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

Found 14,925 cases where Vaccine is COVID19 and Patient Died



Case Details

This is page 63 out of 150

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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


VAERS ID: 1624134 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 7
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: Valsartan
Current Illness:
Preexisting Conditions: hypertension and obesity
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath and weakness


VAERS ID: 1624176 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-07-23
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALPRAZolam Oral (Tablet 0.25 mg) 1 tablet, q12h as needed. Aspirin Oral 325 mg, daily. AzaTHIOprine Oral. B12-Active Oral. ClonazePAM Oral. Home O2 @ 3LPM. Meloxicam Oral. Olmesartan-Amlodipine-HCTZ Oral. PredniSONE Oral. Sulfamethoxazole
Current Illness: Hypertension. Fibromyalgia. Pancreatitis. Paroxysmal Supraventricular Tachycardia. Osteoporosis. Depression. Thyroid Disease. BOOP: (Bronchiolitis obliterans organizing pneumonia).
Preexisting Conditions: Hypertension. Fibromyalgia. Pancreatitis. Paroxysmal Supraventricular Tachycardia. Osteoporosis. Depression. Thyroid Disease. BOOP: (Bronchiolitis obliterans organizing pneumonia).
Allergies: NKDA
Diagnostic Lab Data: SARS Antigen test (+) on 7/25/21
CDC Split Type:

Write-up: Respiratory failure due to Covid pneumonia; Hospitalized 7 days; deceased


VAERS ID: 1624181 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-29
Onset:2021-08-07
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B2A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 0
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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Autopsy was done and family was told she had blood clots were in her heart .
CDC Split Type:

Write-up: Patient Passed on august .


VAERS ID: 1624286 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots in both lungs.


VAERS ID: 1624304 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-02
Onset:2021-08-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, COVID-19, Death, Diarrhoea, Pulmonary embolism, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? Yes
Died? Yes
   Date died: 2021-08-09
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dexamethasone, Loxitane, Ativan, Seroquel, Prilosec, Zoloft, Minipress, Prolia (6 mo injection), Potassium Chloride, Vitamin D, Calcium/Magnesium.
Current Illness: None other than clinical diagnoses (see below)
Preexisting Conditions: Congenital Adrenal Hyperplasia$g21-Hydroxylase deficiency, CVA, White Matter Periventricular Infarction, Meningioma, Lung Nodule, Hyperlipidemia, Gastritis and Gastroduodentitis, GI AVM, GI Bleed, Melena, Diverticulosis.
Allergies: Aspirin, Codeine, Escitalopram, Lodine, Olanzapine, Zyprexa, Risperidone.
Diagnostic Lab Data: COVID-19 Positive Autopsy finding: Pulmonary Embolism (Cause of Death).
CDC Split Type:

Write-up: Vomiting and Diarrhea 08/03-08/09. Found dead at residence on 08/09.


VAERS ID: 1624319 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-20
Onset:2021-05-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Ammonia increased, Arrhythmia, Autopsy, Blood glucose increased, Blood lactic acid, Carbon dioxide decreased, Chest X-ray abnormal, Computerised tomogram head normal, Death, Endotracheal intubation, Loss of consciousness, Myocarditis, Procalcitonin, Resuscitation, Seizure, Seizure like phenomena, Status epilepticus
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blisovi 24 FE BCP OTC once daily multivitamin
Current Illness: no significant illnesses known in 1 mos prior to event
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: ct head negative cxr with mild pulm vasc redistribution but no acute processes CO2 10 glc 248 ammonia 129 lactic acid 13.5 procalcitonin 0.01
CDC Split Type:

Write-up: er records indicate pt noted to pass out with seizure like activity, taken to er and found in status epilepticus, stabilized and transferred to tertiary care facility. tertiary center records not yet available but report from family indicates ongoing seizures as well as recalcitrant cardiac arrhythmias. Pt was intubated and never recovered despite 3 days care and resuscitation. Autopsy report available to me indicates lymphocytic myocarditis as primary cause of death


VAERS ID: 1624351 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-23
Onset:2021-07-08
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Intracardiac thrombus
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis; Valsartin; Pantoprozola; Sertraline; Levothyroxine; Percocet; Gabapentin; Metoprolol; Iron; zinc
Current Illness: high heart rate
Preexisting Conditions: Chronic back pain; AFib; high blood pressure
Allergies: Penicillin
Diagnostic Lab Data: CT scan of heart
CDC Split Type:

Write-up: Blood clot in heart


VAERS ID: 1624537 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-06-08
Onset:2021-07-31
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / -

Administered by: Private       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: 2021-07-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death


VAERS ID: 1624538 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-22
Onset:2021-07-12
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypercapnia, Hypoxia, Pyrexia, Renal replacement therapy
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate 35mg 1 QWeek, Vitamin C 500mg BID, Aspirin 81mg daily, atovaquone 750mg/5ml BID, Azithromycin 250mg 1 tab T,TH, SAT, Bre Ellipta 100-25mcg 1 puff daily, folic acid 1 mg daily, gabapentin 300mg 2 capsules TID, Humalog 1-4 units Q
Current Illness:
Preexisting Conditions: left lung transplant, sarcoidosis, COPD, ILD, OSA on CPAP, CHF s/p AICD, HTN, HLD, DM
Allergies: Adhesives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: Patient received Pfizer Vaccines on 1/26/2021 and 2/22/2021. Patient presented to ED on 07/12/2021 with SOB (starting 3 days ago), cough, and fever. Patient received remdesivir x 5 days and was dosed with actemra on 7/20. Patient also completed azithromycin x 5 days and cefepime x 7days. 7/22/21: Patient was intubated on 7/22/21, proned on 7/23/21, started on CRRT on 7/25/21. Pt declined and was found to have worsening hypercapnia and hypoxia despite full support. Patient expired 7/27/21.


VAERS ID: 1624591 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-23
Onset:2021-06-24
   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 - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Atrial fibrillation, Blood pressure increased, Cardiac failure congestive, Computerised tomogram, Condition aggravated, Death, Hypoacusis, Investigation, Muscle spasms, Pain in extremity, X-ray
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-19
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, Mybetric, Lasix, Percocet, Symvistatin, Synthroid,
Current Illness: IDDM, Hypothyroidism, Chronic Back pain
Preexisting Conditions: Same as above
Allergies: N/A
Diagnostic Lab Data: cat scan, xrays many more
CDC Split Type:

Write-up: Mom started with pain in her left ankle less than 24 hours after receiving the vaccine. The pain made its way up her leg and after 3 phone calls to 911over the course of 6 days she finally agreed to go to the hospital. These severe leg spasms would last for 3 hours and she had them about 4 times a day. She would state her pain level was a 20. She was admitted to the hospital and the Drs said due to the severe pain her BP was highly elevated and she was in congestive heart failure. She spent 2 weeks in the hospital. Went into A-fib. The spasms stopped exactly 2 weeks after they started but at that point she was so weak from being in bed that they wanted to discharge her to a rehab facility but she would have needed her second vaccine and it wasnt time yet( plus she refused because all her issues seemed to stem from the first vaccine). Or she would have to be in complete quarantine for 14 days and she was hard od hearing and that would not have been good either. So we brought her home for myseld and my sister to care for her. She was independent before this vaccine and needed complete care when she got home. She was home for 6 days and progressivly got worse each day and we had to put her on hospice on the 6 day and she passed that night.


VAERS ID: 1625032 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-23
Onset:2021-03-16
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Biopsy liver, Blood bilirubin increased, Death, Decreased appetite, Fatigue, Hepatic enzyme increased, Hepatic failure, Hepatic lesion, Hepatic mass, Paracentesis
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 146
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodopine, Vitamin D, b-12
Current Illness: None
Preexisting Conditions: Had Harvoni hepatitis C treatment in 2014
Allergies: None
Diagnostic Lab Data: July 22nd was admitted to hospital due to elevated liver enzymes. They did an emergency liver biopsy and paracentesis to diagnosis the cause of the elevated liver enzymes and high bilirubin. He was admitted for 14 days due to the oncologist and heptalogist being confused on how aggressive nodules and lesions were taking over his liver that had no cirrhosis or hepatitis. They had never seen anime this and requested I report it.
CDC Split Type:

Write-up: Loss of appetite after vaccine, fatigue, died of organ (liver) failure.


VAERS ID: 1625270 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-08-10
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute hepatic failure, Anticoagulant therapy, Cerebral venous thrombosis, Death, Infusion, Mesenteric venous occlusion, Superior mesenteric artery syndrome, Thrombectomy
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal obstruction (narrow), Thrombophlebitis (broad), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: HRT
Current Illness:
Preexisting Conditions: Breast Ca s/p resection on HRT (2016)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 month after completing immunization series patient noted with SMA, SMV, and cerebral venous thrombus. Report from outside hospital show that the SMA had collateralization in August suggestive of a chronic occlusion s/p thrombectomy with TPA infusion the patient develped ALF and died on 8/23


VAERS ID: 1627712 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-08-24
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK UN / UN

Administered by: Work       Purchased by: ?
Symptoms: Completed suicide, Immediate post-injection reaction, Suicidal ideation
SMQs:, Suicide/self-injury (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: type 1 Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suicidal ideations began immediately. Suicide by gunshot completed July 27, 2021


VAERS ID: 1627981 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-01
Onset:2021-07-17
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004MA20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 13
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: Tylenol 500mg 1-2 tabs, doxazosin 1mg 1 nightly; losartan 25mg 2 tabs QD, Myfortic 360mg 2 tabs BID, Nifedipine 60mg 1 BID, pravastatin 40mg 1 daily, Prednisone 5mg 1 daily, sodium bicarbonate 650mg 2 tablets TID, Bactrim 400-80mg 1 daily M
Current Illness:
Preexisting Conditions: Renal transplant (2018), hyperlipidemia, hypertension, primary ESRD secondary to analgesic nephropathy
Allergies: Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received Moderna Vaccines on 1/27/2021 and 3/01/2021. Patient transferred from another ED on 7/17/2021 with complaint of body aches, cough, fever, chills, sore throat, and difficulty breathing. Patient was Intubated on 7/22/21. Completed 5 days of Remdesivir on 7/21. Completed vanc/cefepime 10 days on 7/27. Received 14 doses of Decadron. Pt continued to decline and comfort care initiated. Patient expired 7/30/21


VAERS ID: 1627989 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-07-26
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Hypoxia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol MDI, Anoro Ellipta 62.5-25 mcg, fludrocortisone 0.1 mg, Olopatadine 0.1%, Donepezil 5 mg, B Complex Vitamin, Cholecalciferol 2000 units, Dutasteride 0.5 mg, Memantine 10 mg, Methimazole 2.5 mg, Miralax 17 grams
Current Illness:
Preexisting Conditions: COPD, Dementia, hyperthyroidism, BPH, CKD, Basal Cell Carcinoma, Esophageal stricture, REM sleep disorder, squamous cell cancer
Allergies: Bactrim (hives), Tamsulosin (hypotension)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA Patient received Pfizer Vaccines on 1/29/2021 and 3/2/2021. Presented to emergency department on 7/20/2021 with c/o fever and dyspnea x24 hours. Patient had a chest xray and positive COVID-19 test at another facility prior to presentation. Patient was hypoxic at 85% and started on Nasal cannula O2. Patient was treated with Remdesivir and dexamethasone. Patient expired on 7/31/2021.


VAERS ID: 1627995 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-25
Onset:2021-08-07
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Cough, Death, Decreased appetite, Fatigue, Headache, Lung opacity, Pneumonia, Pyrexia, Respiratory distress, Respiratory failure, SARS-CoV-2 test positive, Thirst decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: asprin 81mg chewable daily, carvedilol 12.5mg BID cont.
Current Illness:
Preexisting Conditions: Hx of malignant skin melanoma, COPD, paroxysmal AFIB, CAD, DM II cont.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 2/4/2021 and 2/25/2021. Patient diagnosed with COVID-19 on 8/6/21 presented to ED complaining of worsening repsiratory status over a couple of days. 1 day prior to ED visit pt was given Decadron and discharged from unknown location per provider note. Associated symptoms include headache, cough, fever (T-max 104?), chills, decreased appetite/thirst, abdominal cramping with cough, and fatigue. X-ray shows moderate bilateral airspace opacities left greater than right, most consistent with multilevel low-grade pneumonia in this clinical setting. Pt treated with ceftriaxone, azithromycin x 3days 8/10, solumedrol #4 cont.


VAERS ID: 1628006 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-08-14
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization 8/14-8/22/2021 for acute respiratory failure/pneumonia due to COVID. Treated with dexamethasone 6 mg IV daily; Remdesivir for 5 days. Expired 8/22/2021


VAERS ID: 1628018 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-08-10
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Senior Living       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: 2021-08-21
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Patient diagnosed with symptomatic COVID during LTCF outbreak
Allergies: Unknown
Diagnostic Lab Data: Rapid nasal swab 8/10/21
CDC Split Type:

Write-up: PT succumbed to COVID-19 after diagnosis on 8/10/21 during nursing home outbreak. Pt was hospitalized on 8/13/21


VAERS ID: 1628050 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-05
Onset:2021-07-25
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Convalescent plasma transfusion, Death, Pyrexia, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: 2021-08-05
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban 2.5 mg, cholecalciferol (vitamin D3) 1K units, esomeprazole magnesium 20 mg, loratadine 10 mg, melatonin 5 mg, memantine HCl/donepezil HCl 28-10 mg, multivitamin, simvastatin 40 mg
Current Illness:
Preexisting Conditions: Afib (on Eliquis), CAD s/p PCI to RCA (2010), HTN, HLD, colon cancer s/p colostomy, CKD, and Alzheimer''s dementia
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 2/12/2021 and 3/5/2021. Patient presented to ED on 7/25/21 and diagnosed with COVID-19 pneumonia. Associated symptoms included fever and abdominal pain. X-ray showed development of patchy bilateral alveolar airspace. While in the hospital, patient was treated with remdesivir, ceftriaxone, and azithromycin. On 7/27/21, patient received 1 unit of convalescent plasma transfusion. He was discharged on 7/28/2021. Patient expired on 8/5/21.


VAERS ID: 1628054 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-28
Onset:2021-05-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Brain death, Condition aggravated, Decreased appetite, Dyspnoea, Fatigue, General physical health deterioration, Hypotension, Intensive care, Lung assist device therapy, Magnetic resonance imaging thoracic abnormal, Mechanical ventilation, Myositis, Oxygen saturation decreased, Pneumonia, Renal failure, Withdrawal of life support
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), 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 (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 36
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Birth control (Aurovela Fe)
Current Illness: Had been experiencing seasonal allergies in combination with a skin rash
Preexisting Conditions: seasonal allergies, snoring, pneumonia as a child, parasitic infection (around 2009) that caused joint pain an GI issues
Allergies:
Diagnostic Lab Data: All hospital medical records can be provided in electronic format (pdf) by request.
CDC Split Type:

Write-up: 3-4 days after receiving the vaccine, patient developed shortness of breath, loss of appetite, and fatigue. Patient believed that symptoms were a result of seasonal allergies and contacted PCP for treatment. PCP prescribed prednisone and albuterol. Patient took medication for 4 days without change in symptoms. Follow-up appointment with PCP found patient with low blood oxygen levels and low blood pressure, possible mild fever. patient was sent to ER on 5/21. Patient was admitted with pneumonia of unknown origin. Patient spent 1 week on general care floor with worsening conditions, possible ARDS. Patient was admitted to ICU and put on a ventilator on 5/28. Patient continued to worsen until MRI lead to a diagnosis of Myositis with ILD. Patient was transferred on 6/4 and put on ECMO. Patient health continued to decline (kidney failure) and was pronounced brain dead on morning of 6/7 and family decided to remove patient from life support.


VAERS ID: 1628055 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-08-04
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Convalescent plasma transfusion, Cough, Death, Lung infiltration, Pneumonia, Pulmonary oedema, Pyrexia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone 200 MG, aspirin, atorvastatin calcium 40 mg, benazepril HCl 5 MG, calcium citrate/vitamin D2, clopidogrel bisulfate 75 mg, cyanocobalamin (vitamin B-12) 1,000 mcg 1 tablet, folic acid 1 MG, furosemide 20 mg, glipizide 10 MG, insu
Current Illness:
Preexisting Conditions: Diabetes type 2, hypertension, hyperlipidemia, coronary disease status post MI status post stents
Allergies: Fosamax [alendronate], Levaquin [levofloxacin], Entresto [sacubitril-valsartan], Lodine [etodolac], Amaryl [glimepiride]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 1/25/2021 and 3/2/2021. Patient was admitted to the hospital from 7/20/2021 through 7/24/2021 with COVID. She had some cough and an episode of fever. She was not hypoxic. Her chest x-ray did not show any pneumonia at that time. She was readmitted 07/24/2021 through 7/28/2021 and again 8/4/2021 through 8/8/2021. Chest x-ray on 8/4/2021 showed worsening diffuse bilateral infiltrates most suggestive of multifocal infection and/or edema. While in the hospital, patient was treated with convalescent plasma, ceftriaxone, and doxycycline. Patient expired on 8/8/21.


VAERS ID: 1628061 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-27
Onset:2021-08-02
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, Blood uric acid increased, COVID-19, Cough, Death, Laboratory test abnormal, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Tumour lysis syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, calcium, cyclobenzaprine (flexeril) 10 mg, ergocalciferol, vitamin D2, ketorolac (toradol) 10 mg, magnesium, metoprolol succinate xl (toprol xl) 25 mg, turmeric, vitamin b complex
Current Illness:
Preexisting Conditions: Multiple myeloma, heart failure (HFrEF), breast cancer, atrial fibrillation, recent humerus fracture, DVT
Allergies: Lidocaine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Patient received Moderna COVID Vaccines on 1/30/2021 and 2/27/2021. Patient presented to the ED and was admitted on 8/02/2021 for lab abnormalities (high uric acid and glucose). Patient had a previous admission due to AKI and hyponatremia. Patient tested positive for COVID-19 on 8/3/2021. Patient''s symptoms for COVID-19 were mild/asymptomatic with reports of runny nose, sore throat and mild cough. While in the hospital, patient was treated with remdesivir. Patient expired on 8/14/21.


VAERS ID: 1628068 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-07-10
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: doxycycline (100 mg), albuterol (90 mcg), aspirin (81 mg); atorvastatin calcium (40 mg), azithromycin (250 mg), benzonatate (200 mg), bromphenarimine, (10 mLs), carvedilol (25 mg), cholecalciferol (2,000 IU), clotrimazole, doxycycline hycl
Current Illness:
Preexisting Conditions: Abnormal glucose level, Arteriosclerotic vascular disease, Colonic polyp, Coronary artery disease, GERD, Hyperlipemia, Hypertension, Obesity, Type 2 diabetes mellitus, Vitamin D deficiency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA Patient received Pfizer Vaccines on 1/29/2021 and 2/23/2021. Patient presented to ED on 7/16/2021 with symptom onset 7/10/2021 of cough, diagnosed with COVID-19 and acute hypoxic respiratory failure secondary to COVID-19 pneumonia. While in the hospital, patient was treated with remdesivir, steroids, antibiotics and tocilizumab. Patient expired on 8/5/21.


VAERS ID: 1628076 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-03
Onset:2021-08-14
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

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

Write-up: Vaccinated hospitalized patient expired 8/14/2021


VAERS ID: 1628079 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-25
Onset:2021-07-18
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, General physical health deterioration, Lung opacity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: 2021-08-02
   Days after onset: 15
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: Risedronate (35 mg), Aspirin (81 mg), Lipitor (10 mg), Vitamin D and calcium (600 mg), Lasix, (20 mg) Neurontin (400 mg), Cozaar (100 mg), Toprol-XL (50 mg), Klor-Con (10 MEQ), Levothyroxine (100 mcg), Lamisil (1% cream), Detrol (2 mg), fen
Current Illness:
Preexisting Conditions: Hypertension, TIA (2 episodes in past), hypothyroidism, remote history breast cancer, remote history DVTs
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID19 resulting in Hospitalization/ Death Patient presented to ED on 7/20/2021 complaining of SOB for about two days prior, worsening with increasing cough, abdominal pain and fever. COVID-19 test administered in ED and returned positive, admitted for acute COVID-19 pneumonia and acute respiratory failure with hypoxia. CT Angiogram showed no evidence of PE and had patchy ground glass opacities. Treatment included Decadron, antibiotics, Remdesivir. Patient continued to decline and ultimately expired on 8/2/2021 secondary to Pneumonia due to COVID-19. Vaccines administered on 1/29/2021 & 2/25/2021


VAERS ID: 1628098 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-08-15
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization for COVID pneumonia/hypoxemia 8/15-8/21/2021. Treated with dexamethasone 6 mg IV daily; Remdesivir for 5 days; Expired 08/21/2021.


VAERS ID: 1628140 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-25
Onset:2021-07-19
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Death, Fall, Mental impairment, Oxygen saturation decreased, Pyrexia, Renal impairment, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban 2.5 mg BID, atorvastatin 20 mg QD, Cyanocobalamin, 2000 mcg QD, Calcium Carbonate/Vitamin D3 600mg/100 unit QD, Glimepiride 1 mg QD, Dulaglutide 1.5 mg, Metoprolol 25 mg, Terbinafine 250 mg, Zinc 50 mg
Current Illness:
Preexisting Conditions: Diabetes mellitus with nephropathy, hypertension, prostate cancer, hyperlipidemia, CVA with left hand weakness, atrial
Allergies: Penicillin, Ciprofloxacin, Sulfonamide antibiotics, fibrillation, left bundle branch block
Diagnostic Lab Data: COVID-19 Positive Test Result on 7/20/2021 utilizing the Roche LIAT SARA Assay platform PCR or equivalent nucleic acid amplification technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/29/2021 and 2/25/2021. Presented to ED on 7/19/2021 after a fall. For the past several days prior patient developed a dry cough and fever, pneumonia due to COVID-19 present on admission. Patient treated with remdesivir, dexamethasone, convalescent plasma, ceftriaxone, and azithromycin. Patient continued declining in mental status, renal function, and oxygenation. Patient expired on 7/29/2021.


VAERS ID: 1628171 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-08-05
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

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

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

Write-up: Pt mortality from COVID 19 post COVID vaccination.


VAERS ID: 1628279 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-26
Onset:2021-07-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: Awaiting autopsy results
CDC Split Type:

Write-up: Death 4-12 hours after 1st dose administered on 7/26/21. Body discovered on 7/28/21 at approximately 9:30 am


VAERS ID: 1628338 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-08
Onset:2021-07-13
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   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: steroids, except O2
Current Illness: Unk
Preexisting Conditions: Hx COPD and pulmonary fibrosis. Normally on 4L supplemental O2, Diabetes, morbid obesity, high blood pressure
Allergies: Unk
Diagnostic Lab Data: 7/13/2021 COVID-19 positive PCR
CDC Split Type:

Write-up: 7/13/2021: headache, sore throat, cough, shortness of breath,. admitted to the hospital 7/21/2021 dies


VAERS ID: 1628365 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-28
Onset:2021-08-15
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: 2021-08-15
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated patient deceased from COVID.


VAERS ID: 1628493 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-16
Onset:2021-07-06
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Chills, Constipation, Cough, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Pain, Prone position
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, hypertension, GERD, HLD, arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is currently hospitalized and was admitted on 07/06/2021 due to COVID-19. Updated pt symptoms and pre-existing medical conditions. Pt has a PMH of arthritis, DM, GERD, HLD, and HTN. Pt complained of chills, aches, and pains, constipation, shortness of breath, and dry cough. Per medical records, patient developed rapid worsening hypoxia despite BiPAP support and was intubated on 07/13/2021 and proned. Patient died.


VAERS ID: 1628577 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-04-16
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Choking, Death, Mouth haemorrhage
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not sure
Current Illness: Type 2 diabetes
Preexisting Conditions: Type 2 diabetes
Allergies: None
Diagnostic Lab Data: None. Medical Examiner refused to conduct autopsy even after the family begged for it to be done and the primary wouldn?t sign off on the death cert.
CDC Split Type:

Write-up: Death on 4/16/2021?. Hemorrhaged (mouth), and choked on blood. Family was present at the time of occurrence but nothing could be done to help her. This was 16 days after receiving the J and J shot and would not perform autopsy due to age even when her primary wouldn?t sign off on the death cert.


VAERS ID: 1628578 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-19
Onset:2021-08-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plavix, dexilant, oxygen therapy, proair, lasix, diovan, spiriva, DUO neb
Current Illness:
Preexisting Conditions: Congestive Heart Failure, PVD, Hyperlipidemia, coronary atherosclerosis, COPD
Allergies: flexeril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized on 8/22/21 stating that she could not breath and passed away. Her second COVID vaccine was received on 8/19/2021.


VAERS ID: 1628604 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-11
Onset:2021-04-11
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Dyspnoea, Fibrin D dimer increased, Hyponatraemia, Laboratory test abnormal, Lactic acidosis, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 4
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: Aspirin, Celexa, Plavix, Lasix, gabapentin, Norco, Antivert, metformin, Centrum Silver vitamins, Fish oil, Prilosec, Flomax.
Current Illness: Compression fracture of body of thoracic vertebra
Preexisting Conditions: Arthritis, ASHD, basal cell cancer (face), BPH, colon cancer (s/p resection and chemo), cardiac disease, chronic lower back pain, constipation, CAD, CVA, diabetes mellitus with peripheral neuropathy, diffuse large B cell lymphoma, GERD, hard of hearing, hyperlipidemia, leg pain, leg weakness, MALT lymphoma, history of MI, s/p CABGx4 in 2003, spinal stenosis, ulcer, vertigo
Allergies: n/a
Diagnostic Lab Data: COVID-19 by NAA, Limited Use: SARS CoV2 COVID-19 Detected (3/29/2021) D-Dimer: $g10,000 ng/mL FEU (4/11/2021)
CDC Split Type:

Write-up: A 91-year-old gentleman with significant known history for coronary artery disease/CVA/history of B-cell lymphoma/hypertension and significant other medical history, presented to hospital due to shortness of breath; it is noted the patient was saturating at 76% on non-rebreather. The patient was desatting despite being on non-rebreather and therefore it was requested that the patient be transported to the ER. He was evaluated , was on AVAP 80%, alert, however, unable to fully follow any commands. He was placed on AVAP and his oxygenation/pulse ox increased to 90%. Lab workup showed hypernatremia/acute renal failure/lactic acidosis with a D-dimer of more than 10,000. Transitioned to hospice care.


VAERS ID: 1628631 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-08-13
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / 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: 2021-08-21
   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: N/A
Current Illness:
Preexisting Conditions: COPD, Diabetes mellitus, AKI
Allergies: N/A
Diagnostic Lab Data: Pt tested positive for COVID-19 by RNA on 08/13/2021.
CDC Split Type:

Write-up: Pt was hospitalized on 8/13/2021 and passed away on 8/21/2021.


VAERS ID: 1628645 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-04
Onset:2021-07-14
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Body temperature increased, COVID-19, Cough, Death, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: 2021-07-28
   Days after onset: 14
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: immunosuppressive therapy for non-Hodgkin''s lymphoma
Current Illness: non-Hodgkin''s lymphoma
Preexisting Conditions:
Allergies: Unk
Diagnostic Lab Data: 7/17/2021 COVID-19 positive PCR
CDC Split Type:

Write-up: 7/14/2021: symptoms onset. temp 110.4F,abdominal cramps, cough, diarrhea 7/17/2021 hospitalized 7/28/2021 died


VAERS ID: 1628647 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-10
Onset:2021-06-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: enlarge heart medications, and many herbal remedies
Current Illness: prediabetic to diabetic
Preexisting Conditions: enlarge heart, arthritis
Allergies: none
Diagnostic Lab Data: Related to the shot
CDC Split Type:

Write-up: Death


VAERS ID: 1628702 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-08-21
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Endotracheal intubation, Resuscitation, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

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: Patient went into cardiac arrest on 08/21/2021. Patient seen by wife "going down" and CPR was started within minutes. CPR performed prior to arrival to emergency room and after, patient also intubated. Patient non-responsive on arrival to hospital. Patient ultimately died.


VAERS ID: 1628747 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-10
Onset:2021-07-27
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, COVID-19, Chest X-ray abnormal, Death, Fatigue, Hypoxia, Lung opacity, SARS-CoV-2 test positive, Troponin increased
SMQs:, Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ascorbic acid 500 mg daily, acetaminophen 325-650 mg q6h PRN, Azelastine 0.15 % (205.5 mcg) spry Apply or instill 2 Sprays into both nostrils two times daily, carbidopa-levodopa 25-100 mg tablet Take 1 Tab by mouth three times daily, Choles
Current Illness:
Preexisting Conditions: Hypertension, parkinson disease, diabetes mellitus type 2 w/ peripheral neuropathy, stage III chronic kidney disease, hyperlipidemia, osteoarthritis, Gastroesophageal reflux disease without esophagitis, vitamin D deficiency
Allergies: Escitalopram, potassium, sulfonamide antibiotics
Diagnostic Lab Data: 07/27/2021: troponin 0.035; 07/27/2021: CRX scattered bilateral interstitial opacities; 07/27/2021: COVID positive
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/20/2021 and 2/10/2021. On 7/27/2021, patient presents to the ED with weakness and fatigue after being diagnosed with COVID-19 1 day prior. On arrival to the ED, patient O2 saturation 88%, 2LNC initiated. Patient admitted to the hospital for COVID-19, hypoxemia, and elevated troponin. Patient received remdesivir x 5 days, convalescent plasma 1 unit, tocilizumab 800 mg x 1 dose, dexamethasone, azithromycin, ceftriaxone. Patient developed new onset atrial fibrillation on 8/7/2021. Throughout hospitalization patient continued to decompensate and eventually expired on 8/8/2021.


VAERS ID: 1628749 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-05
Onset:2021-06-15
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Cardiac failure, Cellulitis, Chest X-ray abnormal, Condition aggravated, Endotracheal intubation, Hallucination, Hypoxia, Intensive care, Pain in extremity, Pulseless electrical activity, Resuscitation, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Imatinib mesylate for cancer
Current Illness:
Preexisting Conditions: Peripheral arterial disease, chronic heart disease, diabetes suicidal ideation multi nodural goiter cerebrovascular accident Philadelphia chromosone positive chronic myelogenous leukemia coronary artery disease ischemic cardiomyopathy PTSD Chronic recurrent major depressive disorder Parakeratosis Anemia Pleural effusion nephrolithiasis gastritis tinnitus
Allergies: UNK
Diagnostic Lab Data: 6/21/2021 COVID-19 positive PCR pneumonia confirmed by Xray
CDC Split Type:

Write-up: Patient with multiple underlying conditions presented to hospital with severe LE pain on 6/15/2021. Recently treated for cellulitis (6/15/2021). SOB and poor po intake were baseline x 1 year 2/2 cancer and PE. 1L o2 at baseline. Difficult to distinguish any possible COVID sx from other causes, unknown onset of sx. Tested negative upon admission and positive on Hospital Day 3. Hospital course complicated by hypoxemia 2/2 COVID PNA and HF exacerbation, hallucination. Transferred to ICU 6/27-6/30 recieved dexamethasone, remdesivir, piperacillin/tazobactam and then again 7/6. 7/6 asystole/PEA arrest with ROSC achieved after 20 min of CPR and 4 x epinephrine. Intubated 7/6. Increasing pressor requirements, transitioned to comfort care.


VAERS ID: 1628789 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-09
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood loss anaemia, COVID-19, Cerebrovascular accident, Death, Deep vein thrombosis, Endotracheal intubation, General physical health deterioration, Hypotension, Retroperitoneal haematoma, SARS-CoV-2 test positive, Shock haemorrhagic, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Hypovolaemic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: apixaban 5mg BID; Polycitra 1,100-334 mg/5mL TID; escitalopram 10mg daily; gabapentin 100mg TID
Current Illness:
Preexisting Conditions: CVA(2019), AFib (on Eliquis), pulmonary sarcoidosis, Gout, Kidney stones, HLD, CKD 3, coronary arteriosclerosis in native artery
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA Patient received Pfizer-BioNTech COVID Vaccines on 1/20/2021 and 2/12/2021. Presented to ED on 8/9/21 from acute rehab with complaints of unresponsiveness at Rehab. PMH of CVA (2019). 2 weeks prior to admission patient with admitted to hospital and diagnosed with pontine stroke. Patient was scheduled for TEE and underwent routine COVID test and tested positive. Pt caregivers reported patient showed no respiratory symptoms prior to this admission. During this stay patient was treated with empiric antibiotics, Decadron for 10 days and Lovenox for treatment of a DVT and discharged to acute rehab. Upon arrival to ED pt was hypotensive, intubated and found to have a large retroperitoneal hematoma. Pt was also started on Cefepime, Vancomycin, and Doxycycline. Patient diagnosed with acute hemorrhagic shock and, acute blood loss anemia. Patient continued to decline and family decided to withdraw care and initiate comfort care. Patient expired on 8/10/2021.


VAERS ID: 1628824 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-07-22
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Death, Endotracheal intubation, Fatigue, Hypoxia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: 2021-08-10
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Atorvastatin 5 mg QD, Cyanocobalamin 500 mcg, QD, Levothyroxine 100 mcg QD, Lisinopril 40 mg QD, Pantoprazole 40 mg QD, Miralax 17 grams QD, Furosemide 40 mg QD, Potassium Chloride 20 mEq QD, Benzonatate (200 mg).
Current Illness:
Preexisting Conditions: Hypertension, Hypothyroidism, Bilateral leg edema, AV Heart Block, Morbid obesity, basal cell carcinoma, GERD, hyperlipidemia, thyroid disease.
Allergies: Tizanidine (bradycardia)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/6/2021 and 4/1/2021. Patient was diagnosed with COVID-19 infection on 07/16 and has been having intermittent fevers, fatigue, cough and was evaluated at Hospital on 7/16, 7/18, and 7/22. Patient was discharged from the emergency room as he was nontoxic appearing, he was readmitted on 7/22 with hypoxia saturating 83% on 6 L, evidence of COVID pneumonia on CT. Patient quickly escalated from nasal cannula to requiring high-flow oxygen and on 07/24 was also intubated. Required norepinephrine for hemodynamic support. Completed remdesivir course and 9 days of Dexamethasone. Had worsening oxygenation and family decided to withdraw support and provide comfort care. He expired on 8/10/2021.


VAERS ID: 1628876 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-02-19
Onset:2021-02-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, Blood test, Cardiac failure congestive, Chest X-ray, Death, Electrocardiogram, Gait disturbance, General physical health deterioration, Hypotension, Loss of personal independence in daily activities, Mobility decreased, Walking aid user
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 36
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibersartin, Hydrochlorothiazide, Simvastatin, Metoprolol Suc, Pantoprazole, Potassium Chloride, Bayer Aspirin, Vitamin D3
Current Illness: None.
Preexisting Conditions: High Blood Pressure, Cholesterol
Allergies: Morphine
Diagnostic Lab Data: EKG, chest Xray, bloodwork.
CDC Split Type:

Write-up: On the 4th day following the vaccine, patient suddenly became extremely weak, unable to do smallest of activities which were easy to perform before. Could not get up from toilet, chair, etc. Unable to get into vehicle without assistance. Unable to walk without walker and assistance. Prior to day 4 after vaccine, completely able to live independently, preparing meals, doing minor housework, get into and out of chair, on and off of toilet, etc. Patient was moved to daughter''s home, and homecare was set up. After visit to cardiologist and various tests, she was diagnosed with afib and congestive heart failure; was taken off of all blood pressure meds as now blood pressure was suddenly low. Condition continued to deteriorate, and placed on hospice care. Died five weeks later.


VAERS ID: 1629075 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-25
Onset:2021-08-10
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Atelectasis, Blood culture negative, Blood test abnormal, COVID-19, Chest X-ray abnormal, Culture urine negative, Death, Decreased appetite, Endotracheal intubation, Haematemesis, Hypotension, Intensive care, Lethargy, Lower urinary tract symptoms, Malaise, Oxygen saturation decreased, Pollakiuria, Resuscitation, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: rosuvastatin, prednisolone acetate eye drops, metoprolol succinate XL, latanoprost, amlodipine, ranolazine, cholecalciferol
Current Illness: January 14, 2021 - melena
Preexisting Conditions: Diet controlled diabetes, Hepatitis C cirrhosis, CAD, HTN osteoarthritis, colonic polyps, liver lesions, HCC
Allergies: NKDA
Diagnostic Lab Data: 8/10: COVID-19 positive (PCR) 8/11: urine culture: negative 8/11: Blood culture: negative 8/17: COVID-19 positive (PCR) 8/17: CXR: likely mild linear atelectasis in the lung bases
CDC Split Type:

Write-up: PMH of diet controlled DM, hepatitis C induced cirrhosis, CAD with stent replacement, HTN, osteoarthritis, colonic polyps, history of several liver lesions with an elevated AFP consistent with multifocal HCC (refused biopsy) sent in from PCP office for evaluation of hypotension. Patient has been c/o generalized weakness with decreased appetite for 1 week. Patient also endorses urinary symptoms mainly frequency. Denies any CP, SOB, LH, dizziness, N/V/D, HA, abdominal pain, fever, chills or any other complaints. In the ED blood work showed AKI. UA was positive for UTI and incidentally he was found to be covid +. Patient denies any SOB and is not hypoxic. CXR is unremarkable. In the ED patient was given IVF and was started on ceftriaxone x 5 days for UTI. CXR without evidence of pneumonia. On 8/16 Breathing comfortably. However, SPO2 was as low as 80s with activity on 8/13, started on Decadron. On 8/17: 8/17 RRT was called this morning for hypotension with BP 70/40s. Per RN patient received 500cc over night which did not respond, remains hypotensive. Patient reports he "doesn''t feel well". At bedside, patient is lethargic but responsive to commands, satting 97% on room air. Patient transferred to the MICU and Pt emergently intubated at beginning of ACLS and during intubation was noted to have large amount of coffee ground emesis in esophagus and airway concerning for possible UGIB and aspiration. Despite resuscitative efforts for over 30 minutes, no sustained ROSC was able to be obtained.


VAERS ID: 1629288 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       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: 2021-08-21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: THE PATIENT CAME ON 8/16 /2021 WITH COVID SYMPTOMES TESTED WITH PCR THE RESULT CAME POSITIVE FOR COVID THE PATIENT EXPIRED ON 8/21/2021


VAERS ID: 1629325 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-18
Onset:2021-03-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Scoliosis
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died!


VAERS ID: 1629537 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-01
Onset:2021-08-24
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, Death, Dyspnoea, Pericarditis constrictive, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   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: metformin, glimepiride, metoprolol, amlodipine, atorvastatin
Current Illness:
Preexisting Conditions: diabetes, htn
Allergies: na
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WAS VACCINATED SEVERAL MONTHS AGO, PRESENTED TO ER WITH C/O CP AND SOB 8/22, NEG ANGIOGRAM COMPLETED 8/23, DC HOME 8/23 RETURNED TO ER 8/24 WITH LARGE SADDLE PE, PT EXPIRED. ONLY REPORTING BECAUSE PT HAD NO PRIOR HISTORY OF MI OR THROMBOSIS, ONLY HTN AND TYPE 2 DM.


VAERS ID: 1629717 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Cardiac arrest, Cough, Death, Dyspnoea, Fall, Fatigue, Loss of consciousness, Resuscitation, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 70
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: Warfarin, Thyroxin, Metoprolol
Current Illness: unknown
Preexisting Conditions: history of hip fracture
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Developed asthmatic like symptoms about two weeks after the 2nd shot. This manifested itself by coughing, shortness of breath, wheezing and fatigue. These symptoms waxed and waned until on the day of her death, she passed out and fell. Shortly after getting to the ER (within 20 minutes), she went into cardiac arrest, was resuscitated but never regained consciousness.


VAERS ID: 1631068 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210843032

Write-up: DEATH; This spontaneous report received from a consumer via social media and concerned two male patients of unspecified age. 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) dose, 1 total administered, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients died from unknown cause. It was unknown whether an autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patients died (due to unknown cause) on an unspecified date. This report was serious (Death).; Sender''s Comments: V0: 20210843032- Covid-19 vaccine ad26.cov2.s- Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1631079 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-25
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210844140

Write-up: DIED OF HEART ATTACK; This spontaneous report received from a consumer via a company representative via social media concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown)1 total frequency, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. As per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died of heart attack. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0 20210844140-COVID-19 VACCINE AD26.COV2.S-died of 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: HEART ATTACK


VAERS ID: 1631954 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Idaho  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USJNJFOC20210842457

Write-up: DIED FROM COMPLICATIONS OF COVID/COVID AFTER VACCINATED; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a physician via a company representative via social media concerned a 70 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, 1 total, administered on MAR-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died from complications of covid/covid after vaccinated (suspected clinical vaccination failure). Patient was fully vaccinated with the J&J vaccine. It was reported that there was lack of guidance about boosting that vaccine led to his death. It was reported that patient was pretty healthy. Cause of death was reported as complications of covid. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of died from complications of covid/covid after vaccinated on an unspecified date, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20210842457-Covid-19 vaccine ad26.cov2.s- died from complications of covid/covid after vaccinated.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). 20210842457-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: DIED FROM COMPLICATIONS OF COVID


VAERS ID: 1632015 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Agitation, Balance disorder, Confusional state, Death, Hallucination, Pain, Tenderness, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   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: Xarelto, Gembibrozil, Metoprolol, Levothyroixine, Rosuvastatin, Amiodarone, Isosorbide Mononitrate, Donepezil
Current Illness: onset dementia as of December 2020
Preexisting Conditions: Afib, chronic pain due to arthritis
Allergies: Codeine, Sulfur,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 3-4 days of first shot on 3/11/2021 increased pain throughout body, increased agitation and greater confusion and ability to follow simple commands. With 24 hours of second shot on 4/1/2021 unbearable pain throughout body, pain for someone to touch, balance issues. By 4/15/2021 tremors in arms and legs, loss of balance, hallucinations/ Patient died on 4/19/2021


VAERS ID: 1632201 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-08-09
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Asthenia, COVID-19, Confusional state, Cough, Death, Malaise, Pneumonia aspiration, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad), 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: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? ACCU-CHEK SOFTCLIX LANCETS lancets, , Disp: , Rfl: ? Blood Glucose Calibration (TRUE METRIX LEVEL 1) Low solution, , Disp: , Rfl: ? Blood Glucose Monitoring Suppl (TRUE METRIX AIR GLUCOSE METER) devic
Current Illness: No acute illness
Preexisting Conditions: Hypertension Parkinson''s disease Glaucoma Obstructive sleep apnea DM2
Allergies: NKDA
Diagnostic Lab Data: 8/9 COVID 19 detected
CDC Split Type:

Write-up: Patient s/p vaccination in spring 2021. Admitted to the hospital on 8/9/2021 with generalized weakness. Pt reported chronic dry cough, malaise and runny nose; denied chest pain, SOA, V/N/D. No known exposures to COVID. Patient found to be COVID+; started on oxygen, dexamethasone and remdesivir. O2 requirements continued to worsen; imaging showed worsening PNA - concern for secondary aspiration PNA. Started on IV zosyn. After 10 days with worsening confusion, agitation patient family decided to transition to comfort measures. Pt agreed to Hospice on 8/19 and passed on 8/20


VAERS ID: 1632245 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-02-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Death, Renal failure, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
   Days after onset: 81
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: temazepam ocuvite centrum silver
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: April 7, 2021 bloodwork
CDC Split Type:

Write-up: periodic uncontrollable shaking renal failure death


VAERS ID: 1632254 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, aspirin, Lipitor, Juardiance
Current Illness:
Preexisting Conditions: CHF, Hepatitis C, CAD, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient given the Pfizer vaccine on 8/24 and went into cardiac arrest and died at 0650 8/25/21


VAERS ID: 1632537 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-06
Onset:2021-07-30
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 6205 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Disorientation, Dyspnoea, Fatigue, Feeling abnormal, General physical health deterioration, Nasopharyngitis, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Sick relative, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient tested positive for COVID-19. Patient was fully vaccinated. He started feeling "different" about the middle of July. He was more fatigued, disoriented, and unstable. The following week, he developed cold symptoms which everyone assumed was just the common cold. Pt. daughter was sick the previous week with a common cold (took her 3yo to the doctor to confirm, but wasn''t tested for Covid). After 7/26, his condition started to deteriorate more with fever and vomiting. By the evening of 07/30, he was having great difficulty breathing and so he was taken to the hospital. He was admitted for very low blood oxygen levels as well as Covid pneumonia. He has several underlying health conditions to include heart disease and obesity. Patient died due to COVID.


VAERS ID: 1632583 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-01-13
Onset:2021-02-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 1st Pfizer covid shot on January 13, 2021 and had a massive stroke on the morning of Feb 11, 2021. Was hospitalized and passed away the following day, Feb 12, 2021.


VAERS ID: 1632595 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-16
Onset:2021-08-25
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E9267 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Endotracheal intubation, General physical health deterioration, Intensive care, Mechanical ventilation, Renal impairment, Respiration abnormal, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was initially admitted to the medical COVID floor. He was initiated on remdesivir and dexamethasone. He was transferred to the ICU on 8/17/2021 due to worsening respiratory status and need for noninvasive ventilatory support. Due to his worsening renal function, remdesivir was discontinued as it is known to potentially contribute to worsening renal function. He was initiated on CRRT on 8/18/2021. Patient''s respiratory status continued to worsen and he was intubated on 8/21/2021. Unfortunately, over the next several days, patient''s condition worsened overall. He was unable to be weaned from high ventilatory support needs. CRRT was optimized to insure diuresis to try to optimize ventilator conditions. Unfortunately, on the morning of 8/25/2021, the patient did suffer a sudden cardiac arrest. CPR and ACLS interventions were initiated without success. Nursing staff was in contact with the patient''s family via telephone during the cardiac arrest and resuscitation. They did advise that they did not want to continue ongoing resuscitative efforts and further efforts were terminated. Unfortunately, patient did pass on the morning of 8/25/2021 at 0150 hr


VAERS ID: 1632600 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-16
Onset:2021-06-17
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Death, General physical health deterioration, Organ failure, Respiratory arrest, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (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), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 5
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: Prostate Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: throwing up, high white blood cell count, raspatory arrest, cardiac arrest, un able to destabilize, death do to organ failure


VAERS ID: 1632629 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2020-12-19
Onset:2021-08-20
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Acute respiratory failure, Bilevel positive airway pressure, Blood pH decreased, Bronchostenosis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Death, Diaphragmatic hernia, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hiatus hernia, Intensive care, Leukocytosis, Lung consolidation, Malaise, Mechanical ventilation, N-terminal prohormone brain natriuretic peptide increased, Oxygen saturation decreased, PCO2 increased, Pneumonia, Procalcitonin increased, Pulmonary artery stenosis, Pulmonary mass, Pulmonary valve stenosis, Respiratory distress, Respiratory failure, SARS-CoV-2 test positive, Shift to the left, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Lactic acidosis (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), Cardiomyopathy (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), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus test: 08/19/2021 = positive
CDC Split Type:

Write-up: 74-year-old female presents emergency room complaining of shortness of breath. EMS reported that initial sats were 50% she was placed on a non-rebreather mask. She subsequently was placed on BiPAP in the emergency room and her saturations actually decreased therefore she was placed back on a non-rebreather mask. The patient continued to decline and ultimately required intubation after her initial blood gas revealed her to be extremely acidotic with a pH is 7.19 and pCO2 of 83. Little is known about the patient''s history otherwise I do not know if she has had any fever. I have been told that the patient has been fully vaccinated for COVID. She has had a COVID swab returned as positive tonight. I am unaware of exposures at this time. She has other remarkable findings in the emergency room specifically a leukocytosis of 34,000 with left shift. ProBNP is 11000. Procalcitonin is elevated at 1.18. The patient has a history of incarcerated diaphragmatic hernia in 2014. On chest x-ray tonight it appears that she has stomach in her chest. On the CT it also appears that she has hiatal hernia with part of the stomach in the chest also part of the colon in the chest through her diaphragmatic hernia. Question of bowel obstruction is raised but no definitive answer is given on CT. Patient also has a consolidation of the right upper lobe with possible mass. CT also reveals bilateral findings consistent with COVID. No PE. The patient I believe has a cardiac history and has a history of heart failure with reduced ejection fraction. DISCHARGE: Patient was a 74-year-old patient, who was admitted after arriving via EMS with respiratory distress. Apparently, she had been sick for 2 weeks for shortness of breath. She came to the ER, was emergently intubated with acute hypoxic hypercapnic respiratory failure. The patient has multiple CTs done, one of the chest revealed a central mass with significant narrowing of the right upper lobe and right middle lobe pulmonary arteries, stenosis of the right upper lobe bronchus. I thought she probably had a postobstructive pneumonia. Also, of note, she has some patchy airspace disease, consistent with COVID-19 pneumonia. The patient did test positive for COVID-19. The patient was intubated, placed in ICU. Palliative Care was consulted and after discussion with family, it was decided to remove her from the ventilator given her diagnoses. The patient was extubated and pronounced by Dr. at 05:39 p.m.


VAERS ID: 1632684 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-06
Onset:2021-07-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid medication
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second vaccination on 07/06/2021. The next day the patient was having problem breathing with shortness of breath.


VAERS ID: 1632692 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-02
Onset:2021-07-13
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Colonoscopy, Death, Gastrointestinal haemorrhage, General physical health deterioration, Polypectomy, SARS-CoV-2 test positive
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet Take 650 mg by mouth Every 6 (Six) Hours As Needed for Mild Pain amiodarone (PACERONE) 200 MG tablet Take 200 mg by mouth Daily. aspirin 81 MG chewable tablet Chew 81 mg Daily. baclofen (LIORESAL) 1
Current Illness: No acute illness known
Preexisting Conditions: Dementia
Allergies: NKDA
Diagnostic Lab Data: 7/19 Respiratory viral panel COVID 19+
CDC Split Type:

Write-up: Patient is a resident of a SNF - found to be COVID 19 + 6 days prior to admission on 7/19. Pt reported to have minimal symptoms - on O2, but unknown if this is baseline. Patient admitted with GI Bleed; underwent colonoscopy and removal of a oozing polyp. Patient tolerated procedure well, but continued to decline in terms of mentation during hospitalization including the use of sedative medications and restraints. On 7/25 patient and family decided to proceed with comfort/palliative care. Patient passed on 7/26. Although patient was COVID positive, there is no indication that his death was directly due to COVID.


VAERS ID: 1632700 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, 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: 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: UTI dated 8/12/2021
Preexisting Conditions: BPH Restless leg syndrome Primary Essential Hypertension GERD Glaucoma Hyperlipidemia
Allergies: No know drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received vaccine at 10:00 am on 8/18, monitored for 15 post-vaccine, noted unresponsive at 12:30:Pt was noted to be unresponsive to verbal and tactile stimuli. VSS: BP 72/48, Pulse 116, Placed on nonrebreather at 15LPM. O2 sat 98%. NP in the building called and responded. 911 called and responded. HCP niece declined for the resident to be transferred to the hospital. 8/19/2021 09:07 am Resident expired, Code Status: DNR. Dr. was notified. Pronounced at the facility by the RN


VAERS ID: 1632705 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-02
Onset:2021-08-15
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 RA / IM

Administered by: Public       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: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1. Acetaminophen 1000 mg t.i.d. 2. Breo Ellipta. 3. Celexa 10 mg q.a.m. 4. Levoxyl 100 mcg q.a.m. 5. Lisinopril 40 mg q.a.m. 6. Loratadine 10 mg q.a.m. 7. PreserVision one capsule b.i.d. 8. Trazodone 400 mg at bedtime. 9. Vitamin D
Current Illness: 1. CLL, 2. Hypertension. 3. Hyperlipidemia. 4. Hypothyroidism. 5. COPD with chronic hypoxic respiratory failure, on 2 L NC at baseline. 6. History of postherpetic neuralgia. 7. Hard of hearing. 8. Macular degeneration. 9. Chronic venous insufficiency. 10. Vitamin D deficiency. 11. Osteoporosis. 12. History of colon polyps. 13. ROS. 14. Gout.
Preexisting Conditions: See section 11
Allergies: NKDA
Diagnostic Lab Data: Ordered Test: SARS-CoV+SARS-CoV-2 Ag Resp Ql IA.rapid Accession Number: Specimen Source: Nose (nasal passage) Specimen Site: Bilateral Nares Specimen Collection Date/Time: 08/06/2021 Patient Status at Specimen Collection:
CDC Split Type: 1193703

Write-up: Case completed Covid vaccine series 4/2/21, and was admitted to hospital 8/15/21 for Covid, and died of Covid on 8/18/21.


VAERS ID: 1632726 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-24
Onset:2021-08-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Muscle rigidity
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported when questioned.
Preexisting Conditions: None reported upon vaccine screening.
Allergies: No allergies reported.
Diagnostic Lab Data: Per Coroner the patient will be sent to the local Crime Lab for potential autopsy.
CDC Split Type:

Write-up: Patient found in early morning hours by family member. Unfortunately he had already expired with rigor.


VAERS ID: 1632786 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-22
Onset:2021-07-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Ovarian mass, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving vaccination pt felt weak and had trouble breathing. She was rushed to the ER where she was diagnosed with pneumonia and a mass was found on her ovary. She stayed about 2 days and was then released under Hospice care.


VAERS ID: 1632795 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-08-11
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / 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: 2021-08-22
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN, CITRUCEL, ELIQUIS, FINASTERIDE, FLUTICASONE-SALMETEROL INHALER, FUROSEMIDE, HYDROCORTISONE CREAM, MEMANTINE, METOPROLOL, PROAIR HFA INHALER, QUETIAPINE, SIMVASTATIN
Current Illness: NONE
Preexisting Conditions: ALZHEIMER''S DISEASE, ASTHMA, ATHEROSCLEROSIS, ATRIL FIBRILLATION, BENIGN PROSTATIC HYPERTROPHY, CHRONIC KIDNEY DISEASE STAGE III, DIASTOLIC CONGESTIVE HEART FAILURE, GLAUCOMA, HYPERLIPIDEMIA, HYPERTENSION, HYPONATREMIA, MITRAL REGURGITATION, OSTEOARTHRITIS, PREDIABETES, HISTORY OF CVA
Allergies: SULFA, DONEPEZIL, ULTRAM
Diagnostic Lab Data: 8/11/21 POSITIVE COVID TEST
CDC Split Type:

Write-up: DIAGNOSIS OF COVID-19 WITH HOSPITALIZATION/DEATH AFTER BEING FULLY VACCINATED


VAERS ID: 1632912 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-28
Onset:2021-06-04
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Death, Dyspnoea, Echocardiogram, Electrocardiogram, Laboratory test, Pulmonary embolism, X-ray
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 81
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Positive for COVID 11/2021 with minimal symptoms
Preexisting Conditions: hypofibrinoginemia, HTN, Breat Cancer; HTN, Kidney disease, hypothyroidism, COPD, sleep apnea
Allergies: cephalexin, ciprofloxacin, levofloxacin, meperidine
Diagnostic Lab Data: CT, XRAY, ECHO, EKG; Multiple labs
CDC Split Type:

Write-up: Patient started having SOB in June 2021; in July found to have a large Pulmonary embolism; Was readmitting for SOB 2 more times and ultimately died 08/24/2021;


VAERS ID: 1633600 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-16
Onset:2021-08-22
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient had cardiac arrest x2 and died.


VAERS ID: 1634215 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-09
Onset:2021-07-23
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unk
Current Illness: Unk
Preexisting Conditions: Unk
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Heart attack


VAERS ID: 1634859 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-26
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: USJNJFOC20210845181

Write-up: DEATH; This spontaneous report received from a consumer via a company representative from social media concerned an 8 decade old of unspecified age, sex, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported, expiry: Unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20210844359.; Sender''s Comments: V0: 20210845181-covid-19 vaccine ad26.cov2.s- Death.This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1636469 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-10
Onset:2021-08-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: Was scheduled for angioplasty following abnormal stress test. Angioplasty was denied until patient was vaccinated.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had heart attack and died at 10:15 PM following dose at 3:00 PM


VAERS ID: 1636482 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-01
Onset:2021-08-18
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac failure, Condition aggravated, Death, Hypoxia, Intensive care, Pneumonia streptococcal, SARS-CoV-2 test positive, Streptococcus test positive, Urinary tract infection
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, CHF, hypertension, PVD
Allergies: codeine, lisinopril, penicillin, iodine topical, vancomycin
Diagnostic Lab Data: COVID +, strep pneumonia +
CDC Split Type:

Write-up: Admitted on 8/18/21 for hypoxia, COVID +, and was found to have heart failure exacerbation, UTI, COVID pneumonia. Worsening compensation transferred to ICU for hypoxia and max Vapotherm. pt. taking dexamethasone and remdesivir. Patient DNR/DNI . Not a candidate for monoclonal antibody due to strep pneumonia positive infection. Given supportive care with death on 8/25/21.


VAERS ID: 1636496 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-09
Onset:2021-08-13
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Chest pain, Chills, Cough, Death, Diarrhoea, Dyspnoea, Endotracheal intubation, Fatigue, Intensive care, Nausea, Pain, Pleuritic pain, SARS-CoV-2 test positive, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NO KNOWN ALLERGERIES
Diagnostic Lab Data: 8/11/21: PATIENT COVID TESTING DONE AT PCP. 8/13/21 CHEST XRAY CONSIST WITH PNEUMONIA
CDC Split Type:

Write-up: 8/11/201 PRESENTED TO ER REPORTED NAUEA, VOMITING AND DIARRHEA DX COVID POSITIVE. DISHCARGED HOME. 8/13/21 PRESENTED TO ER ADMITTED TO HOSPITAL IN PATIENT. BEGAN FEELING SHORT OF BREATH PROGRESSIVELY GETTING WORSE. DX COVID PNEUMONIA. ALSO REPORTED COUGH, DIFFUSE BODY ACHES, CHILLS. PLEURATIC CHEST PAIN, TIRED. REQUIREING O2. 15L. BY 8/17/21 NEW ONSET OF ATRIL FIB. NOTED. 8/18/21 REQUIRING 100% NON RE BREATHER. 8/23/21 100% /40L VIA VAPOTHERM. ICU LEVEL OF CARE. PATIENT INTUBATED ON 8/25/21. AFTER INTUBATION PATIENT WENT IN TO CARDIAC ARREST. 8/25/21 PATIENT DIED.


VAERS ID: 1636499 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-23
Onset:2021-08-05
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Chest X-ray abnormal, Chronic kidney disease, Fatigue, Lung opacity, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Renal transplant 2015, chronic immunosuppression, hypertension, seizure disorder
Allergies: NKA
Diagnostic Lab Data: Chest s-ray - patchy parenchymal airspace opacities
CDC Split Type:

Write-up: Present on 8/11 following 4-5 days of myalgias, fevers and fatigue. Received only 1 dose of cvocid vaccine. Admitted and started on antibiotics. COVID +. Given decadron and 5 day course of remdesivir. His stay was complicated by AKI and CKD. Respiratory status continued to decline and antibiotics broadened but continued to worsen.


VAERS ID: 1636579 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-07-31
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, 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: 2021-08-04
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, HTN
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Cough, SOB


VAERS ID: 1636612 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-08-21
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Angiogram pulmonary abnormal, Anion gap, Aspartate aminotransferase increased, Bilevel positive airway pressure, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea increased, COVID-19, Chest X-ray abnormal, Cough, Death, Dyspnoea, Glomerular filtration rate normal, Haematocrit normal, Haemoglobin normal, Hypoxia, Lung opacity, Mean cell volume normal, N-terminal prohormone brain natriuretic peptide increased, Neutrophil count increased, Platelet count normal, Pleural effusion, Pneumonia, Procalcitonin, Protein total decreased, Red blood cell count decreased, SARS-CoV-2 test positive, Tachycardia, White blood cell count increased
SMQs:, Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   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: acetaminophen (TYLENOL) 500 MG tablet ALPRAZolam (XANAX) 0.25 MG tablet amoxicillin-clavulanate (AUGMENTIN) 500-125 MG per tablet aspirin 81 MG enteric coated tablet azithromycin (ZITHROMAX) 250 MG tablet bisacodyl (DULCOLAX) 10 MG supposit
Current Illness: 8.8.21: Left displaced femoral neck fracture Closed fracture of neck of left femur, initial encounter Patient underwent LEFT hip hemi arthroplasty on 8/10/2021.
Preexisting Conditions: Osteopenia GERD (gastroesophageal reflux disease) allergies Basal cell carcinoma, leg Osteoporosis Lung cancer Essential hypertension Anxiety CAD (coronary artery disease) Hx of CABG Hyperlipidemia Cervical disc disorder with radiculopathy of cervical region Cervical neck pain with evidence of disc disease Osteoarthritis of lumbar spine, unspecified spinal osteoarthritis complication status Cardiomyopathy Left carotid bruit Atrial flutter CHF (congestive heart failure) Acute respiratory failure with hypoxia and hypercapnia Multiple hepatic and pulmonary lesions, likely metastasis Fracture of left femur Hyponatremia Primary malignant neoplasm of liver Left displaced femoral neck fracture Moderate protein-calorie malnutrition Pneumonia due to COVID-19 virus Bacterial pneumonia
Allergies: Bactrim [Sulfa Drugs]Nausea Only Cipro [Ciprofloxacin]Swelling KeflexHeadache Macrobid [Nitrofurantoin]Swelling MethylprednisoloneEdema Niaspan [Niacin]Hives, Rash NsaidsSwelling PrednisoneSwelling Ultram [Tramadol]Unknown Vicodin [Hydrocodone-acetaminophen]
Diagnostic Lab Data: Lab Results Component Value Date GLUCOSE 107 (H) 08/22/2021 SODIUM 140 08/22/2021 POTASSIUM 4.4 08/22/2021 CHLORIDE 102 08/22/2021 ANIONGAP 14 08/22/2021 BUN 48 (H) 08/22/2021 CREATININE 0.83 08/22/2021 CALCIUM 9.0 08/22/2021 TOTALPROTE 5.6 (L) 08/22/2021 ALBUMIN 2.2 (L) 08/22/2021 ALKALINEPH 360 (H) 08/22/2021 AST 593 (H) 08/22/2021 ALT 164 (H) 08/22/2021 BILIRUBINT 0.4 08/22/2021 EGFR $g60 08/22/2021 Lab Results Component Value Date WBC 15.47 (H) 08/21/2021 RBC 4.16 (L) 08/21/2021 HGB 12.0 08/21/2021 HCT 37.4 08/21/2021 MCV 89.9 08/21/2021 PLATELET 368 08/21/2021 NEUTABSOLU 14.40 (H) 08/21/2021 CTA Thorax with IV contrast Impression: 1. Negative for pulmonary embolism. 2. Consolidative airspace disease in the middle lobe with volume loss related to the previously described pneumonia. There are also now additional patchy and confluent groundglass opacities in both lungs which are nonspecific but suggestive of a viral pneumonia such as COVID-19 pneumonia. 3. Small-to-moderate bilateral pleural effusions. CXR Impression: 1. Negative for pulmonary embolism. 2. Consolidative airspace disease in the middle lobe with volume loss related to the previously described pneumonia. There are also now additional patchy and confluent groundglass opacities in both lungs which are nonspecific but suggestive of a viral pneumonia such as COVID-19 pneumonia. 3. Small-to-moderate bilateral pleural effusions.
CDC Split Type:

Write-up: Patient: Deceased BRIEF OVERVIEW: Admission Date: 8/21/2021 Discharge Date: 8/22/2021 Active Hospital Problems Diagnosis Date Noted POA ? Pneumonia due to COVID-19 virus 08/21/2021 Unknown ? Bacterial pneumonia 08/21/2021 Unknown ? Acute respiratory failure with hypoxia and hypercapnia 10/21/2018 Unknown DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia and hypercapnia Pneumonia of both lungs due to infectious organism, unspecified part of lung Acute hypoxemic respiratory failure due to COVID-19 HOSPITAL COURSE: 87-year-old female with history of heart failure, atrial fibrillation, SIADH, coronary artery disease, metastatic adenocarcinoma (recently diagnosed), and previous lung cancer who presented to the emergency department with hypoxia and cough noted at bed. The patient was recently admitted to our service for a hip fracture for which she underwent repair 8-10. She was reportedly doing well at her rehab facility when she developed hypoxia and a cough. Chest x-ray showed changes consistent with pneumonia. EMS was called when the patient was found to be short of breath requiring 2.5 L of oxygen. Her oxygen saturation was in the 70s on their arrival. She was brought to the emergency department and BiPAP was initiated. She was febrile tachycardic. ProBNP was elevated. Procalcitonin was greater than 100. COVID-19 PCR was positive. CTA was negative for PE, but showed consolidative airspace disease and patchy ground-glass opacities. The patient was started on IV antibiotics and admitted to the hospitalist service. She refused steroid therapy. IV diuresis was initiated. On the morning following admission she refused to be placed back on BiPAP. Goals of care were addressed with the patient at bedside and she elected for comfort care. She had been planning to sign on to hospice services as an outpatient with her recent diagnosis of metastatic adenocarcinoma and requested their services while inpatient. Hospice was consulted and she was transitioned to inpatient hospice. The patient''s family was aware of her wishes and were supportive. A morphine drip was initiated per hospice recommendations. The patient passed away at 16 30 on 08/22/2021. The medical examiner was contacted as her death occurred within 24 hours of admission, but declined the case.


VAERS ID: 1636632 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-26
Onset:2021-08-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW1098 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute kidney injury (nontraumatic) (CMS/HCC)


VAERS ID: 1636675 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-14
Onset:2021-08-24
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
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: Patient was admitted to Medical Center on 8/11/21 in respiratory distress. Patient expired on 8/24/21 vaccine dates were 1st dose Pfizer vaccine on 7/14/21 2nd dose 8/4/21.


VAERS ID: 1636693 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-10
Onset:2021-08-18
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HYPERLIPIDEMIA/DIABETES
Allergies: ASPIRIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: double PE


VAERS ID: 1636955 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-22
Onset:2021-08-08
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization, On supplemental O2, Remdesivir, Decadron, Death


VAERS ID: 1636956 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-28
Onset:2021-08-22
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NONE GIVEN FROM / 1 - / -

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: 2021-08-22
   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:
Current Illness:
Preexisting Conditions: COPD, Diabetes, Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. given dose. NO lot number in our vaccination system, pt. passed from COVID19 on 8/22/2021.


VAERS ID: 1636961 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-05
Onset:2021-08-03
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 13
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient main reason for hospitalization was for hypoxic respiratory stress secondary to covid pneumonia. Pt had two separate hospitalizations, but the hospitalization at time of positive test was admit on 8/8 and discharged to hospice on 8/12. Death: ACUTE RESPIRATORY FAILURE WITH HYPOXIA, PNEUMONIA DUE TO COVID-19


VAERS ID: 1636967 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-29
Onset:2021-08-23
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram abnormal, Aspiration, Central pain syndrome, Cerebellar stroke, Cerebral infarction, Cerebral mass effect, Coma scale abnormal, Computerised tomogram head abnormal, Computerised tomogram neck, Death, Dizziness, Dysarthria, Electroencephalogram, Endotracheal intubation, Heparin-induced thrombocytopenia test, Hydrocephalus, Ischaemic stroke, Magnetic resonance imaging head abnormal, NIH stroke scale abnormal, Paranasal sinus discomfort, Perfusion brain scan, Platelet count normal, Posterior fossa syndrome, Seizure, Seizure like phenomena, Status epilepticus, Thalamic infarction, Tinnitus
SMQs:, Angioedema (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 650 mg as needed for headache/pain
Current Illness: none
Preexisting Conditions: ADHD and anxiety
Allergies: no known allergies
Diagnostic Lab Data: 8/25: HIT antibody (P4F) negative 8/25: platelets 227 8/25 CT Head: 1. Abnormal low density compatible with infarcts throughout the cerebellum, pons and brainstem, and both of the posterior cerebral artery territories including the bilateral thalami. 2. Mass effect within the posterior fossa results in distortion of the fourth ventricles with what appears to be early developing lateral and third ventricular hydrocephalus. There is marked effacement of the basilar cisterns. 3. Residual intracranial contrast limits assessment but there are no current findings of hemorrhagic conversion or acute intracranial hemorrhage. 4. Paranasal sinus disease.
CDC Split Type:

Write-up: Patient woke up 8/23 morning c/o dizziness, slurred speech and with ringing in his left ear. Shortly afterwards pt exhibited seizure-like activity. Family called 911. EMS witnessed seizure at home and was actively seizing on arrival of EMS. Pt was administered 5mg Versed w/o relief then was given Ketamine and intubated. After airway was secured pt was transported to the ED. Pt was admitted for treatment for status epilepticus. Pt sedated on Propofol gtt, Keppra and placed on cEEG. Initial CT Head w/o contrast negative for any acute findings. cEEG was negative for seizures. Pt treated prophylactically with Rocephin and Vancomycin for suspected aspiration. MRI brain w/o contrast obtained early today at the outside hospital and showed Bilateral cerebellar and thalamic AIS with possible basilar occlusion. Dr was contacted and accepted for transfer for acute stroke evaluation and treatment. Prior to transfer obtained CTA head/neck. Pt transported via helicopter. Upon arrival pt was met in ED CT for stat CT cerebral perfusion and CT Head w/o contrast. Pt arrived 8/24/2021 16:08. NIH 36 and GCS 3T. Pt arrived on Propofol and was stopped. Scans showed a large infarction and no intervention recommended. Of note: pt had just received this Johnson and Johnson COVID vaccination 2 weeks ago.


VAERS ID: 1637006 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-12
Onset:2021-08-05
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Death, Dyspnoea, Fatigue, Flank pain, Headache, Hypophagia, Myalgia, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multiple
Current Illness:
Preexisting Conditions: Medullary sponge kidney Recurrent nephrolithiasis Hypertension Prediabetes chronic low back pain, spasm MRI 2020 Osteoarthritis Morbid Obesity Sleep Apnea Renal Calculi: followed/medically managed by Urology Vitamin D Deficiency Gout BPH GERD Recurrent Headaches Hemorrhoids
Allergies: Benzocaine, ciprofloxacin, diphenhydramine, doxycycline, erythromycin, tetracycline, zonisamide
Diagnostic Lab Data:
CDC Split Type:

Write-up: 65 year old male with history of CKD, medullary sponge kidney with recurrent nephrolithiasis presenting for myalgias, fatigue and decreased PO intake for the past 4 days. Symptoms started on 5Aug with fevers and myalgias and presented for COVID test that was initially negative. Continued to have worsening shortness of breath and fatigue and went to be evaluated on 07Aug and found to be COVID pos and was given prednisone taper and albuterol inhaler and discharged home. Since then was having new right flank/abdominal pain consistent with previous kidney stones and called the urology clinic to try to get and appointment and when describing his symptoms was told to go to the ED to be evaluated. Endorses fevers, headache, shortness of breath and cough but denies nausea, vomiting, diarrhea, chest pain, dysuria, polyuria, hematuria, hematemesis, melena, lower extremity edema, orthopnea. Patient died 18 Aug 2021, COD COVID-19 pneumonia.


VAERS ID: 1637039 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-19
Onset:2021-08-08
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ACUTE RESPIRATORY FAILURE WITH HYPOXIA, COVID-19 Hospitalization and Death


VAERS ID: 1637081 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-09
Onset:2021-08-12
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 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: 2021-08-24
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case received Moderna vaccine x 2. Last dose received on 3/9/2021. Patient developed signs and symptoms of COVID 19 Infection on 8/24/2021. Case was tested positive for COVID 19 on 8/24/2021 and was admitted to Medical Center ED on 8/24/2021 and Case expired while still in the hospital on 8/24/2021.


VAERS ID: 1637159 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-18
Onset:2021-08-20
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case received Moderna vaccine x 2 with last dose on 6/18/2021. Was admitted to Medical Center on 8/20/2021. Case expired at hospital 8/21/2021.


VAERS ID: 1637169 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-01
Onset:2021-08-16
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 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: 2021-08-21
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully vaccinated with Pfizer with last dose given on 02/01/2021. Case developed covid symptoms on and tested positive for COVID 8/14/2021. He was admitted to Hospital on 8/16/2021. Case expired on 8/21/2021.


VAERS ID: 1637303 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Fatigue, Malaise, 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: 2021-08-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine
Current Illness: In her end days of lung cancer was not eating and drinking very little for three days before vaccination was given. She became very ill as she was told she might and was unresponsive and in the hospice two days later. Dying on august 4th. The adverse effects of this vaccine served no purpose to be administered to an imminent end to this dying woman. The vaccines effects would never have gotten in her body till after she had died and only made her more sick and weak then she needed to be.
Preexisting Conditions: Cancer
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Suddenly more weak , exhausted, all around much worse then she had been feeling as she was in her last days of lung cancer. Within hours of the vaccine she was worse and in two days unresponsive and in a hospice. 4 days after vaccine she died.


VAERS ID: 1637338 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-20
Onset:2021-08-17
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Carotid artery occlusion, Cerebral artery occlusion, Cerebral haemorrhage, Cerebrovascular accident, Chest X-ray normal, Computerised tomogram head abnormal, Death, Diarrhoea, Dizziness, Dyspnoea, Facial paralysis, Headache, Hypoxia, Intensive care, Mydriasis, Nephropathy, Peripheral swelling, Renal impairment, SARS-CoV-2 test positive, Stent placement, Thrombectomy, Withdrawal of life support
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), 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), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), 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), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acyclovir 400 mg BID, Apixaban 5 mg BID, Aspirin 81 mg QD, Atrovastatin 40 mg QD, Bortezomib weekly, Cholecalciferol 2000 units QD, Cyanocobalamin 1000 mcg QD, Dexamethasone 20 mg on Fridays and Saturdays after bortezomib, Tylenol PM prn,
Current Illness: Left Lower extremity DVT 1 month ago, NSTEMI 6/21/2021
Preexisting Conditions: Anemia, Multiple myeloma, CHF, Diabetes Type 2, DVT of Leg, Hypertension, Neuropathy, Sleep apnea, Thyroid disorder, Varicose vein of leg, Chronic kidney disease,
Allergies: NKDA
Diagnostic Lab Data: COVID-19 positive on 8/17/2021 @ 20:04 analyzed using one or a combination of Real-Time PCR based methods and multiplex reagents including that utilize primer/probe sets specific for the detection of SARS-CoV-2 (COVID-19). The limit of detection of these assays is at least equal to or less than 50 copies/ml.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/27/2021 and 3/20/2021. Presented to ED on 8/17 with complaints of shortness of breath x1 week, diarrhea, light-headedness, headache, and right lower extremity swelling. Patient was placed on supplemental oxygen and admitted. On 8/18 patient exhibited facial droop and left arm/leg weakness. CTA revealed right ICA occlusion and underwent thrombectomy and stenting. ICU, patient had persistent L-sided deficits with concern for devastating neurologic injury. On 08/19, patient was found to have new R pupillary dilation and repeat CTA & CTH revealed re-occlusion of R ICA & R M1 occlusion and petechial hemorrhage. Per Neuro IR, patient not a candidate for repeat MT. Patient was managed with 3% saline and blood pressure control with Cardene gtt with permissive parameters. On 08/21, the patient became hypoxic with increased work of breathing. CXR revealed stable chest and she was placed on HFNC. She was also found to have oliguric AKI in the setting of contrast nephropathy and loss of renal autoregulation in the setting of acute stroke. Nephrology was consulted and discussed with family. Patient''s family decided to transition to comfort care measures and withdraw life-sustaining treatment. On 8/22/2021, the patient was pronounced deceased. For COVID, Patient was treated with Remdesivir, Acyclovir, Dexamethasone.


VAERS ID: 1637391 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-27
Onset:2021-07-01
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic heart disease Chronic kidney disease Stage 3 kidney disease, heart attack at some point
Allergies: Unknown
Diagnostic Lab Data: Tested positive for COVID-19 on 6/22/2021
CDC Split Type: 5417573

Write-up: Patient died of COVID-19 illness on 07/01/2021


VAERS ID: 1637396 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-26
Onset:2021-02-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 124
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Family states patient never recovered after 2nd Moderna dose. Entered hospital with extreme shortness of breath. Ventilated after several days. Passed away while in hospital.


VAERS ID: 1637398 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-27
Onset:2021-08-09
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: date of first dose 01/27/2021 date of second dose 02/18/2021 patient was transferred to hospital on 08/09/2021 and was tested just prior to transfer was found Covid positive. admitted with encephalopathy (mutifactorial)


VAERS ID: 1637847 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 22
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: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death. Unknown


VAERS ID: 1640748 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-02-24
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 3726945 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1640942 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-15
Onset:2021-04-24
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Confusional state, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   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:
Current Illness:
Preexisting Conditions: COPD, Cardia cath, cardiomyopathy, pacemaker, internal defibrillator
Allergies: NKA
Diagnostic Lab Data: CXR, covid test
CDC Split Type:

Write-up: Confusion


VAERS ID: 1641014 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-17
Onset:2021-08-17
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 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: 2021-08-21
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case had covid vaccines x 2 with last dose administered on 2/17/2021. Developed symptoms of Covid 19 on 8/17/2021. Case had a positive COVID 19 lab test on 8/18/2021 was admitted to Medical Center. Case Expired while still hospitalized on 8/21/2021.


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