDC Split Type:

Write-up: 5/20/2021 experiencing symptoms: dyspnea 5/24/2021 Admitted to hosp. and treated for COVID-19/ pneumonia 5/30/2021: died


VAERS ID: 1574592 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-29
Onset:2021-07-25
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid vaccine received 1/29/21 and 3/4/21, Pfizer mRNA Covid-19 vaccine. Client died of Covid related death on 7/25/2021


VAERS ID: 1574608 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-08-02
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, COVID-19, Deafness, Dizziness, Resuscitation, SARS-CoV-2 test positive, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unkown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: NKA
Diagnostic Lab Data: Positive Covid test on or about 6/9/21. Autopsy performed at Conemaugh Hospital on 8/2/21
CDC Split Type:

Write-up: On 8/2/21, client had a reported sudden death in the morning after complaining of "being unable to hear" and dizziness. EMS was called to the site and CPR was attempted by employees until EMS arrived. Resuscitation attempts were unsuccessful. Pt had tested positive for Covid 19 approximately one week after the first vaccine was given. She had not been hospitalized. An autopsy was conducted with reported preliminary report of citing cardiac arrhythmia. PCP name is Dr. was notified. Medical Director Dr. and she was notified. Both the Covid 19 and autopsy reports should be available through Hospital.


VAERS ID: 1574621 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dysphagia, Malaise, Nausea, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 105
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: High Blood Pressure Medication Depression Medication
Current Illness:
Preexisting Conditions: High Blood Pressure Depression
Allergies: Sulfa Drugs Antibiotic
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: She was complaining about feeling nausea and sick. She got extremely weak. She was having difficulties shallowing. Over the next 2-3 weeks she lost 20 pounds.


VAERS ID: 1574642 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-05
Onset:2021-08-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Eloquis, Topral, Renexa, Atarax
Current Illness: Bronchitis - 3 weeks prior, had recovered with no symptoms 10 days prior to vaccination
Preexisting Conditions: HEart bypass surgery 20 years ago, high blood pressure controlled with medication
Allergies: Codeine, shellfish, sulfa, tramadol, Parvon
Diagnostic Lab Data: None known
CDC Split Type:

Write-up: Nausea after 4-5 hours; coughing, fever for 8-10 hours


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210810396

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


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

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

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

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


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

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

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

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


VAERS ID: 1577657 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-22
Onset:2021-08-15
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Overall, critical condition with poor outcome. Discussed with patient''s daughters 8/13. I explained that the patient is deteriorating gradually and I agrees with comfort measures. On 8/14, discussed with the patient''s son at bedside, all questions answered. I also called the POA updated on the patient current condition. Family will meet today and update us on their plan of care. Addendum 3 PM on 8/14: Family had a meeting about goals of care, all questions answered. Family decided to proceed with comfort measures. Will add Ativan and Morphine. Will continue high flow oxygen as per family request. Will continue to monitor. Discussed with the RN. Expired peacefully 8/15/2021


VAERS ID: 1577863 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-08-07
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Exposure to SARS-CoV-2, Fall, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic heart failure, COPD, hypertension, hyperlipidemia, Coronary artery disease, hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/7/21 Came to ED with shortness of breath and fall from standing. Was exposed to COVID on 7/31/21 and started having symptoms on 8/2/21. Had been vaccinated but test was positive for COVID on admission. On and off ventilator. Started on dexamethasone and remdesivir on 8/9. Oxygen requirements continued to increase. Patient/family elected for comfort measures only and patient died on 8/14/2021.


VAERS ID: 1577882 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-20
Onset:2021-07-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac function test, Cerebrovascular accident, Death, Scan brain
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Repaglinide; Nortriptyline HCL; Losartan Potassium; Levocetirizine; Fenofibrate; Donepezil HCL; Fluticasone; Olopatadine HCL
Current Illness:
Preexisting Conditions: diabetes; high blood pressure; replaced aortic valve with bovine valve 21 years ago
Allergies: Latex; sulfer
Diagnostic Lab Data: Several type of brain scans and heart test revealing afib caused clot. No previous history of afib to my knowledge and I have been with her to doctors visits for last 6 years.
CDC Split Type:

Write-up: Massive right MCA stroke 31 hours after receiving vaccine, resulting in death 5 1/2 days later.


VAERS ID: 1577895 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-05-11
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cipro, Spironolactone, Furosemide, Vit B, Nadolol, Ferrous Sulfate, Olanzapine, Novolog, Basaglar, lactulose, Zyprexa, Aldactone, Amaryl, lisinopril, Potassium Gluconate, Allegra, aspirin
Current Illness:
Preexisting Conditions:
Allergies: Tramadol, Metformin, Morphine, Prednisone, Trazodone, Atorvastatin, Codeine, Demerol, Meperidine, Oxycodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 05/11/2021.


VAERS ID: 1577924 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-23
Onset:2021-03-21
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray abnormal, Death, Lung infiltration, Respiratory disorder, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative
SMQs:, Interstitial lung disease (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood tests - unremarkable chest xray showed infiltrate in lung COVID antibody positive but never tested positive on Nasal PCR
CDC Split Type:

Write-up: Death on 3/21/2021 of respiratory illness


VAERS ID: 1577926 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-01
Onset:2021-08-06
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6207 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0170 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Intensive care
SMQs:

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

Write-up: Sxs onset 7/26. -Death Disease Report says that the patient was admitted to ICU. Admitted to hospital on 8/6 and died on 8/10. *Death DIsease Report said he was NOT admitted to hospital due to COVID. *Death Disease Report said his death was NOT related to COVID.


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

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

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

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


VAERS ID: 1577967 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-23
Onset:2021-08-01
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

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: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization for COVID19 8/01/21 and death 8/09/21


VAERS ID: 1577972 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-26
Onset:2021-08-06
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / -

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: 2021-08-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization 8/6/21 for Covid19 and death 8/10/21


VAERS ID: 1577987 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-21
Onset:2021-07-28
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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: 2021-08-07
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization 7/28/21 for Covid19 and death 8/07/21. Received dexamethasone 6 mg IV daily and Remdesivir for 8 doses


VAERS ID: 1578038 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-18
Onset:2021-07-18
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Malaise
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: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sxs onset 7/17. Moderna-1/21 and 2/18. Admitted to hospital 7/18 to 8/09. Died on 08/09 due to COVID related death per Disease report. Never admitted to ICU. Was in Step Down unit when he passed away


VAERS ID: 1578066 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-10
Onset:2021-07-30
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/29/2021 admitted to hospital; Pfizer on 4/10 and 5/3. Positive on 7/30


VAERS ID: 1578245 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-08-05
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 8
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: Pfizer on 3/9 and 3/30. Positive on 8/6 8/5-8/13 admitted


VAERS ID: 1578254 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-04
Onset:2021-08-06
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer on 1/4 and 1/26. Positive on 8/7 8-6/8-16 admitted


VAERS ID: 1578274 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-03
Onset:2021-04-10
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Unknown--patient vaccinated at vaccine clinic
Current Illness: None known
Preexisting Conditions: unknown
Allergies: Denies allergy to vaccine or injectable medication
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired 4/10/2021 as reported by husband


VAERS ID: 1578362 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-06-24
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Intensive care, Lactic acidosis, Pyrexia, Septic shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit 6/24, vaccine 3/16, 4/6. H/O HTN, CAD, emphysema. Per wife patient had asymptomatic COVID in Dec 2020.Admit for fever, SOB. Admit for spetic shock, lactic acidosis. Patient progressively hypoxic, BiPap then emergent intubation. Tfer to ICU, sepsis tx started. Shortly after pt required vasopressors. Coded, cardiac arrest and expired.


VAERS ID: 1578377 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-06-27
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cardio-respiratory 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), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admit 6/27. Vaccine 4/19, 5/18 PRIMARY CAUSE OF DEATH:Cardio respiratory Arrest secondary to Covid 19 pneumonia


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

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

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

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


VAERS ID: 1578487 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-01
Onset:2021-08-07
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1273 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Death, Dyspnoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: chest pain, recent cardiac stents on 7/27
Preexisting Conditions: HTN, coronary bypass
Allergies: bactrim, penicillin
Diagnostic Lab Data: COVID test, CXR
CDC Split Type:

Write-up: short of breath, chest pain resulting in death


VAERS ID: 1578498 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-04
Onset:2021-07-24
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BNT-162B2 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 14
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 51
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: diabetes mellitus, hypertension
Allergies: UNK
Diagnostic Lab Data: COVID-10 PCR positive 06/03/2021
CDC Split Type:

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


VAERS ID: 1578507 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-03
Onset:2021-07-27
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BNT-162B2 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Exposure to SARS-CoV-2, Intensive care, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: COVID TEST, CXR
CDC Split Type:

Write-up: SHORT OF BREATH, EXPOSURE TO WIFE WITH covid, FEVER, ADMITTED TO ICU AND THEN HOSPICE


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

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

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

Write-up: ALTERED MENTAL STATUS, SHORT OF BREATH


VAERS ID: 1578593 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-15
Onset:2021-06-23
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Death, Vaccination complication
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: 2021-06-25
   Days after onset: 2
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: Pertussis reaction as newborn
Other Medications: Gabapentin Clonazepam Baclofen Cimetidine
Current Illness: N/A
Preexisting Conditions: Depression and anxiety
Allergies: Penicillin
Diagnostic Lab Data: Forensic Pathologist after full autopsy determined patient was a healthy adult with no heart disease, no liver disease, and no pnemomia. Coroner determined after toxicology report that covid 19 vaccine was the only contributing factor. Everything else was ruled out.
CDC Split Type:

Write-up: Died June 25th after cardiac arrest on June 23rd, 8 days after his vaccine.


VAERS ID: 1578659 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-19
Onset:2021-06-04
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9236 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Encephalopathy, SARS-CoV-2 test positive
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-11
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 36 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: unk
Preexisting Conditions: chronic heart disease, kidney disease, diabetes mellitus, high blood pressure
Allergies: unk
Diagnostic Lab Data: COVID-19 positive 06/04/2021
CDC Split Type:

Write-up: tested as pre-operative procedure/surveillance. No symptoms. Patient was diagnosed with encephalopathy and was transferred to comfort care on 7/11 and died peacefully with family at bedside. He tested positive for COVID w/no symptoms on 06/04/2021 during admission surveillance; LTCF where patient lived had 3 other residents tests positive


VAERS ID: 1578678 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-06
Onset:2021-07-07
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, Fatigue, Hypoxia, Memory impairment, Pain, Pyrexia
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, hypertension, depression disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found to be hypoxic and he required high-flow oxygen. Patient was also found to be COVID-19 positive. According to the patient he was diagnosed with COVID-19 last year. He also to the vaccine this year. He took the 2nd dose back in March of 2021. When I interviewed the patient. Patient had a hard time recalling events and answering the questions directly. He said something about having some fluids buildup for which he had water pills. Patient appeared to be very poor historian about his current condition. He just said that it started 2 days ago to get really worse. He reports generalized weakness and generalized fatigue with generalized pain. He also reported low-grade fever. Nothing made symptoms worsen nothing made his symptoms better. Patient died on 8/14/2021, cause of death under review.


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

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

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

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


VAERS ID: 1582152 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-07-25
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I21.4 - Non-ST elevation (NSTEMI) myocardial infarction J18.9 - Pneumonia, unspecified organism


VAERS ID: 1582161 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - Acute kidney failure, unspecified


VAERS ID: 1582313 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-21
Onset:2021-07-03
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Asthenia, COVID-19, Chest X-ray abnormal, Death, Decreased appetite, Fatigue, Pneumonia, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (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: 2021-07-05
   Days after onset: 2
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: UNK except Oxygen dependent
Current Illness: UNK
Preexisting Conditions: Chronic heart and lung disease, oxygen dependent, diabetes mellitus high blood pressure
Allergies: UNK
Diagnostic Lab Data: 7/4/2021 COVID-19 positive 7/4/2021 Chest X-ray confirmed pneumonia
CDC Split Type:

Write-up: presented to the hospital with weakness, fatigue, decreased appetite. diagnosed with pneumonia which progressed to ARDS


VAERS ID: 1582335 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Cardiac flutter, Chest pain, Chills, Death, Diarrhoea, Dyspnoea, Fatigue, Headache, Heart rate increased, Injection site erythema, Injection site swelling, Jaundice, Malaise, Myalgia, Nausea, Palpitations, Pancreatitis, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 128
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin and the rest in medical record.
Current Illness: None
Preexisting Conditions: Marathon speed walker, in shape, not over weight, does not smoke or drink in over 40 years.
Allergies: None
Diagnostic Lab Data: See Medical Records.
CDC Split Type:

Write-up: Chest and back pain, Shortness of breath, Feelings of having a fast-beating, fluttering, or pounding heart, tiredness, headache, muscle pain, chills, joint pain, fever, injection site swelling, injection site redness, nausea, feeling unwell, diarrhea, vomiting and eventually signs of pancreatitis, jaundice and death within 4 months of 2nd shot. This is 5 in family and friend group taking Pfizer.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ferrous sulfate
Current Illness: post partum - c section 2/27/21 nothing else
Preexisting Conditions: none 7/15/21 admitted to Medical Center ICU with acute liver failure without hepatic coma
Allergies: none
Diagnostic Lab Data: 7/15/21 - The patient was admitted as a transfer from a HCF with acute liver failure of unknown etiology on 7/15/2021. On arrival, she had altered mental status with respiratory distress and coffee ground emesis. She was promptly intubated for airway protection. A GI bleed was suspected, thus she was started on octreotide and protonix gtts and IV ceftriaxone. An a-line, dialysis line were placed. An orogastric tube was placed and there was no acute GI bleeding thereafter. Labs demonstrated severe lactic acidosis, severe hyperammonemia and acute renal failure, thus CVVH was initiated. She was maxed out on triple pressor support for multifactorial vasodilatory and cardiogenic shock. Cardiac echo demonstrated acute systolic and diastolic heart failure with reduced EF, however no intervention was recommended by cardiology due to multiorgan failure. CT brain on 7/15 demonstrated diffuse brain edema and mild cerebellar tonsillar herniation. Neurosurgery was consulted and bolt placement was performed. ICPs were consistently elevated $g100s. Repeat CT brain demonstrated worsening cerebral edema and herniation. By the evening of 7/15, her pupillary exam became fixed and dilated despite being on maximum pentobarbital therapy, propofol to decrease ICP, head of bed 45 degrees+ all times, mannitol, and mild hyperventilation for cerebral edema and elevated ICPs. Once CVVH was initiated, though, mannitol and hypertonic saline were not treatment options, as the CVVH clears the medication quickly. The patient was listed for OLT that afternoon but later determined to not be a candidate due to her worsening neurological status. She had a change in pupil exam suggestive of worsening herniation (pupils became fixed/dilated) and CT confirmed worsening herniation. ICPs remained 120+ despite triple pressor support in effort to maintain CPP (without success). A diagnostic cerebral angiogram was performed on 7/16 due to limited ability to assess brain death secondary to medication therapy. This revealed no intracranial blood flow. After a discussion with family, the patient became DNR. The family elected to discontinue supportive measures on 7/18. The patient was pronounced dead at 9:22 AM.
CDC Split Type:

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


VAERS ID: 1582568 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-08-02
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute kidney failure, unspecified


VAERS ID: 1582618 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-09
Onset:2021-08-04
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital on 8/10 with acute respiratory failure. Symptoms started 8/4. Respiratory status worsened and transferred to ICU on 8/15. Patient passed away on 8/17/21.


VAERS ID: 1582680 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-14
Onset:2021-02-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Dyspnoea, Incomplete course of vaccination, Lymphadenopathy, Productive cough, Pulmonary thrombosis, Swelling
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 117
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Staton
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s Wife states that after receiving the 1st dose of Moderna 02/14/2021, started experiencing symptoms 02/17/2021 of head swelling, swelling in the Lymphoids lasting 3 weeks, shortness of breath, coughing up mucus, passed away from from Blood Clots in the lungs 06/15/2021. Primary visit (no tests) treated with Antibiotics for 2 months, noted as Congestive Heart Failure. Primary recommendation to not receive the 2nd dose of Moderna.


VAERS ID: 1582847 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-31
Onset:2021-08-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Cardio-respiratory arrest, Death, Endotracheal intubation, General physical health deterioration, Intensive care, Laboratory test, Resuscitation, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution 75 mL 3 5/23/2019 Sig: Take 3 mLs by nebulization every 4 (four) hours as needed for Wheezing. Route: Nebulization PRN Reason(s): Wheezing aspirin low dose (ASPIRIN)
Current Illness: None
Preexisting Conditions: Type 2 DM, ESRD on HD MWF
Allergies: NKA
Diagnostic Lab Data: Too many to list. Diagnosed with Covid on 8/4/21
CDC Split Type:

Write-up: Patient was a 58 year old patient. He had ESRD on HD MWF. He had previously been hospitalized 8/4/21 - 8/5/21 - diagnosed with Covid 19 during this stay - stabilized and was able to be discharged home. He deteriorated at home and was brought back to the ED via EMS 8/6/21 with ARDS secondary to Covid - 19. He was intubated and remained for the duration of his stay in the ICU. He had two code incidents 8/16/21 and 8/17/21. Upon the 3rd Code, they were unable to revive him and upon discussion with family - decision made to stop CPR and patient expired.


VAERS ID: 1582850 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-11
Onset:2021-08-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Respiratory distress, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   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: ASA ATIVAN LORAZEPAM SEROQUEL ZOLOFT LASIX TRAZODONE LOPRESSOR VITANMIN D NAMENDA DIGOXIN
Current Illness: UTI ALZHEIMERS CELLULITIS ATRIAL FIB SICK SINUS SYNDROME ANXIETY MAJOR DEPRESSIVE D/O PSYCHOTIC D/O WITH DELUSIONS HTN RESTLESSNESS/AGITATION CONSTIPATION
Preexisting Conditions: UTI ALZHEIMERS CELLULITIS ATRIAL FIB SICK SINUS SYNDROME ANXIETY MAJOR DEPRESSIVE D/O PSYCHOTIC D/O WITH DELUSIONS HTN RESTLESSNESS/AGITATION CONSTIPATION
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: 8/12/21 @ 03:37 AM - PT NOTED TO HAVE EMESIS ON SHEETS AND GOWN. RESPONSIVE, VITALS STABLE, MD AND FAMILY NOTIFIED, ZOFRAN ORDERED AND GIVEN. NO DISTRESS NOTED. 8/12/21 @ 09:55 AM - PT NOTED TO BE EATING BREAKFAST. NO DISTRESS NOTED. 8/12/21 @ 8:50 PM - VOMITING, NON-RESPONSIVE, RESPIRATORY DISTRESS. 02 SATS 48-50%. AMBULANCE CALLED, PT TAKEN TO ER. 8/12/21 @ 8:58 PM - FACILITY NOTIFIED THAT RESIDENT EXPIRED.


VAERS ID: 1582941 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-26
Onset:2021-03-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Colon cancer, Condition aggravated, Death, Haemorrhage urinary tract, Nephrostomy, Prostate cancer, Pulmonary oedema, Thrombosis
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Prostate malignant tumours (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   Days after onset: 128
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Darifenacin, tamsulosin, ciprofloxacin, duloxetine, prednison, abiraterone, mupirocin, psyllium, ammonium lactate, urea topical, acetaminophen, leuprolide, multivitamin
Current Illness: Stage 4 cancers of prostate and colon
Preexisting Conditions: None
Allergies: Penicillin, some statins
Diagnostic Lab Data: Hospital stays, then nephrostomy, then hospital then death. Water on lungs
CDC Split Type:

Write-up: Four days after the shot, patient started having blood clots in the urine. After a few weeks, was able to get back to normal but seemed to stimulate previously stable cancers into growth. Four days after the 2nd (3/19/21) covid shot blood clots started again.


VAERS ID: 1582950 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-14
Onset:2021-08-04
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: 2021-08-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, atorvastatin, carvedilol, eliquis, furosemide, glipizide, levothyroxine, metolazone, novolog, omeprazole, plavix, potassium chloride, prednisone 10mg daily, spironolactone
Current Illness: Unknown
Preexisting Conditions: Severe COPD, CAD s/p stent, severe ischemic cardiomyopathy, hypothyroidism, T2DM, GERD, atrial fibrillation, CHF, CVA, HTN
Allergies: NKDA
Diagnostic Lab Data: 8/4: antigen positive SARS-CoV-2
CDC Split Type:

Write-up: The patient presented to the ED on 8/4 with 2-3 day history of progressive SOB that had gotten worse in the past 24 hours. She tested positive for SARS-CoV-2 on 8/4 with an antigen positive test. On 8/12/21, the patient took a turn with desaturation and difficulty breathing on high flow oxygen at 15L. The family opted to make her comfort care and she expired at 1715 on 8/12/21


VAERS ID: 1582987 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-21
Onset:2021-08-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriovenous malformation, Cardioversion, Cerebral haemorrhage, Computerised tomogram head abnormal, Cyanosis, Death, Headache, Mechanical ventilation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   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: No
Current Illness: Common cold, recovered.
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: CT Scan showing brain hemorrhage
CDC Split Type:

Write-up: Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?


VAERS ID: 1583011 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-03
Onset:2021-06-11
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL32879 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 48
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: unnamed chemotherapy
Current Illness: UNK
Preexisting Conditions: none listed, although receiving chemotherapy
Allergies: UNK
Diagnostic Lab Data: 6/11/2021 COVID-19 PCR positive
CDC Split Type:

Write-up: Associated with a LTC facility. experienced dyspnea, cough, wheezing and fever Hospitalized


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