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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 62 out of 154

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VAERS ID: 1583081 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-23
Onset:2021-08-15
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / 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: 2021-08-15
   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:
Current Illness:
Preexisting Conditions: Parkinson''s, Dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID19 death


VAERS ID: 1583177 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-28
Onset:2021-08-11
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Dyspnoea, Headache, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tamsulosin, Isosorbide dinitrate, Trazodone, Celecoxib, Gabapentin, Glimepiride, Clopidogrel, Amlodipine,Sertaline, Pantoprazole, Rosuvastatin
Current Illness: Unknown
Preexisting Conditions: HTN, Lung Cancer
Allergies: Taxol
Diagnostic Lab Data: SARS COV2 COVID 19 PCR initial 08/04/2021, repeated 08/06/2021
CDC Split Type:

Write-up: 08/11/2021 19:08 The patient presents with 77 year old male with a PMHx of HTN, MI, distant lung cancer, CAD, and high cholesterol presents with shortness of breath x 2 days. Pt got COVID a week ago and states he was feeling better but reports he started to have shortness of breath 2 days ago. He denies taking any medication for COVID. He denies fever, n/v, diarrhea or any other symptoms. Pt reports he had a headache, chills, myalgia but denies those symptoms now. Pt states he is here to get BAM done. Pt reports he got his COVID vaccine earlier this year but is unsure which one. No chest pain, abdominal pain, urinary symptoms. No leg swelling. No other complaints. The onset was 1 weeks ago.


VAERS ID: 1583179 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-25
Onset:2021-05-06
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0412 / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
   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: allergy medicine, fiber powder
Current Illness:
Preexisting Conditions: bicuspid valve
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away suddenly and unexpectedly on 5/7/21. Cause of death on death certificate states ventricular fibrillation


VAERS ID: 1583196 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-12
Onset:2021-08-11
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 7
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, arthritis, HTN, hypothyroidism, sleep apnea
Allergies: Aspirin, Codeine, compazine, NSAIDs
Diagnostic Lab Data: Covid positive 8/9
CDC Split Type:

Write-up: Pt was hospitalized with covid and died


VAERS ID: 1584021 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-18
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Dyspnoea, Gait disturbance, Pyrexia, Swelling, Vomiting, Wheelchair user
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 83
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 Meds
Current Illness: Had Blood Work and physical in January and everything was doing well. Decided yes for Vaccine.
Preexisting Conditions: High blood Pressure.
Allergies: Oysters
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father threw up and had a fever after the first vaccine. After the 2nd vaccine he couldn''t breath. He could no longer walk well, and started having me push him in a wheel chair. We got him a machine and for one week it seemed to help. He passed away on March 26 2021. Just a month and a half after his vaccine. He was swelling up and having difficulty breathing. I found him dead the day we were going to see Dr. for a follow up. I didn''t want to believe it was the vaccine so I didn''t rush him to the doctor saying it was the vaccine. This is important and you all need to know that some people are dying from it.


VAERS ID: 1586331 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-08-06
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Abdominal pain, Abnormal faeces, COVID-19, Cardiac arrest, Coagulopathy, Colectomy, Colitis ischaemic, Computerised tomogram abdomen abnormal, Condition aggravated, Death, Diverticulitis, Endotracheal intubation, Explorative laparotomy, Hypoxia, Imaging procedure, Intensive care, Intestinal ischaemia, Laboratory test, Large intestinal obstruction, Nausea, Pain, SARS-CoV-2 test positive, Sepsis, Vasopressive therapy
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler allopurinol (ZYLOPRIM) 300 MG tablet amoxicillin (AMOXIL) 500 MG capsule apixaban (ELIQUIS) 5 MG tablet aspirin 81 MG enteric coated tablet atorvastatin (
Current Illness: on CPAP; diabetes mellitus
Preexisting Conditions: Asthma OSA on CPAP Hypoxia Diastolic dysfunction CAD (coronary artery disease) Essential hypertension Anxiety Dyslipidemia Morbid obesity Hypothyroid DM type 2 (diabetes mellitus, type 2) CKD (chronic kidney disease), stage III Pulmonary hypertension Type 2 diabetes mellitus without complication Nonrheumatic aortic valve stenosis Acute bronchitis, unspecified organism Bradycardia Type 2 diabetes mellitus with both eyes affected by mild nonproliferative retinopathy without macular edema, with long-term current use of insulin Posterior vitreous detachment of right eye Regular astigmatism of both eyes Moderate persistent asthma without complication Chest pain PAF (paroxysmal atrial fibrillation) Dry eyes, bilateral Large bowel obstruction
Allergies: Iodine containing dye; morphine; sulfa drugs
Diagnostic Lab Data: HOSPITAL COURSE: Patient presented to the hospital with a one day history of abdominal pain and nausea. Found to have a large bowel obstruction and taken to the OR urgently for subtotal colectomy. Abthera placed and patient transferred to SICU for further treatment. Patient remained intubated and on maximum vasopressor support with no improvement. Bedside laparotomy preformed and patient''s remaining bowel was found to be pan-ischemic. Family updated and decision to transition to comfort care once remaining family members arrived was made. Comfort care and terminal extubation initiated with the guidance of palliative care. Asystole was noted on monitor and exam preformed. Time of death 20:41.
CDC Split Type:

Write-up: Patient expired due to Large Bowel Obstruction. (found to be COVID positive) Attestation signed by MD at 8/7/2021 11:02 PM (Updated) General Surgery Pt seen and examined on 8/6/2021 with the surgery team, all labs, vitals, imaging and objective data reviewed. Agree with the below note with the following addendum: The patient is a 75-year-old female with multiple chronic medical comorbidities presenting to the emergency department with a complaint of abdominal pain. She states that her pain just started this morning and really worsened around noon. Has been rapidly worsening since that time. She also notes significant nausea and abdominal distention. She reportedly underwent colonoscopy several years ago which was incomplete due to inability to pass the colonoscope. She reports that for the last several months the caliber of her stools has been very small. AAOx3. Writhing in pain. No focal Neuro-deficits Non-labored respirations. Very distended, severely ttp throughout Moving all extremities A/P: 75 year old female with large bowel obstruction -large bowel obstruction: The patient''s CT scan and history are consistent with a diagnosis of large bowel obstruction. She has evidence of severe dilation of all proximal colon. The etiology of her obstruction is unclear. It could be related to malignancy or, based on her history, it is more likely related to chronic diverticular inflammation. Regardless of its etiology the patient is in distress and I am concerned that she is at high risk for colon ischemia or perforation. She will need emergent operative exploration. I discussed this case with the Dr with the colorectal surgery service. Following our discussion the decision is made that the general surgery service should take the patient to the operating room. I discussed the plan for operative intervention with the patient as well as her daughter. I will plan for an exploratory laparotomy with sigmoid colectomy. Risks of the surgery are significant. We discussed the risks which include bleeding, infection, need for reoperation, need for multiple operations, cardiopulmonary complications from anesthesia, ostomy creation which may be temporary or permanent, hernia, and need for postoperative ventilator support. The patient voices understanding of these and is eager to proceed with surgery. -COVID positive: The patient has already had COVID and has since been vaccinated. She is PCR positive for COVID today. I will take respiratory precautions. Is unclear whether this is an active COVID infection or not. -Coagulopathy: The patient takes eliquis. Reverse with PCC at this time for emergent operative intervention. -hypoxia: The patient is hypoxic and requiring supplemental oxygen at this time. This is unclear whether this is related to her COVID diagnosis for her severe abdominal distention. -sepsis: The patient has evidence of sepsis with the source of ischemic colon. Administer broad-spectrum antibiotics at this time. Procedure the operating room for source control. Continue with hemodynamic support.


VAERS ID: 1586540 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-10
Onset:2021-08-10
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Respiratory arrest, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: PCR + test on 8/10 /21 (same day as death)
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient. The patient received two doses of the Pfizer vaccine on 2/17 and 3/10. On 8/10/21, the patient tested positive via a PCR test for COVID-19 (vaccine breakthrough). The patient died on 8/10 and the cause of death is listed as ?Respiratory Arrest.? I do not have any further detail regarding pre-existing conditions or provider information.


VAERS ID: 1586554 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-30
Onset:2021-07-18
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, COVID-19, Condition aggravated, Death, Pneumonia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Chronic Lung Disease (asthma/emphysema/copd), chronic renal disease
Preexisting Conditions: Chronic Lung Disease (asthma/emphysema/copd), chronic renal disease (known)
Allergies: Unknown
Diagnostic Lab Data: 07/17 Rapid (Not Detected) 07/19 Rapid (Not Detected) 07/20 Rapid (Not Detected) 07/20 PCR (Detected) 07/28 PCR (Detected)
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of patient. The patient received two doses of the Pfizer vaccine on 03/09 and 03/30. The patient was initially hospitalized on 07/19 with an initial diagnosis of pneumonia. The patient tested COVID + on 07/20 and again on 07/28 via a PCR test (vaccination breakthrough). The patient was reported as having died on 08/15. Cause of death is listed as acute, hypoxic, respiratory failure; pneumonia/ARDS; COVID 19; Acute on Chronic Renal Failure. Underlying health conditions include chronic lung disease (asthma/emphysema/copd), chronic renal disease.


VAERS ID: 1586730 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-06
Onset:2021-03-30
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 162B2 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Cough, 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: 2021-04-11
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, DM
Allergies: NKA
Diagnostic Lab Data: cxr, covid test
CDC Split Type:

Write-up: couch, SOB, chest pain resulting in hospitalization


VAERS ID: 1586737 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-11
Onset:2021-07-17
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, Asthenia, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Death, Diarrhoea, Dizziness, Dyspnoea, Endotracheal intubation, Hypophagia, Hypoxia, Intensive care, Leukocytosis, Lung opacity, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), 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: 2021-08-17
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rituximab 1600 mg subcut every 8 weeks Tretinoin 0.025% topical cream at bedtime 3 times per week Ventolin HFA 2 puffs by mouth every 4 hours PRN SOB/wheezing Acyclovir 400 mg PO BID Estradiol 10 mcg tablet vaginally 1-2 times per week Famo
Current Illness: CLL
Preexisting Conditions: CLL Rheumatoid arthritis Hypogammaglobulinemia R foot stress fracture of R 2nd metatarsal Osteopenia Iron deficiency anemia GERD
Allergies: Cheese (anaphylaxis) Sulfa (anaphylaxis) Carrageenan, corn-containing products, cor syrope, dextrose, geltain, ketchup, lecithin, mayonnaise, molasses, mustard, rennet, sulfites, wine spirit (swelling)
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient tested positive for COVID-19 on 7/24. She felt well for the first week following the test but then started to have symptoms including dizziness, SOB, weakness, diarrhea, and decreased PO intake. She was started on prednisone 5 mg PO on 8/5 and presented to urgent care on 8/10 because her symptoms continued to worsen. She went to an outside hospital ED and was hypoxic to 91% requiring NC. CXR and CTA chest at that time showed diffuse ground glass opacities. She was administered dexamethasone 6 mg IV and 1 L of normal saline. She arrived to the hospital on 8/11 satting well on 4L of nasal cannula. She continued on dexamethasone. Thereafter, her oxygen requirements escalated to max high flow nasal cannula on 8/13 and 8/14. She received tocilizumab 8 mg/kg IV x 1 on 8/14 and transferred to the medical intensive care unit. On 8/15, she was having oxygen desaturations to the 70s and 80s and was intubated. Over the next 24 hours, she developed increasing pressor requirements, was spiking fevers, and started on iNO. She was started on vancomycin and cefepime and her leukocytosis progressed to $g200. The patient was made DNR and passed on 8/17.


VAERS ID: 1586787 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-08
Onset:2021-04-08
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MRNA1273 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: afib, stent, thyroid disease
Allergies: other food allergies
Diagnostic Lab Data: cxr, covid test
CDC Split Type:

Write-up: SOB hospitalized


VAERS ID: 1586812 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-08-18
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Condition aggravated, Death, Pneumonia
SMQs:, Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart disease, alcoholism, ARDS,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 02/09/2021 no lot # Patient died of pneumonia, ARDS on 8/18/2021-not a covid infection, not vaccine related


VAERS ID: 1586819 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-08-18
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CVA, dementia, COPD,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 01/25/2021 moderna lot # 029K201 Pt died from CVA complications on 8/18/2021- NOT a covid or vaccine related death


VAERS ID: 1586824 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-09
Onset:2021-08-05
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted 08/05/2021. Deceased 08/18/2021. Diagnosis was Covid-19.


VAERS ID: 1586852 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-05
Onset:2021-06-28
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Gastroenteritis viral, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Recent N/V/D presented Viral Gastroenteritis COVID vaccine related
Preexisting Conditions: Coronary Artery Disease with Multi Vessel Bypass, 1997 and low ejection fraction,
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Recent N/V/D Presented Viral Gastroenteritis COVID vaccine related


VAERS ID: 1586877 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / 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: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Folic acid Insulin aspart Sertraline Tylenol Silver sulfadiazine Lyrica Insulin Detemir
Current Illness: Cellulitis/osteomyelitis to right lower extremity amputation stump Diabetes Hypertension Anemia, thrombocytopenia
Preexisting Conditions: Diabetes, Hypertension, Foot ulcers, osteomyelitis, DVT''s, back pain, gangrene
Allergies: Rocephin
Diagnostic Lab Data: None, resident deceased.
CDC Split Type:

Write-up: Resident had no issues after receiving vaccination. The next morning he was found in his room laying face down on the floor and unresponsive. CPR was started, 911 called. Unfortunately resident was pronounced dead at 7:55am.


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

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

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

Write-up: hospitalization resulting in death


VAERS ID: 1586936 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Blood pressure immeasurable, Death, Hypopnoea, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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 BUMETANIDE CARVEDILOL ENTRESTO FERROUS SULFATE LEVSIN SPIRONOLACTONE
Current Illness: ENCOUNTER FOR AUTISM SCREENING ACUTE EMBOLISM & THROMBOSIS OF OTHER SPECIFIED VEINS OBESITY IRON DEFICIENT ANEMIA ACUTE ON CHRONIC COMBINED SYSTOLIC & DIASTOLIC CONGESTIVE HEART FAILURE HEART FAILURE DUCHENNE OR BECKER MUSCULAR DYSTROPHY PULMONARY HTN MILD PROTEIN-CALORIE MALNUTRITION
Preexisting Conditions: SEE ABOVE
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: RESIDENT REC''D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334. PROGRESS NOTE FROM FACILITY READS: 8/18/21 @ 15:11- "RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST." 8/18/21 @ 20:50- "RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO ER, RESIDENT FAMILY NOTIFIED, RN NOTIFIED." RN STATES THEY REC''D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.


VAERS ID: 1587119 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-12
Onset:2021-08-14
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / SYR

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

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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient does have pre-existing medical conditions- high blood pressure, lung failure, kidney failure, diabetes and pneumonia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized on August 14th and Passed on August 15th,2021


VAERS ID: 1587125 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-24
Onset:2021-08-04
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Bradycardia, COVID-19, Cardiac arrest, Cough, Death, Fall, Fatigue, Gait disturbance, Mechanical ventilation, Oxygen saturation decreased, Pulseless electrical activity, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 11
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: Hypertension, aortic stenosis, HTN, Chohn''s, GERD, CVA, subdural hemorrhage
Allergies:
Diagnostic Lab Data: Not requiring oxygen however due to small desaturation he was placed on 2 L at 95%. Hospital was asked to admit the patient for further evaluation and management. Per wife, patient with no hx of COPD, asthma, VTE or OSA. No prior hx of oxygen at home.ff sedation has + cough and gag Off pressors Started on nicardipine this am Current support: Invasive Mechanical Ventilatory: Yes - NIV: No - High flow O2: No CRRT: No Vasoactive Drugs: Yes Other: Yes ASSESSMENT S/p In-hospital PEA arrest (8/10) Secondary to hypoxic resp failure - pt pulled off Bipap mask and became hypoxic and then bradycardic per bedside RN ~ 21 mins
CDC Split Type:

Write-up: Patient tested positive for COVID-19. He was hospitalized due to falling frequency, fatigue, and worsening gait. Patient died.


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

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

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

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


VAERS ID: 1587163 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-01-31
Onset:2021-02-15
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / UNK UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthma exercise induced, Cardiac arrest, Dyspnoea, Dyspnoea exertional, Pulseless electrical activity, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 92
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: Treated hypertension
Preexisting Conditions: G.E.R.D. with intrathoracic stomach
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About 2 wks post vaccine my husband started to develop dyspnea which appeared at that time on exertion (walking & exercise). Probably took another week to get into the doctor but I do not remember for sure. Dr. Diagnosed him with exertional asthma. He was put on inhalers and a medication. I do not know what medication. He seemed to be getting worse and was put on a more potent inhaler with cortisone and took an OTC supplement called NAC which he bought at a healthfood store. Then on May 19 at 7;45am we were sitting on the sofa having morning coffee. I noticed he was having what looked like a worse breathing episode. I asked if I should call 911. He said, "No, this will pass." So I said I was going to take a Pulse/Oximeter reading because I brought that and an AED from our surgery center which we had just closed and retired in 2019. His O2 was 100% w 62 pulse. That looked good to me. I layed down the Pulse/Oximeter and about a minute or two he had a cardia arrest! I called 911, pulled him on the floor and started CPR while talking with the EMS all the while. I stopped for a minute to put on the AED. I told EMS I am going to defibrillate , he has not pulse! The AED did not go off. I continued CPR, then the EMS came and started CPR and tried defibrillation but theirs did not go off. The EMS told me he was in a PEA (pulseless electrical activity) where he had not heartbeat but still had electrical activity in his body so the the debribrillators read it as a rythymn that was not amenable to defibrillation.. Now I found out the threat of blod clots and feel that is what he had!


VAERS ID: 1587223 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-08-03
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methadose,Ativan, Lyrica, Senokot, Decadron, Roxanol, Narcan, Norflex, Miralax, Emla, Compazine
Current Illness:
Preexisting Conditions:
Allergies: Diagnostic Xray Contrast
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/03/2021.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Toprol, sodium bicarbonate, Cozaar, Lexapro, Lasix, Aldactone, Glucophage, Buspar, Klor-Con, Remeron, Mag Oxide, aspirin, Calcium 600-D, Pyridoxine
Current Illness:
Preexisting Conditions:
Allergies: Bactrim, Lisinopril
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1587300 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-09
Onset:2021-08-15
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   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:
Current Illness:
Preexisting Conditions: alzheimer''s disease, DJD, GAD and glaucoma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully immunized at time of death from COVID-19


VAERS ID: 1587309 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-19
Onset:2021-08-01
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Chest X-ray abnormal, Cough, Death, Endotracheal intubation, General physical health deterioration, Intensive care, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: Amlodipine, ASA, Plavix, synthroid, lisinopril, lovastatin, metoprolol
Current Illness: unknown
Preexisting Conditions: HTN, cerebrovascular disease, aortic stenosis, skin CA, phlebitis, post surgical aortocoronary bypass, CVA, TIA,, hypothyroid, nephrectomy (voluntary donor)
Allergies: NKA
Diagnostic Lab Data: CXR 8/1/2021 - no acute cardiopulmonary abnormalities. 8/1/2021- SARS CoV 2 NAAT positive
CDC Split Type:

Write-up: 8/1/2021 Client admitted to Hospital with c/o fever, weakness, cough. No persistent hypoxia noted at the time. 8/9/2021 Client transferred to Hospital for Hospice and comfort due to declining condition. Notes on transfer indicating he had been admitted to ICU and intubated and had a CXR indicating pneumonia. Client died 8/10/2021. Death report: PNEUMONIA SECONDARY TO COVID-19. ACUTE HYPOXIC RESPIRATORY FAILURE. Submitter does not have access to any further medical records for this client. Please contact hospitals for any further information required:


VAERS ID: 1591198 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-05
Onset:2021-08-18
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: None reported
Diagnostic Lab Data: Autopsy is pending.
CDC Split Type:

Write-up: I have minimal information but wanted to report as patient''s wife is unsure if patient''s death is related to his vaccine. Patients wife, called me and was very hard to understand but was able to tell me that her seemingly healthy 42 year old husband died out of nowhere on Wednesday August 18th, 13 days after receiving his second dose of the Pfizer vaccine. They are not sure what the patient died from, the wife states everything happened so fast and she said she wasn''t sure if he was having a seizure or a heart attack. According to the wife an autopsy is being performed to discover cause of death. Patient had no complaints after his first dose, and only had normal possible side effects after his first dose.


VAERS ID: 1591215 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-22
Onset:2021-07-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, allopurinol, atorvastatin, cholecalciferol, cyanocobalamin, finasteride, fish oil, , methocarbamol,
Current Illness: Multiple Myeloma, BPH, visual impairment, PTSD, Hx of DVT/PE, HTN, asthma
Preexisting Conditions: Multiple Myeloma, BPH, visual impairment, PTSD, Hx of DVT/PE, HTN, asthma
Allergies: Shrimp
Diagnostic Lab Data: Cause of death not documented.
CDC Split Type:

Write-up: Cause of death not documented. No ADRs reported between the observation period and date of death. Significant comorbidities include multiple myeloma, HTN, BPH, PTSD. History of hospitalization prior to death not available. Death updated on the system on JuL 28, 2021.


VAERS ID: 1591241 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-07
Onset:2021-07-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Information not available in our electronic health record. Patient died on 7/22/2021, medications at time of vaccination not necessary.
Current Illness: Information not available in our electronic health record. Patient died on 7/22/2021.
Preexisting Conditions: Information not available in our electronic health record. Patient died on 7/22/2021.
Allergies: Information not available in our electronic health record. Patient died on 7/22/2021.
Diagnostic Lab Data: Cause of death not documented. Not information about previously COVID-19 positive, predisposing factors, hospitalization history, and co-morbidities on the electronic health record. No adverse events during the observation period after administration of the vaccine. No primary care provider listed. Death documented on our EHR on 08/02/2021.
CDC Split Type:

Write-up: Cause of death not documented. Not information about previously COVID-19 positive, predisposing factors, hospitalization history, and co-morbidities on the electronic health record. No adverse events during the observation period after administration of the vaccine. No primary care provider listed. Death documented on our EHR on 08/02/2021.


VAERS ID: 1591249 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-08-08
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ativan, Roxanol, albuterol, Gas-X, Mylanta, Tylenol, Maalox, Lopressor, Docusate sodium, miralax
Current Illness:
Preexisting Conditions:
Allergies: Bacitracin, Beef-derived products, Codeine, Loperamide, Neomycin, pork derived products, vicodin, percocet
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1591253 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-08-07
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Calcium Vit D, lisinopril, Norvasc, Trelegy Ellipta, Lopressor, Vanicream, Protopic, Kenalog, Multi Vit, B-Complex tab
Current Illness:
Preexisting Conditions:
Allergies: No known alleriges
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/07/2021.


VAERS ID: 1591258 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-07-30
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / -

Administered by: Private       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: Calcium Carb-Vit D, Mag Chloride, Prednisone, Lipitor, Methotrexate, Arava, folic acid
Current Illness:
Preexisting Conditions:
Allergies: Penicillins and plaquenil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/30/2021.


VAERS ID: 1591262 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-05-01
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Septic Shock Bilateral Pneumonia Acute hypoxic and hypercapnic respiratory failure Bilateral mucous plugging, s/p bronchoscopy Lactic acidosis Left Lung Near whiteout ESRD on IHD, now on CRRT Supratherapeutic INR Thrombocytopenia PMH DM, PVD, CAD, CHF, recent history of Covid
Preexisting Conditions: Mechanical Mitral Valve
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1591265 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-30
Onset:2021-08-01
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lomotil, Norco, Flexeril, Flonase, Calquence, Glucophage, Venclexta, Zovirax, Baraclude, Compazine, Prozac, Privigen
Current Illness:
Preexisting Conditions:
Allergies: Allopruinol, Oxycodone, Diagnostic xray material, Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/01/2021.


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

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

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

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


VAERS ID: 1591410 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-06
Onset:2021-07-15
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-20
   Days after onset: 5
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: AKI, CARDIAC ARRHTHMIA,
Allergies:
Diagnostic Lab Data: POSITIV COVID TEST
CDC Split Type:

Write-up: WEAKNESS


VAERS ID: 1591428 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-07-11
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   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: FERROUS SULFATE XARELTO COREG RAMIPRIL TYLENOL ASPIRIN SEROQUEL LASIX MIRALAX LEVOTHYROXINE
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST


VAERS ID: 1591433 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-27
Onset:2021-07-03
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 12
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: VIT C ASPIRIN PLAVIX WELCHOL ZETIA LOPRESSOR
Current Illness:
Preexisting Conditions: CHF
Allergies: MORPHINE
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: COUGH, RUNNY NOSE, FOR TWO WEEKS, GENERAL MALSIE, BODY ACHE


VAERS ID: 1591528 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-01
Onset:2021-07-25
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 162B2 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, kidney disease, leukemia
Allergies: NKA
Diagnostic Lab Data: covid test, cxr
CDC Split Type:

Write-up: covid symptoms beginning on 7/25/21


VAERS ID: 1591538 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-07-30
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amantadine; amlodipine; gabapentin; haloperidol; Humalog; Levemir; levetiracetam; omeprazole; rosuvastatin; warfarin
Current Illness: unknown
Preexisting Conditions: Aphasia, apical thrombosis, embolic stroke, GERD, HTN, T1DM, hyperlipidemia, schizophrenia
Allergies: Aspirin, hydrochlorothiazide and penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was admitted on 7/30/21 for SARS-CoV-2 and remained hospitalized until 8/16/2021 when he expired.


VAERS ID: 1591539 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-07
Onset:2021-05-12
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJI686 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJI686 / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Cardiac arrest, Death, Dementia Alzheimer's type, Hyperhidrosis, Mental status changes, Osteomyelitis, SARS-CoV-2 test positive, Sepsis, Tachypnoea, Urosepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant 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 (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMHx of Alzehimer ds, CVA and dysphagia , HTN presented w/ AMS per Ag Rhods, Per EMS tachypnic & placed oxygen for comfort, on arrival to ED, alert but tachypnic and diaphoretic, 3 L NC oxygen. Patient is admitted with Sepsis 2/2 urosepsis vs osteomyelitis of the left forefoot + AKI + Abbot positive COVID PNA patient''s son decided his mother should not get surgical intervention and he relayed she wouldn''t want aggressive treatment and placed patient on hospice through SNF
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PMHx of Alzehimer ds, CVA and dysphagia , HTN presented w/ AMS per Ag Rhods, Per EMS tachypnic & placed oxygen for comfort, on arrival to ED, alert but tachypnic and diaphoretic, 3 L NC oxygen. Patient is admitted with Sepsis 2/2 urosepsis vs osteomyelitis of the left forefoot + AKI + Abbot positive COVID PNA patient''s son decided his mother should not get surgical intervention and he relayed she wouldn''t want aggressive treatment and placed patient on hospice through SNF Death: CARDIAC ARREST, END STAGE ALZHEIMER''S DISEASE, DEMENTIA, SEPSIS


VAERS ID: 1591545 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-09
Onset:2021-08-15
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Arthritis, Insomnia
Allergies: Ibuprofen, Peanut oil
Diagnostic Lab Data: Covid positive 8/15
CDC Split Type:

Write-up: Pt was hospitalized with covid 8/15 and died 8/20


VAERS ID: 1591552 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-08-19
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, Kenalog, Klor-Con, Aldactone, Desyrel, Zoloft, Prilosec, Glucophage, Zaroxolyn, Mag-Ox, Crestor, Prinivil, Bumex, aspirin, Zyrtec
Current Illness:
Preexisting Conditions:
Allergies: Vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/19/2021


VAERS ID: 1591564 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-08-07
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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: 2021-08-18
   Days after onset: 11
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 received second covid vaccine on 03/04/2021. Hospital on 8/7/21 with respiratory distress . Positive COVID lab on 8/7/21. Case expired at hospital on 8/18/2021.


VAERS ID: 1591608 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05E214 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Central venous catheter removal, Death, Extra dose administered, Life support, Malaise, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TBD
Current Illness: Humeral bone infection
Preexisting Conditions: Diabetes, high cholesterol,
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is the case of a 76 year old with a history of DM, high cholesterol, and a recent humeral bone infection. The decedent had his PORT removed today after his bone infection appeared to be healed. The decedent did not smoke cigarettes, did not drink alcohol, did not use illicit drugs, did not have depression, and did not have any COVID symptoms. Today the decedent appeared in high spirits after he received his booster/third shot of Moderna. He received it on 8/19/21 at the Pharmacy at 1300 hours. This evening the decedent was with his wife when he told her all of a sudden he felt sick. He started toward the bathroom when she reported hearing a noise from him that "she has never heard before". She heard the decedent collapse and called 911. EMS started ALS and EMS took over. They continued for minutes but he could not be resuscitated and was pronounced on scene. EMS confirmed all of the medications were in order, no concerns of foul play, or any other unnatural death. Jurisdiction is assumed due to vaccination shot within 48 hours. Previous vaccinations received included Moderna on 2/14/21, lot #015M20A, Second shot 3/14/21 lot #044A21A


VAERS ID: 1591620 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-08-15
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had covid vaccine x 2. Last dose on 2/8/21. Admitted to Hospital on 08/15/2021 with covid symptoms. Positive COVID specimen on 8/15/2021. Patient expired at hospital on 8/18/2021.


VAERS ID: 1591660 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-27
Onset:2021-08-17
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received covid vaccine x 2. Last dose on 1/27/21. Admitted to Hospital on 8/9/2021 with covid symptom and tested positive for COVID 19 upon admission. Case expired at hospital on 8/17/2021.


VAERS ID: 1591682 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-13
Onset:2021-08-06
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Bilevel positive airway pressure, COVID-19 pneumonia, Death, Endotracheal intubation, Extubation, Intensive care
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: OBSTRUCTIVE SLEEP APNEA, CHRONIC RESPIRATORY FAILURE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, OBESITY WITH BMI 50.0-59.0, MODERATE PERSISTENT ASTHMA, CORONARY ARTERY DISEASE, CONGESTIVE HEART FAILURE
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9260107

Write-up: 2ND COVID19 VACCINE ADMINISTERED 4/13/2021. ADMITTED TO MEDICAL CENTER ON 08/06/2021 WITH COVID PNEUMONIA AND ACUTE HYPOXIC RESPIRATORY FAILURE. WAS TREATED WITH REMDESEVIR IV, DEXAMETHASONE, AND PLACED ON HIGH FLOW O2. PATIENT DECOMPENSATED, WAS PLACED ON BIPAP, AND THEN TRANSFERRED TO ICU AND INTUBATED. CONTINUED TO HAVE INCREASING VENTILATORY SUPPORT. FAMILY EVENTUALLY REQUESTED COMFORT-FOCUSED CARE. EXTUBATED AND EXPIRED ON 8/18/2021.


VAERS ID: 1591702 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-11
Onset:2021-06-30
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018HRSA / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NO
Preexisting Conditions: chronic lung disease, high blood pressure
Allergies: UNK
Diagnostic Lab Data: 7/6/2021 COVID-19 PCR positive
CDC Split Type:

Write-up: 6/30/2021 symptoms: cough, 7/6/2021 Positive COVID-19 7/19/2021 died


VAERS ID: 1591731 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-13
Onset:2021-07-08
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Dyspnoea, Failure to thrive, Hypoxia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (broad), Respiratory failure (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HF
Allergies: penicillins
Diagnostic Lab Data: covid test, cxr
CDC Split Type:

Write-up: weak, short of breath, failure to thrive, hypoxia leading to hospitalization


VAERS ID: 1591750 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-04
Onset:2021-08-15
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), 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: 2021-08-18
   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:
Current Illness:
Preexisting Conditions: SMALL CELL LUNG CANCER--METASTATIC TO LIVER AND BONE. ON CHEMOTHERAPY. CHRONIC OBSTRUCTIVE PULMONARY DISEASE. CORONARY ARTERY DISEASE.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT RECEIVED SINGLE DOSE OF JANSSEN COVID19 VACCINE ON 5/04/2021. ADMITTED TO MEDICAL CENTER ON 08/15/2021 WITH WORSENING SHORTNESS OF BREATH. TESTED POSITIVE FOR COVID19 ON 08/10/2021 AFTER STARTING CHEMOTHERAPY FOR SMALL CELL LUNG CANCER THE WEEK PRIOR. REQUIRED HI FLOW O2 IN ED, STARTED ON DECADRON, REMDESIVIR, CEFTRIAXONE, AND LASIX. PATIENT HAD PROGRESSIVE RESPIRATORY DECLINE. FAMILY ELECTED TO PURSUE COMFORT MEASURES. PATIENT EXPIRED ON 08/18/2021.


VAERS ID: 1591754 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-13
Onset:2021-07-11
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Cough, Diarrhoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 16
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: COPD,
Allergies: sulfadiazine
Diagnostic Lab Data: cxr, covid test
CDC Split Type:

Write-up: weakness, cough, loose stools


VAERS ID: 1591831 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-07-10
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, 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 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 20
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: COPD, stage 4 melanoma
Allergies: NKA
Diagnostic Lab Data: cxr, covid test
CDC Split Type:

Write-up: SOB, fever


VAERS ID: 1591854 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-08-05
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization 8/5/21 on dexamethasone 6 gm IV daily for 10 days and Remdesivir for 5 days; expired 8/17/21


VAERS ID: 1591913 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-08-07
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, COVID-19, Cough, Death, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CAD, HTN, DM, CVA (with residual left sided deficits)
Allergies: heparin
Diagnostic Lab Data: 8/7/2021: SARS CoV 2 PCR COVID-19 Positive
CDC Split Type:

Write-up: 8/7/2021: Patient is a pleasant 82-year-old male c significant past medical history of CVA c left-sided deficits, P 80, hypertension, hyperlipidemia, diabetes, heart failure, carotid artery disease history of endarterectomy. Patient presents to Hospital from nursing home for slight cough. He did test positive for COVID on 8/7/2021 but is been satting well on room air. Chest x-ray is still in progress. Laboratory significant for a dramatic increase in creatinine. Creatinine of 3.42 on 08/07 which has increased from 1.84 2 days prior. 8/12/2021: patient to hospice 8/19/2021: patient expired


VAERS ID: 1591931 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-26
Onset:2021-07-26
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, Dyspnoea, General physical health deterioration, Pneumonia, Renal transplant, SARS-CoV-2 antibody test negative, SARS-CoV-2 test positive
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: fluconazole 100 mg QD, furosemide 80 mg QD, gabapentin 100 mg BID, Insulin Lispro sliding scale TID, Mycophenolate 720 mg BID, Oxycodone 5 mg Q4h PRN, Polyethylene glycol 17 grams PRN, Prednisone 5 mg QD, Senna+Docusate PRN, Sulfamethoxazol
Current Illness:
Preexisting Conditions: Hyperlipidemia, Hypertension, Anemia in ESRD, Retinal Edema, Chronic venous hypertension w/ ulcer, Mild intermittent asthma, Seasonal allergies, Type 2 diabetes mellitus, End Stage Renal Disease, Chronic Dialysis, OSA on CPAP, Metabolic bone disease, secondary hyperparathyroidism, hyperkalemia, history fo CVA with residual effects, diverticulosis of colon without diverticulitis, Obesity, Coronary artery disease, GERD, History of Junctional dysrhythmia
Allergies: Chlorhexidine (Dermatitis)
Diagnostic Lab Data: Positive COVID-19 test 07/27 @ 1827 using PCR Positive COVID-19 test 07/30 @ 1220 using PCR Negative SARS CoV2 Antibodies
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: Fully Vaccinated Expired Patient received Pfizer Vaccines on 3/5/2021 and 3/26/2021. Patient had a history of ESRD secondary to diabetes and hypertension, renal transplant on 7/13/2021, and was admitted on 7/26/2021 through ED for worsening shortness of breath, weakness and dyspnea. Patient found to be positive for COVID-19 and pneumonia. Patient was treated with remdesivir, dexamethasone, and piperacillin+Tazobactam. Patient continued to decline and expired on 8/11/2021


VAERS ID: 1591935 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-07
Onset:2021-07-09
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Influenza like illness, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), 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: 16
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: steroids
Current Illness: no
Preexisting Conditions: 2020 hx breast cancer, Lupus, chronic heart, asthma, chronic lung, HTN, diverticulitis, hiatal hernia, anxiety, hypothyroidism
Allergies: unk
Diagnostic Lab Data: COVID-19 positive 07/09/2021
CDC Split Type:

Write-up: presented to ED for triage with "flu-like symptoms 7/9/21, was tested for COVID. Returned on 7/12, admitted, with increased weakness.


VAERS ID: 1592011 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-02
Onset:2021-07-29
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cerebrovascular accident, Death, Dyspnoea, General physical health deterioration, Intensive care, Respiratory syncytial virus test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg QD, Lidoderm Patch QD, Vitamin QD, Pantoprazole 40 mg BID, gabapentin 300 mg BID, Advair DIskus 500/50 one inhalation BID, allopurinol 100 mg QD, VItamin C 500 mg QD, Aspirin 81 mg QD, Atorvastatin 40 mg QD, carvedilol 25
Current Illness:
Preexisting Conditions: Allergic rhinitis, anemia, arthritis, Asthma, Barrett''s esophagus, Basal cell carcinoma, BPH, CAD, Chronic Pain, Carpal Tunnel, Cervical radiculopathy, chronic respiratory failure secondary to OSA, CKD III, COPD, Erectile dysfunction, hypertension, GERD, GOUT, History of Melanoma, hyperlipidemia, macular degeneration, obesity, history of stroke, Type 2 diabetes mellitus,
Allergies: NKDA
Diagnostic Lab Data: COVID Positive Result on 7/29 @1040
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: Fully Vaccinated - Expired from COVID Patient received Pfizer Vaccines on 1/13/2021 and 2/2/2021. Patient has a previous admission from 6/20-7/2 for stroke and RSV and COVID tests were negative at that time. On 7/29/2021 Patient presented to ED with SOB and found to have COVID Pneumonia. Patient was admitted to ICU and treated with Remdesivir, dexamethasone, ceftriaxone, and azithromyicn. Patient continued to decline an on 8/2/2021 family elected for comfort care. Patient expired on 8/5/2021


VAERS ID: 1592025 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-23
Onset:2021-03-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   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: Vyvanse 70mg 1x daily
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1592078 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-12
Onset:2021-06-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Asthenia, Atrial fibrillation, Blood lactic acid, Brain natriuretic peptide increased, Cardiac arrest, Chest pain, Death, Faeces discoloured, Haematocrit decreased, Haemoglobin decreased, International normalised ratio increased, Melaena, Prothrombin time prolonged, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Hypoglycaemia (broad)

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

Write-up: HX: Prior to event pt reported weakness for 5 days post vaccine. On 06/17 c/o chest pain throughout the day. Pt experienced syncopal episode on EMS arrival at home. Afib- Asystole- Cardiac Arrest. Shocked and cowated, transport - ed. Tarry black stool on arrival to ED. Cardiac arrest in ED, CPR initiated- ACLS algorithm followed. Lab h/h 2.8/10.4, APTT 5635, PT 17.5, INR 1.4, BNP POCT 308, LACTIC ACID 20.00 /Patient died at 8:00 pm 06/21/21. ME accepted the case.


VAERS ID: 1592110 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-05
Onset:2021-07-26
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Pain, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 19
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: Allopurinol 300 mg QD, Amlodipine 5 mg QD, Aspirin 81 mg QD, Atorvastatin 40 mg QD, Carvedilol 6.25 mg BID, Docusate 100 mg BID, Gabapentin 400 mg QD, Metoclopramide 5 mg QD, Miralax 17 grams QD PRN, Sevelamer 3200 mg TID, Apresoline 100 mg
Current Illness:
Preexisting Conditions: Diabetes, ESRD on Dialysis, Hypertension
Allergies: Hydromorphone (Agitation)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID19 resulting in Hospitalization/ Death Patient received Pfizer Vaccines on 4/14/2021 and 5/5/2021. Patient presented to ED on 8/8/2021 with symptom onset 8/6/2021 of SOB, Cough, Fever, Body Aches, diagnosed with COVID-19 and pneumonia. Patient expired on 8/14/2021.


VAERS ID: 1592139 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-14
Onset:2021-04-27
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Diaphragmatic disorder, Myopathy, Myositis, Pneumonia aspiration, Systemic inflammatory response syndrome
SMQs:, Rhabdomyolysis/myopathy (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   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: Suboxone
Current Illness: Ventriculoperitoneal shunt for hydrocephalus and congenital porencephaly
Preexisting Conditions: Hydrocephalus, hypertension
Allergies: unknown
Diagnostic Lab Data: Full autopsy on 04/28/2021
CDC Split Type:

Write-up: Died of aspiration pneumonia due to Diaphragmatic inflammatory myopathy/myositis Systemic inflammatory response Found and pronounced days after the actual death, which probably occurred approximately 5 days after the first shot.


VAERS ID: 1592763 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Progressive dementia
Allergies: None
Diagnostic Lab Data: Contact Hospital. They confirmed all tests and cause of death.
CDC Split Type:

Write-up: Patient suffered a heart attack 18 hours later, and died less than 50 hours after 2nd vaccine injection.


VAERS ID: 1592769 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-29
Onset:2021-06-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004021A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute left ventricular failure, Coagulation test, Computerised tomogram head, Computerised tomogram thorax, Echocardiogram, Electroencephalogram, Full blood count, Generalised tonic-clonic seizure, Magnetic resonance imaging, Metabolic function test, Respiratory failure, X-ray
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (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), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 77
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, diabetes mellitus, anemia, CAD, CVA
Allergies: shellfish, latex, codiene, citrus fruits
Diagnostic Lab Data: EEG, CMP, CBC, Coag studies, X ray, Chest CT, MRI, head CT, echo
CDC Split Type:

Write-up: Patient''s family report that patient developed new onset migraines after first vaccine and then after 2nd vaccination developed seizure disorder with grand mal seizures, acute diastolic heart failure, respiratory failure.


VAERS ID: 1594327 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829146

Write-up: This spontaneous report received from a consumer concerned a patient of an unspecified age, sex, 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) with frequency 1 total administered, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. According to the hearsay on an unspecified date, one patient died from unknown cause of death. It was unknown if autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210829146-Covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1594329 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Suspected COVID-19, Thrombosis, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), 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: Comments: Unknown.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210829189

Write-up: DEATH; BLOOD CLOTS; SUSPECTED CLINICAL VACCINATION FAILURE; COVID RELATED ISSUES; This spontaneous report received from a company representative concerned a 50year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) 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. According to the hearsay, a patient died after taking the Janssen Covid 19 shot some time ago. On an unspecified date, the patient died with Covid related issues (suspected clinical vaccination failure) and he had blood clots. On an unspecified date, the patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and the outcome of covid related issues, blood clots and suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20210829189-COVID-19 VACCINE AD26.COV2.S-death, blood clots. 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). 20210829189-COVID-19 VACCINE AD26.COV2.S-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1594357 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: It was reported that, the patient was fit.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210832457

Write-up: SUSPECTED HEART ATTACK; This spontaneous report received from a company representative concerned a 60 year old male patient. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: It was reported that, the patient was fit. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknow) with frequency as 1 total for prophylactic vaccination. Dose and therapy start date were not reported. The batch number was not reported. Per Procedure, no follow up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient was suspected with heart attack. On an unspecified date, the patient died from suspected heart attack. It was reported that, the patient died within 30 days of receiving vaccine and cause of death was unknown however suspected as heart attack. It was unknown if the 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: 20210832457- covid-19 vaccine ad26.cov2.s-suspected heart attack. 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: SUSPECTED HEART ATTACK


VAERS ID: 1594386 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Coma, Dehydration, Multiple organ dysfunction syndrome, Oxygen saturation, SARS-CoV-2 test, Sepsis, Severe acute respiratory syndrome, Suspected COVID-19, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tumour lysis syndrome (broad), 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: 2021-07-25
   Days after onset: 24
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: ENBREL
Current Illness: Abstains from alcohol; Non-smoker; Rheumatoid arthritis (Enbrel).
Preexisting Conditions: Comments: Patient had no known allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 202107; Test Name: COVID-19 antigen test; Result Unstructured Data: positive to Covid-19; Test Date: 20210717; Test Name: Oxygen saturation; Result Unstructured Data: low.
CDC Split Type: USJNJFOC20210834830

Write-up: COMA; COVID-19 RELATED PNEUMONIA; SEVERE SEPSIS; ACUTE RESPIRATORY SYNDROME; MULTIPLE ORGAN FAILURE; SUSPECTED COVID-19; ACUTE KIDNEY INJURY; THROMBOCYTOPENIA; SEVERELY DEHYDRATED; This spontaneous report received from a consumer concerned a 62 year old White, Not Hispanic or Latino male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: rheumatoid arthritis, non-smoker, and non alcohol user. The patient had no known allergies and no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 201A21A expiry: UNKNOWN) dose was not reported, 1 total administered on 26-MAY-2021 for prophylactic vaccination. Concomitant medications included etanercept for rheumatoid arthritis. On 17-JUL-2021, the patient started feeling chills, fever and throwing up. The oximeter showed that his oxygen levels were low. On The patient was admitted to the hospital and on 18-JUL-2021 the patient was diagnosed with covid-19 related pneumonia. On an unspecified date in JUL-2021, it was reported that the patient was severely dehydrated and had an intravenous (IV), had thrombocytopenia and acute kidney injury. The reporter (spouse) stated that the patient was given 4 liters of oxygen but was not getting better, and hence was put on the ventilator. On JUL-2021, the patient experienced suspected covid-19, multiple organ failure. Laboratory data included: covid-19 antigen test (NR: not provided) positive to Covid-19. On an unspecified date, the patient experienced coma. On 25-JUL-2021, the patient died from covid-19 related pneumonia, severe sepsis, acute respiratory syndrome, suspected covid-19, and multiple organ failure. An autopsy was not performed. The duration of hospitalization was unspecified. The death certificate of the patient had severe sepsis, acute respiratory syndrome and covid-19 related pneumonia. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from coma, thrombocytopenia, acute kidney injury, and severely dehydrated. This report was serious (Death and Hospitalization Caused / Prolonged). This case is associated with a Product Quality Complaint.; Sender''s Comments: V0;20210834830; Covid-19 vaccine ad26.cov2. s, Suspected covid-19, Covid-19 related pneumonia, Acute respiratory syndrome, Severe sepsis, Coma, Thrombocytopenia, Multiple organ failure, Acute kidney injury and Severely dehydrated. This events are considered unassessable. The events have a compatible/suggestive temporal relationship, is unlabeled, and have unknown scientific plausibility. There is no information on any other factors potentially associated with the events.; Reported Cause(s) of Death: COVID-19 RELATED PNEUMONIA; SEVERE SEPSIS; ACUTE RESPIRATORY SYNDROME; SUSPECTED COVID-19; MULTIPLE ORGAN FAILURE


VAERS ID: 1594405 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Headache, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210835168

Write-up: DIED; HEART RACING; HEADACHE; This spontaneous report received from a consumer via a company representative via social media 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, 1 total, start therapy date were not reported for prophylactic vaccination. No concomitant medications were reported. The batch number was not reported. Per procedure, no follow-up will be requested for this case. On an unspecified date, the patient complained of heart racing and headache and the patient died two weeks later. The cause of death was unknown. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unknown cause of death on an unspecified date, and the outcome of heart racing and headache was not reported. This report was serious (Death).; Sender''s Comments: V0 20210835168-COVID-19 VACCINE AD26.COV2.S-died. 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: 1597699 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-12
Onset:2021-03-13
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Blindness, Body temperature, Cerebrovascular accident, Chills, Hyperhidrosis, Myalgia, Nausea, Pneumonia, Pyrexia, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 34
Permanent Disability? Yes
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: Cancer (He has cancer, & got an infusion of Keytruda that day( date not specified))
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210313; Test Name: Body temperature; Result Unstructured Data: High.
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pneumonia; Stroke/couldn''t talk and was blind; Couldn''t talk and was blind; Couldn''t talk; Nausea; Arm was sore at the injection site; He was sweating a lot; Body aches; Temperature was 99.4?F; Had chills; This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Pneumonia), CEREBROVASCULAR ACCIDENT (Stroke/couldn''t talk and was blind) and BLINDNESS (Couldn''t talk and was blind) in an 82-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027L20A and 031L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Cancer (He has cancer, & got an infusion of Keytruda that day( date not specified)). On 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Mar-2021, the patient experienced HYPERHIDROSIS (He was sweating a lot), MYALGIA (Body aches), PYREXIA (Temperature was 99.4?F), CHILLS (Had chills) and VACCINATION SITE PAIN (Arm was sore at the injection site). On 15-Mar-2021, the patient experienced NAUSEA (Nausea). In April 2021, the patient experienced PNEUMONIA (Pneumonia) (seriousness criteria death, hospitalization, medically significant and life threatening), CEREBROVASCULAR ACCIDENT (Stroke/couldn''t talk and was blind) (seriousness criteria death, hospitalization prolonged, medically significant and life threatening), BLINDNESS (Couldn''t talk and was blind) (seriousness criteria disability and medically significant) and APHASIA (Couldn''t talk). The patient was treated with Surgery for Cerebrovascular accident. The patient died on 17-Apr-2021. The reported cause of death was Pneumonia and stroke/couldn''t talk and was blind. It is unknown if an autopsy was performed. At the time of death, BLINDNESS (Couldn''t talk and was blind), APHASIA (Couldn''t talk), HYPERHIDROSIS (He was sweating a lot), MYALGIA (Body aches), PYREXIA (Temperature was 99.4?F), CHILLS (Had chills), NAUSEA (Nausea) and VACCINATION SITE PAIN (Arm was sore at the injection site) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Mar-2021, Body temperature: 99.4 f (High) High. No Concomitant product use was reported. No treatment information was provided. The reporter was calling on behalf of their husband who received their 2nd dose of Moderna vaccine and on that night, their arm was sore at the injection site. The patient''s body temperature was 99.4?F and had chills and developed body aches. Reportedly, the patient was sweating a lot and on 15-Mar-2021 morning, the patient experienced nausea. It was also reported that the patient had cancer and got an infusion of Keytruda that day (Date unspecified). On 05-Aug-2021, the reporter informed that the patient contracted pneumonia in the beginning of Apr-2021 after the patient''s second vaccine. The patient had a stroke on the 5th evening of hospitalization and was transferred to a second hospital where they did surgery. Reportedly, the patient was not able to talk and was blind post-surgery. The reporter also informed that the patient died from getting the COVID vaccine and died on 17-Apr-2021. Company Comment: Very limited information regarding these events has been provided at this time. Patient''s advanced age along with the history of cancer may have been contributory for the occurrence of the events.. This case was linked to MOD-2021-046338 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 05-Aug-2021: Follow-up was received. The case has been upgraded to serious from non-serious. Added the first dose details including the dose start date and batch number. Added new events including Death, pneumonia, stroke, blindness and speech loss and the event outcomes. Added the date of death and the cause of death. Updated the description of event.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Patient''s advanced age along with the history of cancer may have been contributory for the occurrence of the events..; Reported Cause(s) of Death: Pneumonia; Stroke/couldn''t talk and was blind


VAERS ID: 1597748 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Sore arm) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (Sore arm). At the time of the report, PAIN IN EXTREMITY (Sore arm) outcome was unknown. An autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. This case was linked to MOD-2021-043354 (Patient Link). Reporter did not allow further contact


VAERS ID: 1602687 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-10
Onset:2021-03-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Death, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   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: Prednisone, Ativan, morphine
Current Illness: Copd, blood in urine
Preexisting Conditions: Copd, declining health. Symptoms increased to extreme fatigue, Extreme weakness and tremors started after vaccine. Never had tremors prior to vaccine.
Allergies: Nka
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Increasingly weak after receiving vaccine. Tremors started 5 days after vaccine


VAERS ID: 1602904 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-12
Onset:2021-04-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Cardiac stress test, Computerised tomogram, Condition aggravated, Echocardiogram, Fibrin D dimer increased, Hypertension, Renal failure, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Hypertension (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 104
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Welbutrin
Current Illness: none
Preexisting Conditions: Hypertension
Allergies: no
Diagnostic Lab Data: HIgh D-dimer, CT scans, echo heart, stress test and others.
CDC Split Type:

Write-up: Patient developed high D-dimer and blood clots immediately after vaccination. Kidney failure followed shortly thereafter. Went into hypertensive cardiac arrest approximately 3 weeks later. All started with vaccination.


VAERS ID: 1604558 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-16
Onset:2021-07-15
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GWSO217 / UNK AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac failure, Death, Fluid retention
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brought on water retention and heart failure symptoms 3 weeks after second dose. Death on August 5 2021


VAERS ID: 1605742 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   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:
CDC Split Type:

Write-up: Discovered dead approximately 29 hours after receiving vaccine


VAERS ID: 1608978 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-27
Onset:2021-03-29
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthritis, Diarrhoea, Dizziness, Dry eye, Headache, Leukaemia, Muscle spasms, Musculoskeletal stiffness, Nausea, Stomatitis, Suspected COVID-19, Tinnitus, Vertigo
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypersensitivity (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: Arthritis; Tinnitus
Preexisting Conditions: Medical History/Concurrent Conditions: Venous ulcer NOS
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Leukemia/Ldiagnosed Leukemia; Covid-19 Symptoms; Cramps; Diarrhea; Mouth sores,canker sore-like on the roof of her mouth and on backside of the gum behind her back tooth; Pain on right side of her head and feels like a chronic headache; Dry eye; Tinnitus was louder than normal; Vertigo; Light headed; Nauseas/ She still felt queasy; Stiffness in her neck, going up back of her head; Joint pain as an increase in the arthritis pain; This spontaneous case was reported by a patient and describes the occurrence of LEUKAEMIA (Leukemia/Ldiagnosed Leukemia) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 018B21A and 012A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Venous ulcer NOS. Concurrent medical conditions included Arthritis and Tinnitus. On 27-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Mar-2021, the patient experienced ARTHRITIS (Joint pain as an increase in the arthritis pain). On 09-Apr-2021, the patient experienced MUSCULOSKELETAL STIFFNESS (Stiffness in her neck, going up back of her head). On 10-Apr-2021, the patient experienced VERTIGO (Vertigo), DIZZINESS (Light headed) and NAUSEA (Nauseas/ She still felt queasy). On 11-Apr-2021, the patient experienced TINNITUS (Tinnitus was louder than normal) and DRY EYE (Dry eye). On 17-Apr-2021, the patient experienced STOMATITIS (Mouth sores,canker sore-like on the roof of her mouth and on backside of the gum behind her back tooth) and HEADACHE (Pain on right side of her head and feels like a chronic headache). On 19-Apr-2021, the patient experienced DIARRHOEA (Diarrhea) and MUSCLE SPASMS (Cramps). On an unknown date, the patient experienced LEUKAEMIA (Leukemia/Ldiagnosed Leukemia) (seriousness criteria death and medically significant) and SUSPECTED COVID-19 (Covid-19 Symptoms). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. On 11-Apr-2021, VERTIGO (Vertigo), DIZZINESS (Light headed) and NAUSEA (Nauseas/ She still felt queasy) had resolved. The patient died on an unknown date. It is unknown if an autopsy was performed. At the time of death, MUSCULOSKELETAL STIFFNESS (Stiffness in her neck, going up back of her head), DIARRHOEA (Diarrhea), SUSPECTED COVID-19 (Covid-19 Symptoms), TINNITUS (Tinnitus was louder than normal), MUSCLE SPASMS (Cramps), DRY EYE (Dry eye), STOMATITIS (Mouth sores,canker sore-like on the roof of her mouth and on backside of the gum behind her back tooth), ARTHRITIS (Joint pain as an increase in the arthritis pain) and HEADACHE (Pain on right side of her head and feels like a chronic headache) outcome was unknown. Concomitant medications were not provided. Additional treatment information also included the use of unspecified eye drops. Patient was on chemotherapy for 4 weeks. Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded except for the event of Leukemia which the Company believes is unlikely related due to the natural course of the disease. This case was linked to US-MODERNATX, INC.-MOD-2021-080458 (E2B Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 03-Aug-2021: Significant followup contains new event Leukamia with outcome fatal. On 03-Aug-2021: Follow up received included no new significant information. On 03-Aug-2021: Non Significant follow up appended included no new significant information (AE contact info updated); Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded except for the event of Leukemia which the Company believes is unlikely related due to the natural course of the disease. US-MODERNATX, INC.-MOD-2021-080458:Husband case


VAERS ID: 1617434 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-25
Onset:2021-07-23
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Bacterial test positive, COVID-19, Cerebral infarction, Chills, Computerised tomogram head abnormal, Computerised tomogram thorax normal, Death, Endotracheal intubation, Fatigue, Haemoglobin decreased, Infection, Intensive care, Loss of personal independence in daily activities, Lung disorder, Mycetoma mycotic, Oropharyngeal pain, Pneumonia, Post procedural haemorrhage, Pyrexia, Rash, Respiratory failure, SARS-CoV-2 test positive, Staphylococcal infection, Subdural haematoma, Suture insertion, Thrombocytopenia, Tracheostomy, Transfusion, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 29 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: clindamycin (CLEOCIN) 150 MG Oral Capsule Take 3 capsules by mouth 3 times daily at 8 AM, 2 PM, & 10 PM for 10 days cyanocobalamin (VITAMIN B-12) 500 MCG Oral Tablet Take 1 tablet by mouth daily. 5/3/21 folic acid 1 MG Oral Tablet Take
Current Illness:
Preexisting Conditions: Anemia H/H 10.7/34.6 (9/1/20) ? Asthma ? B12 deficiency ? Blood transfusion without reported diagnosis ? Fall 7/25/2020 ? Pulmonary Mycobacterium avium complex (MAC) infection 11/2016 ? Traumatic hematoma of left forearm 07/13/2018
Allergies: Linezolid
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 08/18/21
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. She received J&J vaccine on 05/25/21. Hospitalized from 07/23/21 - 08/21/21 (death). Below is copied from discharge (death) summary: Patient 47 y.o. female with PMH of asthma, MAC PNA, and MRSA PNA (treatment course above) admitted to Hospital on 07/24/2021 for evaluation of progressive fatigue of 2 weeks, generalized weakness limiting activities of daily living. Found to be COVID positive. She recived J&J COVID-19 vaccination 5/25/21. Pt also noted to have a fever of 101, chills, and sore throat. Patient has been followed by pulmonary service for pulmonary cavitary lesions, MRSA, and MAC. Pt went to PCP and told her to go to ED. Patient admitted to Hospital North campus. Pulm and ID consulted this admission. CT chest with mycetomas noted. IV abx given per ID recs. BAL done 07/27 cx growing MRSA put on Bactrim, which was transitioned to Vanc, Zosyn, and minocycline given worsening thrombocytopenia. MICU consulted for worsening respiratory status and increasing oxygen requirements. 8/10/2021 ED Intubated in the setting of respiratory failure and transferred to MICU for further management. On 8/12 CT Head showed 3.4mm thickness subdural hematoma in the R frontal with occipital infarcts. S/p BAL with MRSA, started on linezold. 8/15 Transitioned from Zyvox to Bactrim due to rash, for treatment of superimposed pneumonia with MRSA on BAL. Pt transitioned to PS 8/16 and tolerated well. After discussion w family, they would like to proceed with tracheostomy. Pt has increasing WBC this AM. Respiratory cultures. Tracheostomy placed 8/20 with minimal blood loss 8/20, 95/39 MAP 59 200mcg phenylephrine given plus 100 more Pt was found to be bleeding through her tracheostomy tube, surgery consulted and placed sutures, bleeding slightly decrease Hbg 6.8 1U blood trans 8/21/2021: Patient''s family visited at bedside, and then proceeded to the family counseling room. After an extensive discussion regarding the patients status and prognosis, the family (Pt''s mother, father, and daughter) decided to compassionately wean the patient. A morphine drip was started, pressors, and O2 were weaned. The patient expired shortly after.


VAERS ID: 1617479 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-10
Onset:2021-08-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Atypical pneumonia, B-cell lymphoma, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic lymphocytic leukaemia, Computerised tomogram abdomen abnormal, Death, Dyspnoea, Flow cytometry, Hyperkalaemia, Hypertension, Leukocytosis, Lymphadenopathy, Nucleic acid test, Obesity, Organ failure, Patient isolation, Pneumonia, Pulse abnormal, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Sepsis, Unresponsive to stimuli, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 11
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: amLODIPine (NORVASC) 10 MG PO Tablet Take 1 tablet by mouth once for 1 dose. 8/9/19 8/9/19 hydroCHLOROthiazide (HYDRODIURIL) 12.5 MG PO Tablet Take 2 tablets by mouth daily for 30 days. 8/9/19 9/8/19
Current Illness:
Preexisting Conditions: Edema 8/22/2014 HTN (hypertension) 8/22/2014
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, Detected: 07/31/21
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. She received the Moderna vaccine (2nd dose in series) on 07/10/21. Hospitalized from 08/01/21 - 08/12/21 (discharged and then admitted 2 hours later, result was death in ED). Below is copied from discharge summary: Patient is a 50 y/o morbidly obese female admitted on 8/2/2021 due to acute respiratory failure due to COVID 19 pneumonia. Severe Sepsis with acute organ dysfunction/ Acute respiratory failure with hypoxia 2/2 COVID 19: - Now on 4L , oxygen delivered at bedside - Chest Xray showed bilateral atypical findings - CRP 63, sed rate 22. - DVT ppx given while inpatient - dexamethasone completed x10 days on 8/10/2021 - atorvastatin given during admission - Completed Remdesevir 8/5/2021 - Isolation Chronic lymphocytic leukemia - Leukocytosis due to CLL Flow cytometry with CD+5 mature B cell lymphoma CT abdomen showing lymphadenopathy Out patient hematology follow up, no need for acute intervention AKI: resolved -Cr back to baseline Hyperkalemia: -Resolved Arterial hypertension -Controlled - continue amlodipine + HCTz Morbid Obesity, BMI of$g 40s: -would benefit from lifestyles modifications regarding low fat diet, weight loss and daily excercise -F/U with PCP Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge. ED admission 2 hours later: 50 y.o. female presents c/o SOB. Pt was discharged from hospital today and was known covid positive. She was discharged with home O2. At home, patient''s mother noticed that she was having more difficulty breathing than usual, prompting her to call 911. Pt arrived via EMS, which states she became unresponsive on arrival with a faint pulse. She quickly lost her pulse after her arrival here. Hx limited by events/condition of patient. The history is provided by the EMS personnel, a parent and medical records. The history is limited by the condition of the patient.


VAERS ID: 1617486 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-25
Onset:2021-07-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest pain, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   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: PERSCRIPTIONS; CARVEDILOL, FUROSEMIDE, LISINOPRIL, SPIRONOLACTONE. DIETARY SUPPLEMENTS; SELENIUM, THIAMIN, FISH OIL, GARLIC, CINIMMON, VITAMIN B-1, C, D, MULTIVITAMIN WITH CALCIUM, MAGNESIUM, ZINC, AND LUTHEUM.
Current Illness: PREVIOUSLY DIAGNOSED WITHCONGESTIVE HEART FAILURE.
Preexisting Conditions: PREVIOUSLY DIAGNOSED WITHCONGESTIVE HEART FAILURE.
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: NEXT DAY AFTER RECIEVING THE VACCINE, MY FATHER EXPERIENCED CHEST PAIN, SHORTNESS OF BREATH, AND WEAKNESS. DUE TO MY FATHER BEING BLIND, HE WAS NOT PROPERLY INFORMED OF ALL THE POTENTIAL RISK, AND SIDE EFFECTS BY THE CLINIC. THE CLINIC GAVE HIM LITERATURE ON THIS, BUT HE COULDNT SEE TO READ ALL THE SIDE EFFECTS THAT MAY BE CAUSED BY TAKING THIS VACCINE, NOT KNOWING HOW CRITICAL IT WAS TO BE SEEN BY A PHYSICIAN, HE STAYED HOME. CONTINUED TO HAVE SHORTNESS OF BREATH, AND WEAKNESS SYMPTOMS UNTIL HE PASSED. MY FATHER DIED ON 8/9/2021.


VAERS ID: 1617525 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-03
Onset:2021-03-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient is not responsive on March 4, 2021 around 8:30 pm. He is not breathing, preformed CPR and call 911 right away. Then the police and ambulance came. The paramedics tried to save him by electrical cardioversion. However, he died. Later the coroner came and she made a call to funeral service. At the end, the funeral service people came and took his body away.


VAERS ID: 1617531 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-22
Onset:2021-04-01
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M2OA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Computerised tomogram, Death, Organ failure, Septic shock
SMQs:, Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 2
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: Jardiance, Glucotrol, Levothyroxine, Omeprazole, Korcon, Amlodipine, Vitamin D supplements, Vitamin B supplements
Current Illness:
Preexisting Conditions: Diabetic, 10+ year cancer survivor, high blood pressure
Allergies: Not known
Diagnostic Lab Data: Blood tests, CT scans from 4/1/21 to 4/3/21. Please ask Hospital for a full list of tests and lab results.
CDC Split Type:

Write-up: Severe septic shock, followed by death. Stomach pain, followed by hospitalization, gradual organ failure, septic shock and death.


VAERS ID: 1617585 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-29
Onset:2021-05-31
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Autopsy performed
CDC Split Type:

Write-up: Dilated cardiomyopathy- right ventricle. CAUSED DEATH!!!! Complained of a headache and tired two hours prior.


VAERS ID: 1617843 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-02
Onset:2021-08-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Death, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burning in chest, vomiting. Death


VAERS ID: 1622381 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Malaise
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 65
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Heart disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Feeling sick after the Modena vaccine; Stomachache; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of ABDOMINAL PAIN UPPER (Stomachache) and MALAISE (Feeling sick after the Modena vaccine) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028A21A) for COVID-19 vaccination. Concurrent medical conditions included Heart disorder. On 25-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In April 2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ABDOMINAL PAIN UPPER (Stomachache). On an unknown date, the patient experienced MALAISE (Feeling sick after the Modena vaccine). At the time of the report, ABDOMINAL PAIN UPPER (Stomachache) and MALAISE (Feeling sick after the Modena vaccine) outcome was unknown. Concomitant product use was not provided by the reporter. After 2-3 weeks of vaccination patient experienced stomachache, patient thought this was indigestion or pancreatitis. Patient contacted doctor online. Patient''s condition aggravated after second dose and died on 05-Jun-2021. No treatment was provided. Action taken with mRNA-1273 in response to the events was not Applicable. This case was linked to MOD-2021-211616 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 07-Jun-2021: Follow up information received on 07-May-2021 had a new event feeling sick after the Modena vaccine was added to the case.


VAERS ID: 1622738 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-10
Onset:2021-08-19
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown at this time
Current Illness: None
Preexisting Conditions: Htn, dm2, copd, afib, neuropathy , chronic back pain
Allergies: None
Diagnostic Lab Data: Autopsy denied by coroner despite 3 vaccines deaths reported by officer on scene.
CDC Split Type:

Write-up: Sudden death


VAERS ID: 1623388 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Death, Headache, Internal haemorrhage, Nausea, Organ failure, Thrombosis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisentapril
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: Blood Work 03/07/2021
CDC Split Type:

Write-up: Pt.''s daughter states that after her Mother received the 2nd dose of Moderna 03/04/2021, started experiencing symptoms 03/05/2021 with nausea, vomiting, and severe headache. ER visit 03/07/2021 noted internal bleeding (treated with coils) 03/15/2021 discharged. Blood clot located *heparin treated. No resolve, made comfortable and passed away 03/18/2021 03:00pm. Blood Clot blocking blood flow to bowels. No noted Autopsy, Cause of Death listed (Organ Failure)


VAERS ID: 1623471 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-08-04
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Arteriosclerosis coronary artery, Atelectasis, Atypical pneumonia, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Chest tube insertion, Echocardiogram abnormal, Endotracheal intubation, Fluid overload, Goitre, Interstitial lung disease, Lung consolidation, Lung infiltration, Lung opacity, Pericardial effusion, Pleural effusion, Pneumomediastinum, Pneumonia, Pneumothorax, Pulmonary congestion, Pulmonary oedema, Scan with contrast abnormal, Subcutaneous emphysema, Thrombophlebitis superficial, Thrombosis, Thyroid calcification, Ultrasound Doppler abnormal, Vascular calcification
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD B-12 drops Gabapentin 300 mg BID Gabapentin 900 mg QHS Imdur 30 mg 24H tabpet QD Hyzaar 100/12.5 mg QD Lovastatin 40 mg QD Omega 3 fish oil 100/160/1000 mg QD Potassium chloride 20 MEQ QD Trazodone 160 mg QHS Effexor-XR 150
Current Illness:
Preexisting Conditions: DMII without insulin Vascular disease High blood pressure
Allergies: Sulfa drugs
Diagnostic Lab Data: 8/9/2021 Echo 2D: 1: Extensive interstitial and alveolar infiltrates throughout both lungs. This may represent pneumonic infiltrate and/or pulmonary edema. 2: Trace pleural fluid 3: Cardiomegaly with coronary artery and other vascular calcifications and trace pericardial effusion. 4: No evidence of pneumothorax or pneumomediastinum. 8/4/2021 Portable CXR: Hazy opacity in the left lung baser possibly due to a small pleural effusion associated with atelectasis or pneumonia. Patchy opacities in the midlung fields bilaterally possibly related to atelectasis or pneumonia. Cardiac silhouette is enlarged. 8/6/2021 Portable CXR: 1: Cardiomegaly 2: Marked worsening of bilateral upper lobe perihilar interstitial patchy opacities. Worsening of bibasilar infrahilar interstitial patchy opacities. This would be suspicious for worsening multifocal pneumonia including atypical viral etiology and/or pulmonary edema. 8/7/2021 Portable CXR: There is stable and significant bilateral vascular congestion, suspicious for underlying changes of volume overload. Superimposed infiltrates in the right upper, mid, and lower lung zone and in the left perihilar region are noted. 8/8/2021 Portable CXR: Congestive heart failure. No significant change. 8/9/2021 Portable CXR: Extensive interstitial and bilateral airspace disease is similar though has mildly improved relative to 8/8/2021. This again likely reflects at least a component of infection, though edema could also be contributing to this appearance. 8/10/2021 Portable CXR: Interval worsening in the diffuse groundglass infiltrates throughout the lungs is present. Findings suggest worsening infectious and/or edematous process. 8/10/2021 Portable CXR: 1: Endotracheal tube in place. 2: Extensive bilateral airspace disease, stable since earlier today and again infectious in appearance. 3: Pneumomediastinum, also present previously. 8/11/2021 Portable CXR: There has been interval development of a moderate to large pneumothorax. 8/12/2021 Portable CXR: 1: No pneumothorax. 2: Persistent diffuse interstitial infiltrates with superimposed left lower lobe atelectasis/consolidation. 8/13/2021 Portable CXR: 1: There is minimal right apical pneumothorax which is probably better delineated on today''s exam and is likely unchanged. 2: There is relative stability of the bilateral interstitial and alveolar infiltrates. 8/15/2021 Portable CXR: No significant change. 8/16/2021 Portable CXR: 1: Endotracheal tube in place as above. 2: Extensive opacity throughout both lungs appearing increased. 8/17/2021 Portable CXR: No significant interval change 8/18/2021 Portable CXR: No significant interval change 8/19/2021 Portable CXR: 1: Worsening pneumomediastinum with development of subcutaneous emphysema in the soft tissue of the neck. 2: Right-sided chest tube in place without pneumothorax. 3: Persistent extensive interstitial infiltrates with left lower lobe atelectasis. 8/9/2021 CTA chest with contrast: No evidence of central pulmonary embolism. Assessment of branches of pulmonary artery distal to the segmental branches are limited due to suboptimal contrast. Bilateral diffuse groundglass opacities in the lung parenchyma, with consolidation in the mid to lower lung on both sides, due to COVID-19 pneumonia. Mild to moderate pneumomediastinum extending to the base of the neck. Cardiomegaly with trace amount of pericardial effusion. Goitrous change of bilateral thyroid glands with calcification on the left measuring 4.4 mm. 8/10/2021 VL lower extremity venous imaging bilateral: 1: Thrombus within right gastrocnemius vein with is a branch vessel of the right popliteal vein. 2: Thrombus proximal left greater saphenous vein at a level estimated to be within approximately 5 cm. of the junction with the left common femoral vein. 3: Thrombus within a superficial vein at the level of the distal left calf likely in the distal left grater saphenous vein. 4: Portions of the mid to distal left femoral vein could bot be adequately imaged for assessment as detailed above.
CDC Split Type:

Write-up: Acute respiratory failure secondary to COVID-19 infection


VAERS ID: 1623476 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-10
Onset:2021-04-04
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A AND 001 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: high blood pressure
Allergies: unknown
Diagnostic Lab Data: NO TESTS WERE DONE BECAUSE OUR MOTHER WAS CREMATED BEFORE WE COULD REQUEST TESTING
CDC Split Type:

Write-up: DEATH


VAERS ID: 1623489 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-05
Onset:2021-08-01
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood fibrinogen increased, International normalised ratio increased, Malaise, Productive cough, Prothrombin time prolonged, Retching
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: A. Fib, Glaucoma, Goiter, HTN, Osteoporosis, Post menopausal bleeding, Obesity,
Allergies: No
Diagnostic Lab Data: PT $g90.0, INR $g8.0. Fibrinogen 622.0
CDC Split Type:

Write-up: Patient became sick aroun 8/5. Not tested for COVID, but quarantined. Came into ED extreme weakness, productive cough, dry heaves. Oxygen was 89% room air


VAERS ID: 1623505 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-25
Onset:2021-08-10
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, COVID-19, Cardiac arrest, Cardio-respiratory arrest, Cough, Death, Dyspnoea, Myalgia, Oxygen saturation decreased, Pulseless electrical activity, Resuscitation, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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: acetaminophen, apixaban, vitamin C, aspirin, atorvastatin, bisacodyl, furosemide, levothyroxine, midodrine, niacin, nitroglycerin, fish oil
Current Illness:
Preexisting Conditions: HTN, CAD, Hyperlipidemia, Arrhythmia, Thyroid
Allergies: NKA
Diagnostic Lab Data: SARS CoV2 PCR COVID19 detected on 8/10/21
CDC Split Type:

Write-up: 8/10/21: He developed SOB, cough, and muscle aches, starting 3 days ago. He was referred to ER, where he was admitted on 8/10/21. Tested positive for COVID-19 on 8/10/21. 8/18/21: waxing and waning mentation, requires non-rebreather mask and desaturates quickly. In the afternoon of 8/18/21, he was found in cardiac arrest, PEA and code was called. Family requested to stop resuscitation given his age and poor prognosis. Time of death was called at 1628. Note: He received Pfizer vaccines on 2/3/21 and 2/25/21.


VAERS ID: 1623508 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-30
Onset:2021-08-21
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / N/A UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Death, General physical health deterioration, Oxygen saturation decreased, Rales, Respiration abnormal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Vascular dementia, Alzheimer''s disease, dysphagia, major depressive disorder, hypertension, type 2 diabetes
Allergies: Penicillins, sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident was diagnosed with COVID-19 on 8/19/2021. Code status DNR with comfort measures. Began taking Recephin due to cough and crackles in lung bases on 8/20/2021. On 8/21/2021, resident began purse lip breathing and O2 sat dropped to low 80s. Continued to decline and passed away morning of 8/22/2021.


VAERS ID: 1623587 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-10
Onset:2021-07-29
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chest pain, Confusional state, Death, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received Pfizer Dose 1 on 2/16/21 and Dose 2 on 3/10/21. On 7/29/21 she had chest pain and confusion. She was taken to the ER - diagnosed w/ "little pneumonia." While still in the hospital, she wasn''t tested for COVID until 8/2 when she tested positive. Client passed away on 8/8 with "Acute Hypoxemic Respiratory Failure due to COVID-19."


VAERS ID: 1623625 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-05-04
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EF9231 / 2 LA / IM

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

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

Write-up: Patient deceased on 5/4/21 - learned of this on 8/23/21 and filed report. Unknown cause of death.


VAERS ID: 1623756 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-05
Onset:2021-06-06
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: 12 hours, back pain.


VAERS ID: 1623771 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-03-25
Onset:2021-08-03
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 15
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: Diabetes
Allergies:
Diagnostic Lab Data: Covid 19
CDC Split Type:

Write-up: Covid 19 pneumonia


VAERS ID: 1623782 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-07
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Angiogram pulmonary normal, Atelectasis, COVID-19, Cardiac failure congestive, Deep vein thrombosis, Hyponatraemia, Lung opacity, Pleural effusion, Pneumonia viral, Scan with contrast normal, Septic shock, Ultrasound Doppler abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (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), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD Atorvastatin 20 mg QD Donepezil 5 mg QHS Metoprolol 25 mg 24H tablet QD Valsartan-HCTZ 160/12.5 mg QD
Current Illness: Unknown
Preexisting Conditions: Vascular disease Alzheimers High blood pressure
Allergies: Unknown
Diagnostic Lab Data: 8/6/2021: CTA chest pulmonary embolism with contrast: No evidence of pulmonary embolism. There are small bilateral pleural effusions and bibasilar atelectasis. Geographic areas of groundglass attenuation are noted throughout both lungs suspicious for pneumonia, congestive heart failure, or other inflammatory process. 8/10/2021 VL lower extremity bilateral venous imaging: 1: Popliteal vein DVT. 2: No sonographic evidence of left lower extremity DVT.
CDC Split Type:

Write-up: Discharge diagnosis: Acute hypoxic respiratory failure secondary to viral pneumonia in the setting of COVID-19 Acute kidney injury Septic shock Right popliteal DVT Hyponatremia


VAERS ID: 1623874 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JSN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   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: ASA, Dabigatran, Dexamethasone, Septra
Current Illness: Covid Pneumonia, PE
Preexisting Conditions: DM, AF, HTN, HIV, Hypothyroidism
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Died the day after receiving the vaccine


VAERS ID: 1624009 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-13
Onset:2021-07-10
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Asymptomatic COVID-19, Bladder dilatation, Emphysematous cystitis, Mental status changes, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: 2021-07-15
   Days after onset: 5
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: Unk
Current Illness: Unk
Preexisting Conditions: dementia, chronic heart failure, pulmonary HTN, sick sinus syndrome after pacemaker placement
Allergies: Unk
Diagnostic Lab Data: 7/10/2021 Positive COVID-19 PCR
CDC Split Type:

Write-up: Case is hospitalized at Hospital. Per EMR, case was admitted for weakness and altered mental status; also complaining of abdominal pain. "CT of the abd was done in the ED which shows distended bladder with emphysematous cystitis." It was later documented in EMR that case had "asymptomatic COVID".


VAERS ID: 1624023 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Malaise
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: Ambien, Lisinopril, Xymbalta, Xanax, Tylenol#4, Tizanidine
Current Illness: Hypertensive cardiovascular disease
Preexisting Conditions: HYpertension
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased began to not feel wall after the vaccine. Patient died on May 10, 2021


VAERS ID: 1624122 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-08-18
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   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: N/A
Current Illness:
Preexisting Conditions: Obesity
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Expired


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