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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 64 out of 150

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VAERS ID: 1641054 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-08-06
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 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: 2021-08-19
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, depression, DM, hypercholesterolemia, measles, mumps, shingles, sleep apnea.
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Came to ER with SOBx1 month worse around midnight, cough x 1 month.


VAERS ID: 1641059 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-08-26
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Cardiac failure, Condition aggravated, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: heart failure, TIA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 st dose Moderna 01/28/2021- no lot # Pt dies from heart failure complications in the hospital Did not die from Covid 19


VAERS ID: 1641066 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-01
Onset:2021-05-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Death
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 100
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: metformin and BP Rx
Current Illness: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: none, didn''t even think it was vaccine, till we started adding up the ppl we''ve lost, who were there for their shots,
CDC Split Type:

Write-up: strong healthy active mom went into Afib passed 9 wks later....of the 50-60 ppl there 5 have passed since May. (2 others currently in Hospital)


VAERS ID: 1641127 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-09
Onset:2021-08-04
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 - / -

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: 2021-08-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized due to COVID-19 and died. Patient is fully vaccinated.


VAERS ID: 1641163 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Georgia  
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 EL9263 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19 after being fully vaccinated. Patient visited the ER. Patient died.


VAERS ID: 1641168 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-22
Onset:2021-08-24
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive covid test


VAERS ID: 1641180 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-15
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   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:
Current Illness:
Preexisting Conditions: HTN, kidney disease, blindness both eyes.
Allergies: Novocain
Diagnostic Lab Data: 8/15/21: CXR, covid test- positive
CDC Split Type:

Write-up: Pt came to ER with difficulty breathing, came by EMS. Pt admitted to ICU.


VAERS ID: 1641198 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-19
Onset:2021-08-24
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, Dementia Alzheimer's type, Extra dose administered, No adverse event
SMQs:, Dementia (narrow), Medication errors (narrow)

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? No
Previous Vaccinations:
Other Medications: Flomax 0.4 mg, Remeron 15 mg, methotrexate 2.5 mg, levothyroxine 88 mcg, Namzeric 28-10 mg, Folic acid 1 mg, Clonidine 0.1 mg, Colace 100 mg, Buspar 10 mg, Aspirin 81 mg
Current Illness: aspiration pneumonia in July
Preexisting Conditions: heart failure, hypertension, Alzheimer''s disease
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: no adverse effect noted after administration of 3rd dose. resident expired on 8/24/21 after long battle with Alzheimer''s disease. death does not appear to vaccine related


VAERS ID: 1641233 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-08-15
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   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: Calan, hytrin, seroquel, prilosec, claritin, humalog, lantus, robitussin, Vit. D albuterol, acetaminophen
Current Illness:
Preexisting Conditions: HTN, Peripheral artery disease, chronic atrial fibrillation, DM, Type 2 diabetes, arthritis, peripheral neuropathy, AKI hyperlipidemia,
Allergies:
Diagnostic Lab Data: Tested positive upon admission 8/15/2021
CDC Split Type:

Write-up: Weak and fell Exposed from caregiver who had recently tested positive


VAERS ID: 1641249 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-08-12
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Intensive care, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 10
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: Hypercholesterolemia, heart attack.
Allergies: Erythromycin
Diagnostic Lab Data: Cxr: bilateral bronchopneumonia, covid test positive.
CDC Split Type:

Write-up: Pt came to ER with difficulty breathing and cough onset 1 week ago. Patient admitted to ICU.


VAERS ID: 1641295 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-05
Onset:2021-08-11
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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: 2021-08-19
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COvid vaccine x2 with last dose administered on 2/5/2021. Patient developed symptoms of Covid 19 Case tested positive for COvid 19 on 7/30/2021 and was admitted to Medical Center on 8/11/2021. Patient expired while still hospitalized on 8/19/2021.


VAERS ID: 1641319 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-28
Onset:2021-08-17
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Dementia, Arthritis, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. passed of COVID19 in August after being fully vaccinated in January


VAERS ID: 1641348 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-23
Onset:2021-04-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chills, Headache, Pain, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anxiety, HTN,.
Allergies: Sufa, betadine
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Body aches, headaches, fevers, chills.


VAERS ID: 1641358 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-23
Onset:2021-04-05
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM II, HTN, GERD
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Difficulty breathing, on 6L oxygen from PCP office, cough, weakness.


VAERS ID: 1641364 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-10
Onset:2021-05-02
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Chest X-ray, SARS-CoV-2 test, Syncope, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Kidney stones
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Patient brought to ER with cardiac arrest. At home woke up to go to bathroom was wheezing and collapsed (family report).


VAERS ID: 1641372 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-28
Onset:2021-08-24
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Infection
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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS A BREAKTHROUGH CASE OF COVID-19. PT EXPIRED ON 8/24/2021.


VAERS ID: 1641389 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-29
Onset:2021-07-29
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Bilevel positive airway pressure, COVID-19, Diarrhoea, Dyspnoea, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 11
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: lisinopril, glimepiride, atorvastatin,gabapentin, baclofen
Current Illness:
Preexisting Conditions: DM, HTN, peripheral neuropathy, hyperlipidemia
Allergies: no known allergies
Diagnostic Lab Data: SARS COV2 Covid 19 PCR 07/29/2021 result positive
CDC Split Type:

Write-up: Admitted 7/29/21. Received both doses of Pfizer vaccine, the last on 3/29/21. Presents with diarrhea x5 days, weakness and SOB. Tested positive for COVID on 7/27/21. Patient treated with COVID protocol, antibiotics, remdesivir, BiPAP. Patient responded poorly to treatment and condition declined. On 8/9/21 pt discharged.


VAERS ID: 1641422 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-08-19
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Death, Dyspnoea, Lung opacity, SARS-CoV-2 test positive, Scan with contrast abnormal, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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: 2021-08-24
   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: DM, hypercholesterolemia.
Allergies: NKA
Diagnostic Lab Data: Covid test-positive. Chest xray-moderate diffuse bilateral groundglass and heterogenous opacities. CT chest PE with contrast.
CDC Split Type:

Write-up: Pt came to ER c/o SOB that started earlier that morning. Pt became very winded and could not catch his breath, EMS called and pt sats in the 60-70''s with tachypnea.


VAERS ID: 1641444 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-22
Onset:2021-08-22
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary, COVID-19, Chest X-ray abnormal, Dyspnoea, Hypoxia, Lung infiltration, Pleural effusion, SARS-CoV-2 test positive, Scan with contrast
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Arthritis, Lung CA, heart murmur, kidney disease, kidney failure, lung mass, rheumatic fever.
Allergies: Morphine, Anoro ellipta, codeine, iodine containing compounds.
Diagnostic Lab Data: Covid test-positive. Chest xray-bilateral pulmonary infiltrates and small left pleural effusion. CT chest PE with contrast.
CDC Split Type:

Write-up: Pt came to ER with SOB that began morning of. Found to be hypoxic by EMS.


VAERS ID: 1641484 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-03-02
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Death, Fatigue, Headache, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Upper respiratory tract infection, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 167
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: TYPE 2 DIABETES, OBESTIY, HTN, HYPERLIPIDEMIA
Allergies: UNKNOWN
Diagnostic Lab Data: SARS coronavirus 2 RNA: Detected, Collected 8/10/21.
CDC Split Type:

Write-up: Became symptomatic on 8/8/21 feverish, chills, runny nose, headache, fatigue, cough, vomiting, and tested positive for COVID-19 on 8/10/21. Died on 8/17/21 due to upper respiratory infection d/t COVID-19, HTN, hyperlipidemia, T2D, obesity, per death certificate.


VAERS ID: 1641497 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-22
Onset:2021-08-04
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Lung opacity, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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: 10
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: Heartburn, Hearing impaired, lupus, unifocal PVC''s.
Allergies: NKA
Diagnostic Lab Data: Covid test-positive, cxr basilar predominant alveolar opacitities bilaterally.
CDC Split Type:

Write-up: Pt came to ER with SOB, cough, difficulty breathing onset 1 day ago.


VAERS ID: 1641503 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-04-29
Onset:2021-08-24
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 04/29/2021 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death NSTEMI (non-ST elevated myocardial infarction)


VAERS ID: 1641544 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-08-07
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Blood creatinine increased, Breath sounds absent, COVID-19, Cardio-respiratory arrest, Death, Dyspnoea, Endotracheal intubation, Haemoglobin decreased, Hyperkalaemia, Hypotension, Neutropenia, Pulse absent, Pupil fixed, Renal impairment, Unresponsive to stimuli, Vaccine breakthrough infection, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), 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: 2021-08-23
   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: ALLOPURINOL (ZYLOPRIM) 300 MG ORAL TABLET Take 1 tablet by mouth daily for 30 days. AMLODIPINE (NORVASC) 5 MG ORAL TABLET Take 1 tablet by mouth once daily AMOXICILLIN (AMOXIL) 500 MG ORAL CAPSULE Take 2 capsules by mouth 2 ti
Current Illness:
Preexisting Conditions: ? Abdominal pain ? Anemia ? Cancer ? Congestive heart disease ? GERD (gastroesophageal reflux disease) ? History of chemotherapy ? Hyperlipidemia ? Hypertension ? Nausea ? No blood products ? Non Hodgkin''s lymphoma 09/2015 ? Pacemaker ? Sarcoidosis
Allergies: NKDA
Diagnostic Lab Data: Hospital Course: Patient is a 64 year old female with PMH of marginal zone lymphoma diagnosed in 2017 with subsequent richter''s transformation to DLBCL in 2/2021, HTN, sarcoidosis, SSS s/p dual chamber PPM, CHF (EF 40-45%) initially admitted to internal medicine 8/7/21 for SOB. Patient follows with Dr. and last received chemotherapy regimen 7/2 (R-CVP). She initially presented after becoming increasingly SOB over a week. Patient was diagnosed with COVID 7/23. Hem/Onc consulted for neutropenia. Neupogen was given 8/8 and 8/14 with increase in WBC count. ID workup has been negative to date. Initially on ffbipap eventually requiring intubation on 8/18. Her hgb continued to downtrend to 4.6, Procrit was started on 8/22. Her kidney function continued to worsen with Cr 4.25 and persistent hyperkalemia despite treatment. She was peristently hypotensive despite being on Epi, Levo, and Vaso. I was called to patient?s bedside to pronounce that patient has expired. No spontaneous movements were present. There was not response to verbal or tactile stimuli. Pupils were dilated and fixed. No breath sounds were appreciated over either lung field. No carotid pulses or peripheral pulses were palpable. No heart sounds were auscultated over entire precordium. Patient pronounced dead at 22:15 by Dr.. Family were notified. Condolences offered. Chaplain and postmortem services offered. Pt was full code. Time of death was 22:15, confirmed and witnessed by RN.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. She received Pfizer vaccine (2nd dose in series) on 05/07/21. Hospitalized from 08/07/21 - 08/23/21. Below is copied from discharge (death ) summary:


VAERS ID: 1641551 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-08
Onset:2021-08-13
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Death, Fall, Hypoxia, Mental status changes, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (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), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 9
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: Glimepiride, metformin, Flonase, omeprazole, Synthroid, Zyrtec
Current Illness:
Preexisting Conditions: Diabetes, hypertension, COPD CAD, afib, MI, former smoker
Allergies: Carvedilol, Olmesartan, Penicillin
Diagnostic Lab Data: SARS CoV2 PCR detected on 8/13/21
CDC Split Type:

Write-up: 7/30/21: admitted for multiple falls 8/5/21: Transitioned to Inpatient Rehab. 8/13/21: He became altered and hypoxic, prompting testing for COVID-19. Resulted positive COVID PCR on 8/13/21; breathing comfortably on 2L nasal cannula 8/17/21: completed remdesivir course, worsening confusion and altered mentation; using heated-high flow at 35L, non-rebreather 8/19/21: patient discharged to hospice. 8/22/21: patient passed. Time of death 0508.


VAERS ID: 1641573 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-14
Onset:2021-07-14
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID infection. Specimen collected on 7/21/2021. Patient died on 8/21/2021.


VAERS ID: 1641586 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-28
Onset:2021-08-08
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201728146 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID infection. Specimen collected 8/8/21. Patient died on 8/11/21.


VAERS ID: 1641607 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-18
Onset:2021-08-26
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1641622 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-07-21
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Bacterial test positive, Bilevel positive airway pressure, Blood lactic acid, Blood pH decreased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Convalescent plasma transfusion, Culture, Culture urine positive, Death, Dyspnoea, Echocardiogram, Endotracheal intubation, Enterococcal infection, Glycosylated haemoglobin, Hypoxia, Intensive care, Laboratory test, Legionella test, Leukocytosis, Lung opacity, Mechanical ventilation, Metabolic function test, PCO2 increased, Paralysis, Positive end-expiratory pressure, Productive cough, Respiratory failure, Respiratory viral panel, SARS-CoV-2 test positive, Sepsis, Shock, Streptococcus test, Urinary tract candidiasis, Wheezing, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   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: ariprazole, atorvastatin, certirizine, chlecalciferol, dapagliflozin, fluoxetine, Trelegy Elipta, furosemide, gabapentin, glipizine, hydrocodone-acetaminophen, glycopyrrolate-fomoterol, insulin detemir, linsiinopril, meloxicam, metoprolol t
Current Illness:
Preexisting Conditions: past medical history of COPD (3L NC at baseline), DM, HTN, HLD, GERD, restless leg syndrome, peripheral neuropathy, anxiety, depression, chronic opiate dependence, and tobacco use
Allergies: NKDA
Diagnostic Lab Data: COVID Test 7/21/2021 (positive)
CDC Split Type:

Write-up: Patient admitted 7/21/2021 for presents as transfer for acute hypoxic respiratory failure and covid pneumonia. Vaccinated for COVID 3/31/2021, tested positive 7/21/2021 Patient discharged, DEATH, 7/26/2021 Date of Vaccination:3/31/2021 & 3/10/2021 Dose: 2 doses total Vaccine Manufacturer: Pfizer Lot #: EN6202/EN6207 Clinic Administering Vaccine: unknown Injection site: R deltoid both times Description of event/reaction: patient died from severe ARDS from COVID-19 Patient initially presented on 06/29 with dyspnea, productive cough and wheezing. She reported having difficulty breathing for the last month, however, her symptoms progressively worsened after 6/26/21. Patient was found to be hypoxic on her home oxygen requirement of 3L to SpO2 52% upon arrival to ER. Of note, patient was discharged from a hospitalization on 6/22/21 (unknown reason for hospitalization, duration, and location). Patient is reportedly fully vaccinated for COVID prior to her current admission and received her last vaccine in February 2021. She tested positive for COVID on 6/29 upon admission, and stated that her daughter had been sick recently and tested negative for COVID. Patient was started on Remdesivir, Decadron, Albuterol, Thiamine, Zinc, Quercetin complex, and Vitamin D. Patient was also started on Vapotherm for supplemental oxygen which was alternated with BiPAP, as well as empiric Vancomycin (6/29-7/10 and 7/15-7/21) and Zosyn (6/29-7/8). Patient was ultimately intubated on 07/15 and her antibiotics were escalated to Vanc and Meropenem (7/13-7/21) for presumed pneumonia. She continued to require high ventilator settings (100%, PEEP 16). Her hospitalization was complicated by shock requiring vasopressors. On 7/17, patient was increasingly acidotic with pH 6.99 and PCO2 78 and was subsequently proned and paralyzed. Her infectious work-up was positive for VRE bacteremia on 7/17 and candida in urine culture. On 7/21 she was transferred to MICU for hypoxic respiratory failure and COVID pneumonia. On arrival, she is sedated on mechanical ventilation...Acute Hypoxic Hypercapneic Respiratory Failure requiring Mechanical Ventilation (POA) COVID PNA (POA) History of COPD (POA) - Etiology: COVID PNA - COVID positive 6/29 - Fully vaccinated with Moderna vaccine prior to admission - s/p Remdesivir, convalescent plasma, dexamethasone - 7/15 Intubated at outside hospital - 7/17 Paralyzed and proned - CXR: bilateral diffuse patchy airspace disease - ABG on arrival: 7.43/53/65/35 on 80%, PEEP 10, PF 81 PLAN: - PAL, comp resp panel, Strep and Legionella urine Ag pending - Continue mechanical ventilation to optimize ventilation and oxygenation, maintain SpO2 $g/= 92% - DuoNebs q4hr - Empiric broad spectrum antibiotics as outlined below: Linezolid and cefepime - Propofol and Dilaudid drips to facilitate tolerance of mechanical ventilation - Start DEXARDS protocol - Repeat ABG at 2000; prone if PF ratio not improved - Consider CT chest when clinically stable VRE Bacteremia (POA) Sepsis (POA) Leukocytosis (POA) - Has received dexamethasone - Received the following courses abx: Vanc 6/29-7/10, 7/15- 7/21 Zosyn 6/29 - 7/8 Merrem 7/13-7/21 - BCx from 7/17 resulted for +VRE; transitioned to Linezolid prior to transfer - On vasopressors on 7/18 - WBC 26k, lactate here 1.2 - CXR: bilateral diffuse patchy airspace disease Plan: - PAN cultures: Bcx, UA, PAL, strep/legionella urinary Ag pending - Follow cultures; determine insertion date of PICC line - Empiric antibiotics with : Linezolid (start 7/21) and cefepime - ECHO pending AKI (POA) - Scr on admission 0.96, up to 1.96 on 7/17 - Multifactorial AKI is likely related to sepsis PLAN: - BMP here pending - Renal lytes pending - Renally dose medications, avoid contrast medications - Consult the renal team when appropriate T2DM (POA) - HgbA1C pending - FSBG with correction SSI q6hr per ICU protocol


VAERS ID: 1641634 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-16
Onset:2021-08-08
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hemodialysis
Preexisting Conditions: HD, COVID + confirmed on 8/8/21 hospitalized with COVID patient expired 8/21/21
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID infection resulting in hospitalization and death


VAERS ID: 1641642 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-15
Onset:2021-08-15
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-27
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 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Cough, Death, Dyspnoea, Endotracheal intubation, Oxygen saturation decreased, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone, Apixaban, Aspirin, Atorvastatin, Bumetanide, cholecalciferol, empagliflozin, Entresto, Insulin aspart, lamotrigine, Insulin glargine, levothyroxine, metolazone, metoprolol, milrinone, mirtazapine, triamcinolone cream
Current Illness:
Preexisting Conditions: Hypothyroidism, Acute on Chronic Systolic and Diastolic heart failure, Adynamic ileis, Acute Kidney injury, A-Fib, CHF LV Ejection fraction less than 20%, Chronic kidney disease, Obesity, CAD, Diverticulosis, Elevated BNP, Epilepsy, Hyperlipidemia, Hypertension, left bundle branch block, Pulmonary hypertension, Sleep apnea, history of stroke, Polyp of transverse colon, Type 2 diabetes, panvalvular mild regurgitation, chronic peripheral venous insufficiency.
Allergies: Carbamazepine (unknown), Betadine (Dermatitis)
Diagnostic Lab Data: COVID Positive Test on 8/15/2021 @ 1350 analyzed using PCR or equivalent nucleic acid amplification
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/18/2021 and 4/15/2021. Presented to ED on 8/15/2021 with past medical history of CHF with EF less than 20%, pulmonary hypertension on continuous Milrinone infusion, AFib, CKD arrives via EMS in respiratory distress. When EMS arrived, O2 sats 56% on room air, improved to 86% with 15L NRB. Patient reports 1 week of progressively worsening shortness of breath and cough. Denies any chest pain. Has not been tested for COVID, but lives with household members that have been ill. Patient was intubated in ED. Patient was initially full code but was changed to DNR after discussions with family.


VAERS ID: 1641668 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-14
Onset:2021-08-14
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A212A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cerebral hypoperfusion, Death, Dyspnoea, Hypoxia, Magnetic resonance imaging head abnormal, Mental status changes, SARS-CoV-2 test positive, Speech disorder, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira 40mg every 14 days starting 2 weeks after second; budesonide 9mg daily; carvedilol 25mg BID; clonidine 0.1mg BID; colesevelam 625mg BID; Vitamin D2 1,250mcg weekly; fluoxetine 10mg daily; fluoxetine 20mg daily; fluticasone 50mcg each
Current Illness: latent TB
Preexisting Conditions: HTN, UC, T2DM, GAD
Allergies: NKDA
Diagnostic Lab Data: Standard NAA detected SARS-CoV-2 on 8/14/21
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/18/2021 and 4/14/2021. Patient presented on 8/14/21 via EMS with shortness of breath and AMS. Per EMS, patient was found unresponsive and short of breath by family member for an unknown duration. EMS was called, with SpO2 of approximately 50%. EMS reports administering 20L O2 by NC and nonrebreather which improved SpO2 to 94% with improved mental status. Per chart review patient symptoms began around 8/5/21 and she tested positive 8/11/21. On admission, patient knew name, responded to pain, and followed commands- otherwise, was unable to communicate. MRI revealed Bilateral globus pallidi infarcts probably related to hypoxic ischemic injury, possibly due to hypoxia from COVID pneumonia. Based on irreversible state of mental status, patient was recommended to hospice team. Patient was transferred to inpatient hospice care on 8/19/21. Patient expired on 8/20/21.


VAERS ID: 1641714 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-05
Onset:2021-08-13
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Agonal respiration, Bradycardia, Death, Dyspnoea, Endotracheal intubation, Extubation, Unresponsive to stimuli, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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: Ascorbic acid 500mg daily, aspirin 325mg daily, atorvastatin 80mg nightly, Calcium Carbonate- vitamin D3 600mg-400unit BID, digoxin 0.125 1 tab M/W/F, donepezil 10mg BID, ferrous sulfate 325mg daily, furosemide 20mg bid prn, insulin aspart
Current Illness:
Preexisting Conditions: S/P CABG x3, CAD, T2DM with CKD3, Encephalopathy, Hyperlipidemia, Osteoporosis, Alzheimer''s Disease, Hx of stroke
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/5/2021 and 3/5/2021. Presented to ED on 8/13/21 via EMS from home due to shortness of breath. Patient was 93% on RA en route to ED and stable upon arrival. After arriving to ED, patient has SpO2 88% and was placed on supplemental O2. It was noticed patient may have had short run of ventricular tachycardia and patient went unresponsive with a pulse but agonal respirations. Patient was intubated in the ED on 8/13/21 and eventually extubated on 8/15/21. Patient received Rocephin, Decadron, remdesivir. During this time patient was in AKI. On 8/16/21, pt found to have HR in 20-30s and on 8/17 was severely bradycardic. Remdesivir was stopped. Pt was transitioned to comfort care and hospice Patient expired on 8/18/21.


VAERS ID: 1642678 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-03-01
Onset:2021-03-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 147
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: ASA Colchicine Ergocalciferol Ezetimibe Hydrochlorothiazide Lisinopril Metformin Rosvustatin Tamsulosin Carvedilol
Current Illness: Congestive Heart Failure Hypertension Obesity
Preexisting Conditions: Diabetes Mellitus Hypertension BPH
Allergies: NKDA
Diagnostic Lab Data: Veteran suffered from COVID Pneumonia
CDC Split Type:

Write-up: Veteran Died on 8/23/2021


VAERS ID: 1642957 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:2021-08-11
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Haemorrhagic stroke, Laboratory test, Medication error, Platelet count
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: BNT 162
Current Illness: Hyperlipidemia; Hypertension; Overweight
Preexisting Conditions: Medical History/Concurrent Conditions: Hemorrhagic stroke
Allergies:
Diagnostic Lab Data: Test Date: 202107; Test Name: Lab test; Result Unstructured Data: Normal; Test Date: 20210801; Test Name: Platelet count; Result Unstructured Data: 4800
CDC Split Type: USJNJFOC20210837606

Write-up: HEMORRHAGIC STROKE; MEDICATION ERROR (RECEIVED A FULL SERIES OF PFIZER FOLLOWED BY JNJ VACCINE); This spontaneous report received from a consumer via a company representative concerned a 48 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: hemorrhagic stroke, and concurrent conditions included: controlled hypertension, hyperlipidemia, and overweight. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, 1 total administered on 11-AUG-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Concomitant medications included bnt 162 for prophylactic vaccination. The patient received a full series of Pfizer sometime between MAR-2021 and MAY-2021. On JUL-2021, Laboratory data included: Lab tests were normal. On 01-AUG-2021, Laboratory data included: Platelet count (NR: not provided) 4800 and the patient had 3 brain bleeds. On 11-AUG-2021, the patient had medication error (received a full series of pfizer followed by JNJ vaccine). On 16-AUG-2021, the patient experienced hemorrhagic stroke and was hospitalized for one day. On 17-AUG-2021, the patient died from hemorrhagic stroke. It was unknown if an autopsy was performed or not. The action taken with covid-19 vaccine was not applicable. The outcome of the medication error (received a full series of Pfizer followed by JNJ vaccine) was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210837606 -covid-19 vaccine ad26.cov2.s- Hemorrhagic stroke. 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: Hemorrhagic stroke


VAERS ID: 1642962 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210846858

Write-up: ENDED UP IN THE HOSPITAL; DEATH; This spontaneous report received from a consumer via a company representative from social media concerned ''multiple patients''. The patient''s height, and weight were not reported. No past medical histories or concurrent conditions were reported. The patients received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose were not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch numbers were not reported and have been requested. No concomitant medications were reported. On an unspecified date, the many patients got vaccinated and ended up in the hospital, and were hospitalized (date unspecified). The number of days of hospitalization were not reported. On an unspecified date, the patients died from an unknown cause of death. It was unspecified if an autopsy was performed. The cause of death was not reported. The action taken with covid-19 vaccine was not applicable. The patients died of death and ended up in the hospital on an unspecified date. This report was serious (Death, and Hospitalization Caused / Prolonged). This case, from the same reporter is linked to 20210844140, 20210844317 and 20210844359.; Sender''s Comments: V0-20210846858-COVID-19 VACCINE AD26.COV2.S-Death and Ended up in the Hospital(Fatal); These events are considered un-assessable. The events have a compatible/suggestive temporal relationship, are unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1644342 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-04-01
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Behaviour disorder, Completed suicide, Depression, Insomnia, Mood altered, Oral mucosal blistering, Suicidal ideation
SMQs:, Severe cutaneous adverse reactions (broad), Suicide/self-injury (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Suicidal ideation; Mouth blisters; Anxiety; Depression; Insomnia; Major changes in mood, demeanor and thought; Irrational behavior; Took his own life Apr2021; This spontaneous case was reported by a consumer and describes the occurrence of COMPLETED SUICIDE (Took his own life Apr2021) and SUICIDAL IDEATION (Suicidal ideation) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In February 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In April 2021, the patient experienced COMPLETED SUICIDE (Took his own life Apr2021) (seriousness criteria death and medically significant). On an unknown date, the patient experienced SUICIDAL IDEATION (Suicidal ideation) (seriousness criterion medically significant), ORAL MUCOSAL BLISTERING (Mouth blisters), ANXIETY (Anxiety), DEPRESSION (Depression), INSOMNIA (Insomnia), MOOD ALTERED (Major changes in mood, demeanor and thought) and BEHAVIOUR DISORDER (Irrational behavior). The patient was treated with HYDROXYZINE EMBONATE (VISTARIL [HYDROXYZINE EMBONATE]) at an unspecified dose and frequency. The patient died in April 2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, SUICIDAL IDEATION (Suicidal ideation), ORAL MUCOSAL BLISTERING (Mouth blisters), ANXIETY (Anxiety), DEPRESSION (Depression), INSOMNIA (Insomnia), MOOD ALTERED (Major changes in mood, demeanor and thought) and BEHAVIOUR DISORDER (Irrational behavior) outcome was unknown. No concomitant medications were given by the reporter. Patient went to the hospital to have these side effects checked for about 5 times. He was diagnosed to have Depression, Anxiety, Insomnia, and Suicidal Ideation and was prescribed with Vistaril. Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1644357 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-24
Onset:2021-05-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chest pain, Dyspnoea, Feeling abnormal, Headache, Joint stiffness, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 14
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 [ACETYLSALICYLIC ACID]; AMLODIPINE; LOSARTAN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Chest pain/Heart attack symptoms; Patient did not seem himself; Fatal heart attack; Shortness of breath; Pressure in his jaw; Stabbing pain in his back; Headache; This spontaneous case was reported by a patient family member or friend and describes the occurrence of MYOCARDIAL INFARCTION (Fatal heart attack), CHEST PAIN (Chest pain/Heart attack symptoms), DYSPNOEA (Shortness of breath), JOINT STIFFNESS (Pressure in his jaw), BACK PAIN (Stabbing pain in his back) and HEADACHE (Headache) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026C21A and 001C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included ASPIRIN [ACETYLSALICYLIC ACID], AMLODIPINE and LOSARTAN for an unknown indication. On 24-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-May-2021, the patient experienced CHEST PAIN (Chest pain/Heart attack symptoms) (seriousness criterion hospitalization). On 24-May-2021, the patient experienced DYSPNOEA (Shortness of breath) (seriousness criterion hospitalization), JOINT STIFFNESS (Pressure in his jaw) (seriousness criterion hospitalization), BACK PAIN (Stabbing pain in his back) (seriousness criterion hospitalization) and HEADACHE (Headache) (seriousness criterion hospitalization). On 29-May-2021, the patient experienced MYOCARDIAL INFARCTION (Fatal heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced FEELING ABNORMAL (Patient did not seem himself). The patient was hospitalized from 24-May-2021 to 26-May-2021 due to CHEST PAIN. The patient died on 29-May-2021. The reported cause of death was fatal heart attack. It is unknown if an autopsy was performed. At the time of death, CHEST PAIN (Chest pain/Heart attack symptoms), DYSPNOEA (Shortness of breath), JOINT STIFFNESS (Pressure in his jaw), BACK PAIN (Stabbing pain in his back), HEADACHE (Headache) and FEELING ABNORMAL (Patient did not seem himself) outcome was unknown. Treatment information was not provided. This is a case of a 64 yo Male who died of a Myocardial Infarction 7 days after receiving the second dose. Very limited information regarding these events have been provided at this time. Patient''s symptoms of jaw pain, pressure I his head and chest pain prior to vaccination may be a confounding factor to the events. No further information is expected. This case was linked to MOD-2021-287620 (Patient Link).; Sender''s Comments: This is a case of a 64 yo Male who died of a Myocardial Infarction 7 days after receiving the second dose. Very limited information regarding these events have been provided at this time. Patient''s symptoms of jaw pain, pressure I his head and chest pain prior to vaccination may be a confounding factor to the events. No further information is expected.; Reported Cause(s) of Death: Fatal Heart attack


VAERS ID: 1644373 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hepatic failure, Portal vein thrombosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: liver failure; developed a clot in her portal vein; This spontaneous case was reported by a consumer and describes the occurrence of PORTAL VEIN THROMBOSIS (developed a clot in her portal vein) and HEPATIC FAILURE (liver failure) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002A21A and 041L20A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Diabetes. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PORTAL VEIN THROMBOSIS (developed a clot in her portal vein) (seriousness criteria death, hospitalization and medically significant) and HEPATIC FAILURE (liver failure) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was Liver failure. It is unknown if an autopsy was performed. It was reported that the reporter believed that her mother passed away as a result of a complication with the vaccine. Patient''s mother received first dose on 28-JAN-2021. Patient received second dose one 26-FEB-2021. The patient was 85-year-old with hypertension and diabetes and developed a clot in her portal vein. Patient was hospitalized. The clot made her go into liver failure which was the cause of death. The date of the reported events remained unknown at the time of the report. Treatment information were not provided by the reporter. Concomitant medications were not reported by reporter. Company Comment: This is the case of an 85-year-old female subject with a history of hypetension and diabetes who died due to hepatic falure. Reportedly, the patient initially developed thrombosis in portal vein (a clot in her portal vein), however a temporal association between the use of the product and the start date of the event was not reported. The patient subsequently developed liver failure and died due to liver failure, as reported, however, the date of death was not provided. It is unknown if an autopsy was performed. Very limited information regarding these events has been provided at this time. Causality is confounded with the patient''s advanced age, hypertension and diabetes.; Sender''s Comments: This is the case of an 85-year-old female subject with a history of hypetension and diabetes who died due to hepatic falure. Reportedly, the patient initially developed thrombosis in portal vein (a clot in her portal vein), however a temporal association between the use of the product and the start date of the event was not reported. The patient subsequently developed liver failure and died due to liver failure, as reported, however, the date of death was not provided. It is unknown if an autopsy was performed. Very limited information regarding these events has been provided at this time. Causality is confounded with the patient''s advanced age, hypertension and diabetes.; Reported Cause(s) of Death: Liver failure


VAERS ID: 1644387 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-03-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes; Heart disorder (Heart rhythm was not normal)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Patients father passed away; sore arm; Hemorrhagic stroke; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Patients father passed away) and HAEMORRHAGIC STROKE (Hemorrhagic stroke) in a 78-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Diabetes and Heart disorder (Heart rhythm was not normal). On 26-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, the patient experienced HAEMORRHAGIC STROKE (Hemorrhagic stroke) (seriousness criterion medically significant). On an unknown date, the patient experienced DEATH (Patients father passed away) (seriousness criteria death and medically significant) and MYALGIA (sore arm). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HAEMORRHAGIC STROKE (Hemorrhagic stroke) and MYALGIA (sore arm) outcome was unknown. Concomitant product was not provided by the reporter. Treatment product was not provided by the reporter. Company comment: Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1644390 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Blood clots; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (Blood clots) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (Blood clots) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was blood clots. It is unknown if an autopsy was performed. The concomitant medication was not reported. A consumer called and stated that his uncle passed away 2 days after receiving Moderna Covis-19 Vaccine. Reporter stated that his uncle had to go to ICU due to blood clots and died from it. No treatment medication information was provided. This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Sender''s Comments: This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Reported Cause(s) of Death: blood clots


VAERS ID: 1644391 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: patient died after the second dose of the Moderna vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (patient died after the second dose of the Moderna vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company Comment: Very limited information regarding the events has been provided at this time.; Sender''s Comments: Very limited information regarding the events has been provided at this time.; Reported Cause(s) of Death: patient died after the second dose of the Moderna vaccine


VAERS ID: 1644393 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Death after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death after vaccination) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medication details was provided. No treatment medication details was provided. Company comment: Very limited information regarding the events has been provided at this time. Further information is not expected.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information is not expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1644406 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-10
Onset:2021-04-20
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Gait disturbance, Headache, Intestinal obstruction, Nausea, Nervousness, Pallor, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 6
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dialysis (15 years in dialysis with multiple medical conditions).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Bowel blockage; Fever; Severe stomach cramp pain; Headache; Nauseous; Shaky with chills; Could not walk; Chills; Turned pale white like a ghost after vaccination; This spontaneous case was reported by a consumer and describes the occurrence of INTESTINAL OBSTRUCTION (Bowel blockage), PYREXIA (Fever), ABDOMINAL PAIN UPPER (Severe stomach cramp pain), HEADACHE (Headache), NAUSEA (Nauseous), NERVOUSNESS (Shaky with chills), GAIT DISTURBANCE (Could not walk) and CHILLS (Chills) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Dialysis (15 years in dialysis with multiple medical conditions). On 10-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 20-Apr-2021, the patient experienced PYREXIA (Fever) (seriousness criterion hospitalization), ABDOMINAL PAIN UPPER (Severe stomach cramp pain) (seriousness criterion hospitalization), HEADACHE (Headache) (seriousness criterion hospitalization), NAUSEA (Nauseous) (seriousness criterion hospitalization), NERVOUSNESS (Shaky with chills) (seriousness criterion hospitalization), GAIT DISTURBANCE (Could not walk) (seriousness criterion hospitalization) and CHILLS (Chills) (seriousness criterion hospitalization). On 26-Apr-2021, the patient experienced INTESTINAL OBSTRUCTION (Bowel blockage) (seriousness criteria death, hospitalization and medically significant). On an unknown date, the patient experienced PALLOR (Turned pale white like a ghost after vaccination). The patient was hospitalized for 6 days due to ABDOMINAL PAIN UPPER, CHILLS, GAIT DISTURBANCE, HEADACHE, INTESTINAL OBSTRUCTION, NAUSEA, NERVOUSNESS and PYREXIA. On 26-Apr-2021, PYREXIA (Fever), ABDOMINAL PAIN UPPER (Severe stomach cramp pain), HEADACHE (Headache), NAUSEA (Nauseous), NERVOUSNESS (Shaky with chills), GAIT DISTURBANCE (Could not walk) and CHILLS (Chills) outcome was unknown. The patient died on 26-Apr-2021. The reported cause of death was Intestinal obstruction. It is unknown if an autopsy was performed. Concomitant medications was not reported. No treatment information was provided. Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Further information has been requested Very Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: Intestinal obstruction


VAERS ID: 1644431 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-19
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: wife passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (wife passed away) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 19-May-2021 The patient died on 19-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. Very limited information regarding this event has been provided at this time. Further information has been requested. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was not applicable. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1644452 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Death; This spontaneous case was reported by a patient family member or friend and describes the occurrence of DEATH (Death) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Company Comment: Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1644561 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-04-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Back pain, Burning sensation, Cerebral thrombosis, Cerebrovascular accident, Chills, Diarrhoea, Fall, Gastrointestinal pain, Haemorrhage, Headache, Lid sulcus deepened, Muscle spasms, Pain in extremity, Pyrexia, Swelling face, Thrombosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (Codeine allergy); Penicillin allergy (penicillin allergy).
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Hysterectomy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: she ends up bleeding; Swollen face; Sunken eyes; Couldn''t speak; legs were cramping; burning legs; Blood clots on brain; Stroke; Blood clots on legs (left and right); stinging in leg; Fever; Diarrhea; Chills; Lower gut pain; Headache; back pain; Fall; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Stroke), THROMBOSIS (Blood clots on legs (left and right)), HAEMORRHAGE (she ends up bleeding), PYREXIA (Fever), DIARRHEA (Diarrhea), CHILLS (Chills), GASTROINTESTINAL PAIN (Lower gut pain), HEADACHE (Headache), PAIN IN EXTREMITY (stinging in leg), FALL (Fall), SWELLING FACE (Swollen face), LID SULCUS DEEPENED (Sunken eyes), APHASIA (Couldn''t speak), BACK PAIN (back pain), MUSCLE SPASMS (legs were cramping), BURNING SENSATION (burning legs) and CEREBRAL THROMBOSIS (Blood clots on brain) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Blood pressure high and Hysterectomy in 1981. Concurrent medical conditions included Penicillin allergy (penicillin allergy) and Drug allergy (Codeine allergy). In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Apr-2021, the patient experienced PYREXIA (Fever) (seriousness criterion hospitalization), DIARRHOEA (Diarrhea) (seriousness criterion hospitalization), CHILLS (Chills) (seriousness criterion hospitalization), GASTROINTESTINAL PAIN (Lower gut pain) (seriousness criterion hospitalization), HEADACHE (Headache) (seriousness criterion hospitalization) and BACK PAIN (back pain) (seriousness criterion hospitalization). On 11-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criteria death, hospitalization and medically significant), THROMBOSIS (Blood clots on legs (left and right)) (seriousness criteria hospitalization and medically significant), PAIN IN EXTREMITY (stinging in leg) (seriousness criterion hospitalization), MUSCLE SPASMS (legs were cramping) (seriousness criterion hospitalization), BURNING SENSATION (burning legs) (seriousness criterion hospitalization) and CEREBRAL THROMBOSIS (Blood clots on brain) (seriousness criteria hospitalization and medically significant). In 2021, the patient experienced FALL (Fall) (seriousness criterion hospitalization). In July 2021, the patient experienced SWELLING FACE (Swollen face) (seriousness criterion hospitalization), LID SULCUS DEEPENED (Sunken eyes) (seriousness criterion hospitalization) and APHASIA (Couldn''t speak) (seriousness criterion hospitalization). On an unknown date, the patient experienced HAEMORRHAGE (she ends up bleeding) (seriousness criteria hospitalization and medically significant). The patient was treated with Surgery (blood transfusion) for Thrombosis. The patient died on an unknown date. The reported cause of death was Stroke. It is unknown if an autopsy was performed. At the time of death, THROMBOSIS (Blood clots on legs (left and right)), HAEMORRHAGE (she ends up bleeding), PYREXIA (Fever), DIARRHOEA (Diarrhea), CHILLS (Chills), GASTROINTESTINAL PAIN (Lower gut pain), HEADACHE (Headache), PAIN IN EXTREMITY (stinging in leg), FALL (Fall), SWELLING FACE (Swollen face), LID SULCUS DEEPENED (Sunken eyes), APHASIA (Couldn''t speak), BACK PAIN (back pain), MUSCLE SPASMS (legs were cramping), BURNING SENSATION (burning legs) and CEREBRAL THROMBOSIS (Blood clots on brain) outcome was unknown. Patient was sent to the hospital that day and several tests were conducted like urine and Pet scan. No pulse on her legs as per husband and it also revealed that she had blood clots on both her left and right leg. She had 3 surgeries to take out the blood clot, however, she ended up bleeding. It got worse and hit her brain but fortunately, she did some therapy and after about 6 weeks, she was progressing well. Added that she fell three times in 2 days as per husband. Three weeks ago, he could not remember the exact date at around 7:15PM, he found his wife with swollen face, sunken eyes and couldn''t speak. That day, he called 911 and was sent at the medical facility and was referred to a neurologist. They found out that she had massive blood clot on her brain that keeps on leaking and major stroke. She laid there for 3 days and the doctor told the husband that brain scan showed worst results and so they decided to remove her breathing tool and or extubated. She lasted for about 12 hours and died. No concomitant drugs were provided. Company comment Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: Stroke


VAERS ID: 1644831 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USMODERNATX, INC.MOD20212

Write-up: cardiac arrest; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC ARREST (cardiac arrest) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CARDIAC ARREST (cardiac arrest) (seriousness criteria death and medically significant). The reported cause of death was Cardiac arrest. It is unknown if an autopsy was performed. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. This is a fatal case of cardiac arrest in a female, age unknown, who received mRNA-1273 on an unknown date. Cause of death was cardiac arrest. Very limited information has been provided at this time. Further information has been requested.; Sender''s Comments: This is a fatal case of cardiac arrest in a female, age unknown, who received mRNA-1273 on an unknown date. Cause of death was cardiac arrest. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: cardiac arrest


VAERS ID: 1645002 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Someone passed away after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Someone passed away after getting the vaccine) in a 65-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment information was not provided. The patient died the day after receiving the Moderna Covid-19 vaccine. Very limited information regarding this event has been provided at this time. Further information can''t be requested (No consent for safety follow-up).; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information can''t be requested (No consent for safety follow-up).; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645033 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
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: USMODERNATX, INC.MOD20212

Write-up: few other things; headache; This spontaneous case was reported by an other health care professional and describes the occurrence of ADVERSE EVENT (few other things) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced ADVERSE EVENT (few other things) (seriousness criterion death) and HEADACHE (headache). On 30-Jul-2021, HEADACHE (headache) had resolved. The patient died on 30-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant and treatment medications were reported Very limited information regarding the events has been provided at this time. This case was linked to MOD-2021-286501 (Patient Link).; Sender''s Comments: Very limited information regarding the events has been provided at this time.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1645034 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-06-22
Onset:2021-07-30
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Fatigue, Headache, Illness, Influenza like illness, Mobility decreased
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Very very sick; In bed for several days; flu-like symptoms; Headache; Fatigue; Died in their sleep; This spontaneous case was reported by an other health care professional and describes the occurrence of DEATH (Died in their sleep) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 078C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 16-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced ILLNESS (Very very sick), MOBILITY DECREASED (In bed for several days), INFLUENZA LIKE ILLNESS (flu-like symptoms), HEADACHE (Headache) and FATIGUE (Fatigue). The patient died on 30-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, ILLNESS (Very very sick), MOBILITY DECREASED (In bed for several days), INFLUENZA LIKE ILLNESS (flu-like symptoms), HEADACHE (Headache) and FATIGUE (Fatigue) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. Concomitant medication information not provided. Treatment information not provided. The caller was calling on behalf of their son who died on 30Jul2021. The patient received first dose of Moderna COVID-19 vaccine on 22Jun2021 and second on 16Jul2021. The caller stated the patient received the second dose early. The caller did not know which arm the vaccine was given in. The caller stated after receiving the second dose the patient became very very sick, the patient was in bed for several days, they had flu-like symptoms, a headache, and fatigue. The caller confirmed patient seemed to get better however then the patient died in their sleep on 30Jul2021. The caller did not know if the patient took anything to help with the symptoms experienced and confirmed the patient was not taking any daily medications. Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to MOD-2021-286489 (Patient Link).; Sender''s Comments: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645045 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-07-13
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: feeling sick; COVID-19; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (COVID-19) and MALAISE (feeling sick) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In April 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In May 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Jul-2021, the patient experienced MALAISE (feeling sick) (seriousness criteria death and hospitalization). On an unknown date, the patient experienced COVID-19 (COVID-19) (seriousness criterion death). The patient died on 05-Aug-2021. The reported cause of death was Covid-19. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. Patient started feeling sick on 13 Jul 2021 and was hospitalized a few days later. Patient was passed away on 05 Aug 2021 with a cause of Death of COVID-19. Very limited information regarding this event/s has been provided at this time. Further information has been requested. The causality for the event Covid-19 will be considered as "Not Applicable".; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested. The causality for the event Covid-19 will be considered as "Not Applicable"; Reported Cause(s) of Death: COVID-19


VAERS ID: 1645093 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (no medical history per source document).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: People have died from the Moderna vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (People have died from the Moderna vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (no medical history per source document). On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant products were reported. No treatment information provided. Company comment: This is a case of sudden death in a patient with unknown age and gender and with unknown past medical history who died in unknown days after receiving a dose of the vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of sudden death in a patient with unknown age and gender and with unknown past medical history who died in unknown days after receiving a dose of the vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: People have died from the Moderna vaccine


VAERS ID: 1645204 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-01
Onset:2021-02-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arterial occlusive disease, Asthenia, Biopsy, Biopsy muscle, COVID-19, Cardiac arrest, Coma, Hospitalisation, Hypokinesia, Oral candidiasis, Pain, Peroneal nerve palsy, Pyrexia, Rales
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), 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), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Oropharyngeal infections (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 171
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: biopsy; Result Unstructured Data: extreme vasculitis after a nerve biopsy; Test Date: 2021; Test Name: biopsy; Result Unstructured Data: muscles were debilitating; Test Date: 2021; Test Name: COVID-19; Test Result: Positive; Result Unstructured Data: positive.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of COMA (went into a coma), CARDIAC ARREST (2 days after she was diagnosed with COVID, she fell into cardiac arrest), HYPOKINESIA (couldn''t get out of bed/couldn''t move), ARTERIAL OCCLUSIVE DISEASE (clogged arteries in her legs), PERONEAL NERVE PALSY (foot drop), COVID-19 (acquired COVID/2 days after she was diagnosed with COVID, she fell into cardiac arrest), RALES (a little bit of crackling in her lungs), ORAL CANDIDIASIS (thrush in her mouth), ASTHENIA (completely weak/extreme weakness), PAIN (extreme pain/continued with the pain), HOSPITALISATION (she was in the hospital for a total of 131 days) and PYREXIA (fever) in a 74-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In February 2021, the patient experienced PAIN (extreme pain/continued with the pain) (seriousness criteria death, hospitalization and disability). In July 2021, the patient experienced COMA (went into a coma) (seriousness criteria death, hospitalization, disability, medically significant and life threatening), CARDIAC ARREST (2 days after she was diagnosed with COVID, she fell into cardiac arrest) (seriousness criteria death, hospitalization, disability and medically significant) and COVID-19 (acquired COVID/2 days after she was diagnosed with COVID, she fell into cardiac arrest) (seriousness criteria death, hospitalization prolonged and disability). On an unknown date, the patient experienced HYPOKINESIA (couldn''t get out of bed/couldn''t move) (seriousness criteria death, hospitalization and disability), ARTERIAL OCCLUSIVE DISEASE (clogged arteries in her legs) (seriousness criteria death, hospitalization and disability), PERONEAL NERVE PALSY (foot drop) (seriousness criteria death, hospitalization and disability), RALES (a little bit of crackling in her lungs) (seriousness criteria death, hospitalization and disability), ORAL CANDIDIASIS (thrush in her mouth) (seriousness criteria death, hospitalization and disability), ASTHENIA (completely weak/extreme weakness) (seriousness criteria death, hospitalization and disability), HOSPITALISATION (she was in the hospital for a total of 131 days) (seriousness criteria death and hospitalization prolonged) and PYREXIA (fever) (seriousness criteria death, hospitalization and disability). The patient died on 23-Jul-2021. The reported cause of death was Coma, Cardiac arrest, Movements reduced, Arterial occlusion, Foot drop, covid-19, Crackles lung, Oral thrush, Weakness, Pain and Fever. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Biopsy: abnormal (abnormal) extreme vasculitis after a nerve biopsy. In 2021, Biopsy muscle: abnormal (abnormal) muscles were debilitating. In 2021, COVID-19: positive (Positive) positive. No concomitant and treatment information was provided. Patient was removed from the hospital and taken to a rehabilitation facility. Patient had a fever at that facility and a little bit of crackling in her lungs. Then patient was admitted back in the hospital for four months. They did a biopsy in the throat due to thrush in patients mouth, which the patient never had before. patient was completely weak, and couldn''t find out what patient had.. After 3 months in the hospital, they found that patient had extreme vasculitis after a nerve biopsy. They gave patient a treatment to lower her vascular system; the name is unknown. patient was doing well, but then patient acquired COVID in July 2021. Two days after patient was diagnosed with COVID, and fell into cardiac arrest. patient went into a coma, then passed 3 days later on 23Jul2021. patient was in the hospital for a total of 131 days. Company Comment: This is a case of death in a 74-year-old female patient, after receiving on February, date unknown an unspecified dose of vaccine (Lot number unknown). Cause of death was coma, cardiac arrest, movements reduced, arterial occlusion, foot drop, covid-19, crackles lung, oral thrush, weakness, pain and fever. Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. Further information is expected.; Sender''s Comments: This is a case of death in a 74-year-old female patient, after receiving on February, date unknown an unspecified dose of vaccine (Lot number unknown). Cause of death was coma, cardiac arrest, movements reduced, arterial occlusion, foot drop, covid-19, crackles lung, oral thrush, weakness, pain and fever. Very limited information regarding underlying medical history, concomitant medications and autopsy report was provided at this time. Further information is expected.; Reported Cause(s) of Death: cardiac arrest; coma; Pain; Movements reduced; arterial occlusion; foot drop; fever; crackles lung; Oral thrush; weakness; COVID-19


VAERS ID: 1645248 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: People that died; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (People that died) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. The concomitant medications were not reported. The treatment information was not provided. Company Comment : This case cannot be evaluated, it seems invalid. More info has been required to assess its validity.; Sender''s Comments: This case cannot be evaluated, it seems invalid. More info has been required to assess its validity.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645285 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-01
Onset:2021-08-01
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, COVID-19, Death, Drug ineffective, Oxygen saturation, Pyrexia, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: very low; Test Name: Oxygen saturation; Result Unstructured Data: oxygen was not going to the blood; Test Name: COVID-19 virus test; Test Result: Positive; Result Unstructured Data: positive.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: He was placed in the ICU and passed on 16Aug2021; COVID-19; High grade fever; Lack of drug effect; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (He was placed in the ICU and passed on 16Aug2021), COVID-19 (COVID-19) and PYREXIA (High grade fever) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In August 2021, the patient experienced COVID-19 (COVID-19) (seriousness criteria death and life threatening), PYREXIA (High grade fever) (seriousness criterion life threatening) and DRUG INEFFECTIVE (Lack of drug effect). On 16-Aug-2021, PYREXIA (High grade fever) outcome was unknown. The patient died on 16-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DRUG INEFFECTIVE (Lack of drug effect) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure measurement: very low (Low) very low. On an unknown date, Oxygen saturation: low (Low) oxygen was not going to the blood. On an unknown date, SARS-CoV-2 test: positive (Positive) positive. Concomitant information was not provided by reporter. No treatment information was provided. Patient had 1st dose of Moderna COVID-19 vaccine in last week of Jan2021 and 2nd dose was administered 28 days after. Two weeks ago patient was diagnosed to have COVID-19 and initially had high grade fever for a few days but had to be taken to a hospital where patient was intubated because oxygen was not going to the blood and was also noted to have very low blood pressure. Patient was placed in the ICU and passed on 16-Aug-2021. Company comment: This is a case of COVID-19 infection with fatal outcome in a 67-year-old male who died about six months after receiving the second dose of vaccine. This report refers to a case of Drug ineffective for mRNA-1273, lot #unspecified (for the two doses). Based on the current available information and temporal association between the use of the product and the Drug ineffective event, a causal relationship cannot be excluded. For the event COVID-19, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable. Based on the prolonged time since the last dose of vaccine was administered and compatibility of the event of Pyrexia with a severe COVID-19 infection, this event is assessed as unlikely related to mRNA-1273. Further information was requested.; Sender''s Comments: This is a case of COVID-19 infection with fatal outcome in a 67-year-old male who died about six months after receiving the second dose of vaccine. This report refers to a case of Drug ineffective for mRNA-1273, lot #unspecified (for the two doses). Based on the current available information and temporal association between the use of the product and the Drug ineffective event, a causal relationship cannot be excluded. For the event COVID-19, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable. Based on the prolonged time since the last dose of vaccine was administered and compatibility of the event of Pyrexia with a severe COVID-19 infection, this event is assessed as unlikely related to mRNA-1273. Further information was requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1645289 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-01-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood bicarbonate, Blood creatinine, Blood gases, Blood glucose, Brain natriuretic peptide, COVID-19, Carbon dioxide, Chest X-ray, Cough, Fibrin D dimer, Glycosylated haemoglobin, Lymphocyte count, Oxygen saturation, PO2, Pyrexia, Respiratory failure, Respiratory rate, SARS-CoV-2 antibody test, SARS-CoV-2 test, Tachypnoea, Troponin, Vital signs measurement, White blood cell count, pH body fluid
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (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? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TACROLIMUS; MYCOPHENOLATE MOFETIL
Current Illness: End stage renal disease; Exertional dyspnea; IgA nephropathy; Immunosuppression (on stable maintenance immunosuppression); Noninvasive mechanical ventilation (Shortly after admission, noninvasive positive pressure ventilation was initiated for increasing oxygen requirements).
Preexisting Conditions: Medical History/Concurrent Conditions: Renal transplant (with antithymocyte globulin induction 6 years prior presented with exertional dyspnea, posttransplant course has been uncomplicated without kidney allograft rejection, chronic infection, or hospitalization).
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: HCO3; Result Unstructured Data: 24.5 mmol/L on presenting to the hospital second time; Test Date: 2021; Test Name: serum creatinine; Result Unstructured Data: baseline serum creatinine ranging from 0.9 to 1.0 mg/dL without proteinuria.; Test Date: 2021; Test Name: serum creatinine; Result Unstructured Data: serum creatinine, 1.5 mg/dL on admission; Test Date: 2021; Test Name: arterial blood gases; Result Unstructured Data: Arterial blood gas (FiO2 0.44) confirmed acute hypoxic respiratory failure on presenting to the hospital second time; Test Date: 2021; Test Name: Non-fasting glucose; Result Unstructured Data: Non-fasting glucose was 492 mg/dL; Test Date: 2021; Test Name: BNP; Result Unstructured Data: BNP, 175 pg/mL on admission; Test Date: 2021; Test Name: PaCO2; Result Unstructured Data: 30.3 mm Hg on presenting to the hospital second time; Test Date: 2021; Test Name: Chest X-ray; Result Unstructured Data: Chest X-ray did not demonstrate any acute findings; Test Date: 2021; Test Name: Chest X-ray; Result Unstructured Data: Chest X-ray now showed an interstitial opacity in the left lower lung on presenting to the hospital second time; Test Date: 2021; Test Name: D-dimer; Result Unstructured Data: D-dimer, 557 ng/mL on admission; Test Date: 2021; Test Name: hemoglobin A1c; Result Unstructured Data: hemoglobin A1c was 8.2%; Test Date: 2021; Test Name: absolute lymphocyte count; Result Unstructured Data: 150/?L (baseline 5 months prior: 550/?L) - On admission; Test Date: 2021; Test Name: pulse oximeter; Result Unstructured Data: pulse oximeter reading was 66% on ambient air on presenting to the hospital second time; Test Date: 2021; Test Name: SatO2; Result Unstructured Data: 89.7% despite supplemental oxygen on presenting to the hospital second time; Test Date: 2021; Test Name: pH; Result Unstructured Data: pH 7.49 on presenting to the hospital second time; Test Date: 2021; Test Name: PaO2; Result Unstructured Data: 55.5mm Hg on presenting to the hospital second time; Test Date: 2021; Test Name: respiratory rate; Result Unstructured Data: 30 bpm on presenting to the hospital second time; Test Date: 2021; Test Name: SARS-CoV-2 antispike antibody; Test Result: Negative; Result Unstructured Data: A SARS-CoV-2 antispike antibody was undetectable (<0.8 units) by semiquantitative immunoassay; Comments: used Elecsys Anti-SARS-CoV-2 S, ; Test Date: 2021; Test Name: SARS-CoV-2; Test Result: Positive; Result Unstructured Data: COVID-19 was confirmed with a positive nasopharyngeal swab sample by SARS-CoV-2 real-time reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 of 19.5; Comments: Used Xpert Xpress SARS-CoV-2, Cepheid; Test Date: 2021; Test Name: SARS-CoV-2; Test Result: Positive; Result Unstructured Data: A repeat nasopharyngeal sample obtained 2 days after admission confirmed persistent positivity of SARS CoV- 2 by reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 gene of 15.2; Test Date: 2021; Test Name: Troponin; Result Unstructured Data: Troponin-I, 0.01 ng/mL on admission; Test Date: 2021; Test Name: Vital signs; Result Unstructured Data: Vital signs were notable for tachypnea: body temperature 36.7 ?C, blood pressure 127/83 mm Hg, heart rate 83 bpm, respiratory rate 24 bpm, and SatO2 96% on ambient air.; Comments: Patient''s physical examination was otherwise unremarkable; Test Date: 2021; Test Name: White blood cell count; Result Unstructured Data: White blood cell count was 7500/?L on admission.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: fatal COVID-19 infection; hypoxic respiratory failure; tachypnea/tachypneic; nonproductive cough; intermittent low-grade; This literature-non-study case was reported in a literature article and describes the occurrence of COVID-19 (fatal COVID-19 infection), RESPIRATORY FAILURE (hypoxic respiratory failure) and TACHYPNOEA (tachypnea/tachypneic) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. LITERATURE REFERENCE: Case report: Severe COVID-19 in a kidney transplant recipient without humoral response to SARS-CoV-2 mRNA vaccine series. Transplant Direct. 2021;7(9):e473 The patient''s past medical history included Renal transplant (with antithymocyte globulin induction 6 years prior presented with exertional dyspnea, posttransplant course has been uncomplicated without kidney allograft rejection, chronic infection, or hospitalization.) in 2015 and Noninvasive mechanical ventilation (Shortly after admission, noninvasive positive pressure ventilation was initiated for increasing oxygen requirements.) since an unknown date. Concurrent medical conditions included End stage renal disease, IgA nephropathy, Immunosuppression (on stable maintenance immunosuppression) and Exertional dyspnea. Concomitant products included TACROLIMUS and MYCOPHENOLATE MOFETIL for Immunosuppression. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. In February 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced COVID-19 (fatal COVID-19 infection) (seriousness criteria death and hospitalization prolonged), RESPIRATORY FAILURE (hypoxic respiratory failure) (seriousness criteria death, hospitalization prolonged and medically significant), TACHYPNOEA (tachypnea/tachypneic) (seriousness criterion hospitalization prolonged), COUGH (nonproductive cough) and PYREXIA (intermittent low-grade). The patient was hospitalized for 7 days due to COVID-19, RESPIRATORY FAILURE and TACHYPNOEA. The patient was treated with DEXAMETHASONE (intravenous) for COVID-19, at a dose of 6 mg once a day; REMDESIVIR (intravenous) at a dose of 100 mg once a day; PREDNISONE for Cough and Fever, at a dose of 30 milligram; PREDNISONE for Cough and Fever, at a dose of 20 milligram and PREDNISONE for Cough and Fever, at a dose of 10 milligram. The patient died on an unknown date. The reported cause of death was this case of a kidney transplant recipient who developed a fatal covid-19 infection about 11 d after completion of the sars-cov-2 mrna vaccine series and Hypoxic respiratory failure. It is unknown if an autopsy was performed. At the time of death, TACHYPNOEA (tachypnea/tachypneic), COUGH (nonproductive cough) and PYREXIA (intermittent low-grade) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Blood bicarbonate: high (High) 24.5 mmol/L on presenting to the hospital second time. In 2021, Blood creatinine: 0.9 to 1.0 mg/dl (normal) baseline serum creatinine ranging from 0.9 to 1.0 mg/dL without proteinuria. and normal (normal) serum creatinine, 1.5 mg/dL on admission. In 2021, Blood gases: abnormal (abnormal) Arterial blood gas (FiO2 0.44) confirmed acute hypoxic respiratory failure on presenting to the hospital second time. In 2021, Blood glucose: high (High) Non-fasting glucose was 492 mg/dL. In 2021, Brain natriuretic peptide: normal (normal) BNP, 175 pg/mL on admission. In 2021, Carbon dioxide: low (Low) 30.3 mm Hg on presenting to the hospital second time. In 2021, Chest X-ray: normal (normal) Chest X-ray did not demonstrate any acute findings and abnormal (abnormal) Chest X-ray now showed an interstitial opacity in the left lower lung on presenting to the hospital second time. In 2021, Fibrin D dimer: 557 ng/ml (abnormal) D-dimer, 557 ng/mL on admission. In 2021, Glycosylated haemoglobin: high (High) hemoglobin A1c was 8.2%. In 2021, Lymphocyte count: low (Low) 150/?L (baseline 5 months prior: 550/?L) - On admission. In 2021, Oxygen saturation: low (Low) pulse oximeter reading was 66% on ambient air on presenting to the hospital second time and low (Low) 89.7% despite supplemental oxygen on presenting to the hospital second time. In 2021, PO2: low (Low) 55.5mm Hg on presenting to the hospital second time. In 2021, Respiratory rate: high (High) 30 bpm on presenting to the hospital second time. In 2021, SARS-CoV-2 antibody test: negative (Negative) A SARS-CoV-2 antispike antibody was undetectable (<0.8 units) by semiquantitative immunoassay. In 2021, SARS-CoV-2 test: positive (Positive) COVID-19 was confirmed with a positive nasopharyngeal swab sample by SARS-CoV-2 real-time reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 of 19.5 and positive (Positive) A repeat nasopharyngeal sample obtained 2 days after admission confirmed persistent positivity of SARS CoV- 2 by reverse transcription-polymerase chain reaction with a cycle threshold value for target N2 gene of 15.2. In 2021, Troponin: low (Low) Troponin-I, 0.01 ng/mL on admission. In 2021, Vital signs measurement: normal (normal) Vital signs were notable for tachypnea: body temperature 36.7 ?C, blood pressure 127/83 mm Hg, heart rate 83 bpm, respiratory rate 24 bpm, and SatO2 96% on ambient air.. In 2021, White blood cell count: normal (normal) White blood cell count was 7500/?L on admission. In 2021, pH body fluid: high (High) pH 7.49 on presenting to the hospital second time. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered COVID-19 (fatal COVID-19 infection), RESPIRATORY FAILURE (hypoxic respiratory failure), TACHYPNOEA (tachypnea/tachypneic), COUGH (nonproductive cough) and PYREXIA (intermittent low-grade) to be possibly related. Patient started to develop nonproductive cough and intermittent low-grade fevers. His symptoms gradually worsened, and 5 days before admission, he was evaluated in the emergency department. Patient was discharged with a 6 day course of glucocorticoid therapy. He was not tested for SARS-CoV-2 at that time because he had been fully vaccinated. Patient was admitted to the intensive care unit for further treatment after presenting to the hospital the second time where he was found to be tachypneic and severely hypoxic. Upon admission, his exam was notable for bibasilar crackles in lower lung fields without peripheral edema. Patient continued to decompensate and died on the seventh day after admission. Company Comment: Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Reported Cause(s) of Death: This case of a kidney transplant recipient who developed a fatal COVID-19 infection about 11 d after completion of the SARS-CoV-2 mRNA vaccine series; hypoxic respiratory failure


VAERS ID: 1645361 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: died from a rapid heartbeat after getting the vaccine; Result Unstructured Data: increased
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: died from a rapid heartbeat after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of HEART RATE INCREASED (died from a rapid heartbeat after getting the vaccine) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced HEART RATE INCREASED (died from a rapid heartbeat after getting the vaccine) (seriousness criterion death). The reported cause of death was died from a rapid heartbeat after getting the vaccine. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Heart rate increased: increased (High) increased. No concomitant medication details was reported. No treatment medication details was reported. Company Comment: This case concerns a female patient of unknown age who had a fatal event of HEART RATE INCREASED after receiving mRNA-1273. The reported cause of death was died from a rapid heartbeat after getting the vaccine. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: This case concerns a female patient of unknown age who had a fatal event of HEART RATE INCREASED after receiving mRNA-1273. The reported cause of death was died from a rapid heartbeat after getting the vaccine. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: died from a rapid heartbeat after getting the vaccine


VAERS ID: 1645370 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Fell down on the floor and died; This spontaneous case was reported by a nurse and describes the occurrence of FALL (Fell down on the floor and died) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced FALL (Fell down on the floor and died) (seriousness criterion death). The patient died on 20-Aug-2021. The reported cause of death was fell on the floor and died. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. The patient died yesterday after 9 days [unsure of the date] of getting the booster dose of the Moderna COVID-19 vaccine. The patient did not had any side effects with the first 2 doses of the Moderna COVID-19 Vaccine. Treatment information was not provided. Company Comment : Very limited information regarding the events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Fell on the floor and died


VAERS ID: 1645387 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angiocardiogram, Angiogram, Autopsy, Cardiogenic shock, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Myocarditis, Pyrexia, SARS-CoV-2 test, Serology test, Tachycardia, Ventricular dysfunction
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Coronary angiography; Result Unstructured Data: revealed no coronary artery disease.; Test Date: 2021; Test Name: Coronary angiography; Result Unstructured Data: revealed no coronary artery disease.; Test Date: 2021; Test Name: Autopsy; Result Unstructured Data: An inflammatory infiltrate admixed with macrophages, T-cells, eosinophils, and B cells was observed; Test Date: 2021; Test Name: transthoracic Echocardiogram; Result Unstructured Data: global biventricular dysfunction (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy; Test Date: 2021; Test Name: Electrocardiogram; Result Unstructured Data: showed diffuse ST-segment elevation; Test Date: 2021; Test Name: SARS-CoV-2 PCR test; Test Result: Negative ; Result Unstructured Data: Negative for SARS-CoV-2 and no other causes were identified.; Test Date: 2021; Test Name: serologic examination; Result Unstructured Data: no other causes were identified.
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Cardiogenic shock; biventricular myocarditis; Global biventricular dysfunction; tachycardia; chest pain; dyspnea; Fever; This literature-non-study case was reported in a literature article and describes the occurrence of CARDIOGENIC SHOCK (Cardiogenic shock), MYOCARDITIS (biventricular myocarditis) and VENTRICULAR DYSFUNCTION (Global biventricular dysfunction) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CARDIOGENIC SHOCK (Cardiogenic shock) (seriousness criteria death and medically significant), MYOCARDITIS (biventricular myocarditis) (seriousness criteria death and medically significant), VENTRICULAR DYSFUNCTION (Global biventricular dysfunction) (seriousness criterion death), TACHYCARDIA (tachycardia), CHEST PAIN (chest pain), DYSPNOEA (dyspnea) and PYREXIA (Fever). The patient died on an unknown date. The reported cause of death was biventricular myocarditis, Cardiogenic shock and global biventricular dysfunction. An autopsy was performed. At the time of death, TACHYCARDIA (tachycardia), CHEST PAIN (chest pain), DYSPNOEA (dyspnea) and PYREXIA (Fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Angiocardiogram: normal (normal) revealed no coronary artery disease.. In 2021, Angiogram: normal (normal) revealed no coronary artery disease.. In 2021, Autopsy: biventricular myocarditis (abnormal) An inflammatory infiltrate admixed with macrophages, T-cells, eosinophils, and B cells was observed. In 2021, Echocardiogram: abnormal (abnormal) global biventricular dysfunction (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy. In 2021, Electrocardiogram: abnormal (abnormal) showed diffuse ST-segment elevation. In 2021, SARS-CoV-2 test: negative (Negative) Negative for SARS-CoV-2 and no other causes were identified.. In 2021, Serology test: abnormal (abnormal) no other causes were identified.. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient had not reported a viral prodrome The letter stated that a direct causal relationship could not be definitively established because they did not perform testing for viral genomes or autoantibodies in the tissue specimens. However, no other causes were identified by PCR assay or serologic examination. Concomitant product use was not provided by the reporter. ? No treatment information was provided. Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested. Further information is not expected.; Reported Cause(s) of Death: biventricular myocarditis; Cardiogenic shock; Global biventricular dysfunction


VAERS ID: 1646186 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-23
Onset:2021-06-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart enlarged
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100987047

Write-up: passed away 19Jun2021; This is a spontaneous report from a contactable consumer (patient''s mother). A 25-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 23May2021 (Lot Number: EW0172) (at age of 25-year-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included diagnosed with an enlarged vessel sized heart. The patient''s concomitant medications were not reported. The patient experienced passed away on 19Jun2021.An autopsy was performed and results were not provided. Two days after the first vaccine was when the information came out about males 20-30 getting inflammation of the heart. The patient''s mother told him not to take the second shot. Then, this happened. She doesn''t have the results of the autopsy yet. She believed the Pfizer vaccine escalated his death. He did get diagnosed with an enlarged vessel sized heart. He got it because he thought he was doing the right thing. There was no history of all previous immunization with the Pfizer vaccine considered as suspect. No additional Vaccines Administered on Same Date of the Pfizer Suspect. No Prior Vaccinations (within 4 weeks). Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: passed away 19Jun2021


VAERS ID: 1646190 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-10
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cardiogenic shock, Disease recurrence, Hyperhidrosis, Hypersomnia, Illness, Incoherent, Malaise, Memory impairment, Pyrexia
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart valve disorders (from 5 years ago.); Knee replacement (the second knee replacement was in Feb2021.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100987324

Write-up: very weak; very sick; had super high fever; had sweats; The same evvents Incoherent, very sick, very ill, had super high fever and had sweats also occurred after second dose; sleeping most of the time with fever; not feeling good; she couldn''t answer questions, did not know who she was.; Heart had stopped; incoherent after second dose/she couldn''t answer questions, did not know who she was; This is a spontaneous report from a contactable consumer (patient''s husband). A 68-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Left upper arm on 10Jun2021 10:00 at the age of 68-year-old (Batch/Lot Number: EW0217) as single dose for covid-19 immunisation. Medical History: The patient had underlying conditions. The patient had two mechanical heart valves from 5 years ago. The patient had 2 knee replacements. The second knee replacement was in Feb2021. The patient recovered from the second knee replacement and was outpatient PT. Two weeks before the first dose Pfizer Covid 19 Vaccine, the patient said for the first time in years she did not have any kind of knee pain of any kind, other than regeneration of nerves, no bone pain from the replacements. The patient was doing so well. There were no concomitant medications. The patient previously received first dose of BNT162B2 (lot: EW0176) in upper arm on 20May2021 10:00 at the age of 68-year-old for COVID-19 Immunization and experienced became very sick, very ill, super high fever, incoherent, couldn''t remember who she was or what her children''s names were or grandchildren''s names, had sweats. Vaccine Administered at another Facility? No. List all vaccines administered on same date with the Pfizer vaccine considered as suspect: no. List any other vaccinations within four weeks prior to the first administration date of the suspect vaccine(s): no. AE(s) following prior vaccinations: No, not that the report is aware of. The patient got vaccinated as a child, the age bracket. The patient had flu shots and shingles shots, all of them were given with no adverse reactions other than the patient''s arm hurt. The patient experienced heart had stopped on Jun2021, incoherent after second dose/she couldn''t answer questions, did not know who she was on Jun2021, very sick on 10Jun2021, had super high fever on 10Jun2021, had sweats on 10Jun2021, sleeping most of the time with fever on Jun2021, very weak on 12Jun2021, not feeling good on Jun2021. Clinical course: The patient received both doses Pfizer Covid 19 Vaccine and died. To be more specific, the patient was fixated on having to have the vaccination card. The patient received the first dose Pfizer Covid 19 Vaccine on 20May2021 and became very sick, very ill began the night of 20May2021. The patient had a super high fever and sweats began the night of 20May2021 and this lasted for about 2 days. The patient was also incoherent after receiving the first dose Pfizer Covid 19 Vaccine. The patient couldn''t remember who she was or what her children''s names were or grandchildren''s names. The exact same thing occurred after the patient received the second dose Pfizer Covid 19 Vaccine. The patient kind of recovered for 4 days. The patient received the second dose Pfizer Covid 19 Vaccine on 10Jun2021. The patient got even more sick than she got with the first dose Pfizer Covid 19 Vaccine began on 10Jun2021. By 12Jun2021, the patient was feeling somewhat better but totally weak. Incoherent, very sick, very ill, had super high fever and had sweats after receiving the second dose Pfizer Covid 19 Vaccine. The pateint was sleeping most of the time with fever. When the patient was awake she couldn''t answer questions, did not know who she was. The patient was very weak and could hardly get up. The patient was meeting with neighbors that night and around 1900 said she was not feeling good and was going to bed. By midnight the patient was totally out of it. Between 13Jun2021 and morning 14Jun2021, the patient dead at 0111, her heart had stopped. The patient died on 14Jun2021. It was not reported if an autopsy was performed. Cause of death verbatim description: Heart had stopped. AE(s) require a visit to: Emergency Room/Physician Office: No. Investigation Assessment: No. Relevant Tests: none. The outcome of Heart had stopped was fatal, outcome of other events was unknown. Verbatim event relatedness: Pfizer Covid 19 Vaccine: Second dose: Heart had stopped-Related.; Reported Cause(s) of Death: Heart had stopped


VAERS ID: 1646195 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2021-05-03
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / OT

Administered by: Private       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, Premature baby
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100987373

Write-up: Preemie baby died in the NICU; Maternal Exposure During Pregnancy; This is a spontaneous report from a contactable consumer (patient''s mother). This consumer reported information for both mother and fetus/baby. This is a baby report. A 36-year-old female pregnant patient received BNT162B2, first dose via an unspecified route of administration, administered in right arm on 12Apr2021 05:00 PM (Batch/Lot Number: EW0153) as dose 1, single; second dose via an unspecified route of administration, administered in left arm on 03May2021 (Batch/Lot Number: ER8735) as dose 2, single for covid-19 immunization. The patient''s medical history was not reported. There were no concomitant medications. Until Monday the 17, She has emergency cesarean to deliver at 24 weeks, 4 weeks later the preemie baby died in the NICU. The preemie baby died in the NICU in 2021. The event was serious per death, life threatening, hospitalization. The patient died in 2021. It was not reported if an autopsy was performed.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202100986436 mother case;US-PFIZER INC-202100987372 mother case; Reported Cause(s) of Death: Maternal exposure during pregnancy; 4 weeks later our preemie baby died in the NICU


VAERS ID: 1646213 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-25
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Herpes zoster, Inappropriate schedule of product administration, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-07
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: JAKAFI
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Myeloid leukemia
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100991285

Write-up: complete state of confusion and disillusion; Dose 1 on 05Feb2021, doe 2 on 25Mar2021; shingles; acute reaction to the vaccine and it killed her/ the shot killed her; This is a spontaneous report from a contactable consumer. An 88-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on 25Mar2021 (at the age of 88 years old) (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included Myeloid leukaemia from early 2020. Concomitant medication included ruxolitinib phosphate (JAKAFI) taken for myeloid leukaemia. The patient previously received the first dose of BNT162B2 on 05Feb2021 (at the age of 88 years old) for Covid-19 Immunization and experienced confused state; panicked; Urinary tract infection (UTI); shingles; within 2 days it looked like somebody had punched her in her face, her face was purple on one side; shooting pain, across left cheek from her nose, her cheeks, down to her mouth. On 25Mar2021, somebody at that recovery center thought that it was a good idea for her to go get another vaccine. And the patient also had acute myeloid leukemia (Later clarified as history) and this was known by all parties. And when she got that vaccine on 25Mar2021, she didn''t even make it back to the recovery center, they took her straight to the hospital because she went in to a complete state of confusion and disillusion then. And she really never recovered and she died on 07May2021 and the reporter just want to let you all know because reporter just listened to NPR and listened to doctors try to prove some relationship between the shingles and the vaccine, and reporter was not saying shingles caused it or vice versa but she had an acute reaction to the vaccine and it killed her. For the patient''s Height and Weight, Reporter stated She was 4 foot 11, she was a little bit taller but as she got older her spinal cord begin to kind of shrink up on her, so 4 foot 11 works, she was barely 100 pounds when she died. For the Reason of Death, Reporter stated Somebody decided that it was a good idea to give her second COVID vaccine, that''s what killed her. If she hadn''t got the second COVID vaccine, she was recovering, she was doing much better, and the reporter spoke to her on 24Mar2021, just before she got that shot and she was never the same after that, the shot killed her, reporter was not saying you all killed her, she was saying the person who said it was a good idea to give her the shot, killed the patient. The reporter was not a doctor, resisted it somebody not do that but they went ahead and did it anyway and it killed her. She suffered for 90 days after she got her shot and suffered like hell after she got her second shot. It was unknown if Autopsy was performed. The outcome of event "acute reaction to the vaccine and it killed her/ the shot killed her" was fatal, of the other events was unknown. The lot number for the vaccine bnt162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: acute reaction to the vaccine and it killed her/ the shot killed her


VAERS ID: 1646311 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2020-12-01
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100994247

Write-up: Died after getting the vaccine.; This is a spontaneous report from a contactable consumer or other non hcp. This consumer reported for a patient (Doctor). A patient of unspecified age and gender received bnt162b2 (BNT162B2, PFIZER-BIOTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunization. No medical history and no concomitant medications were not reported. The reporter was asking about a doctor in (Withheld) that died after getting the vaccine. She wanted to know what the reports are. She said that this happened in the beginning around Dec2020. She wanted to know what the cause of death was. she insisted on getting information or a supervisor or anyone that could give her answers. The patient died on Dec2020. It was not reported if an autopsy was performed. The following information was provided to the reporter from CDC website: The Centers for Disease Control and Prevention (CDC) conducted descriptive analyses of safety data from the first month of vaccination with COVID-19 vaccines in the United States (14Dec2020-13Jan2021). During this period, 13,794,904 vaccine doses of Pfizer-BioNTech and Moderna COVID-19 vaccines were administered and a total of 113 deaths were reported to the CDC''s Vaccine Adverse Event Reporting System (VAERS). Initial doses were recommended for healthcare personnel and long-term care facility (LTCF) residents. This analysis, which evaluated available information from death certificates, autopsy reports, medical records, and clinical descriptions from VAERS reports and health care providers, concluded that a causal relationship between COVID-19 vaccination and death was not suggested No follow-up attempts are possible; Information on batch/lot number cannot be obtained. No further information expected.; Reported Cause(s) of Death: Died after getting the vaccine.


VAERS ID: 1646411 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-09
Onset:2021-02-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-11
   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: LIPITOR
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none, Comment: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100999274

Write-up: he passed away within 48 hours; This is a spontaneous report from a contactable consumer. A 64-year-old male patient received bnt162b2 (Pfizer-Biontech Covid-19 vaccine), dose 1 via an unspecified route of administration, administered in Arm Right on 09Feb2021 15:30 (Batch/Lot Number: em9809) as dose 1, single for covid-19 immunisation. The patient has no medical history. Concomitant medication included atorvastatin calcium (LIPITOR) taken for an unspecified indication, start and stop date were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 11Feb2021, 12:00, the patient passed away within 48 hours. The patient received defibrillation as treatment for the event. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient has not been tested for COVID-19. The patient died on 11Feb2021 due to cardiac disorder. An autopsy was not performed.; Reported Cause(s) of Death: Cardiac


VAERS ID: 1646432 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202100999479

Write-up: died; This is a spontaneous report from a contactable healthcare professional via medical information team and via a Pfizer-sponsored program. A 55-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in May2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The healthcare professional reported that they were definitely seeing a rise in COVID and that a 55-year-old guy died in their hospital the other day (unspecified date), he was vaccinated in May with Pfizer. It was unknown if an autopsy was done. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of serious event Death cannot be totally excluded. There is limited information provided in this report. Additional information is needed to better assess the case, including complete medical history, diagnostics, concomitant medications and dates of vaccination.This case will be reassessed once additional information is available.The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: died


VAERS ID: 1646449 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101000032

Write-up: developed it (blood clots) and died; This is a spontaneous report from a Pfizer-sponsored program from a non-contactable consumer or other non hcp. A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) dose number unknown, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient developed it (blood clots) and died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible, information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: developed it (blood clots) and died


VAERS ID: 1646584 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Illness
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: USPFIZER INC202101008353

Write-up: got sick after getting vaccinated and a week later he was buried; This is a spontaneous report from a contactable consumer. This consumer (patient''s friend) reported for a male patient (reporter''s friend). A male patient of an unspecified age received bnt162b2 (BNT162B2), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient got sick after getting vaccinated and a week later he was buried on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: got sick after getting vaccinated and a week later he was buried


VAERS ID: 1646740 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-08-02
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Carditis
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101016381

Write-up: Patient failed to wake in the morning. Suspected heart inflammation.; This is a spontaneous report from a non-contactable consumer. An adult male patient received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), second dose, via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient previously took the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE), on an unspecified date (Batch/Lot number was not reported) for covid-19 immunisation. There was no other vaccine in four weeks. The patient failed to wake in the morning on 02Aug2021. suspected heart inflammation. The patient died on 02Aug2021. death cause was heart Inflammation. It was unknown if treatment was received. Case was reported serious due to Results in death. It was not reported if an autopsy was performed. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected. ; Reported Cause(s) of Death: Heart Inflammation


VAERS ID: 1646782 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
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: USPFIZER INC202101022590

Write-up: Her aunt just had the Pfizer Covid vaccine but ended up getting the delta variant then died; Her aunt just had the Pfizer Covid vaccine but ended up getting the delta variant then died; This is a spontaneous report from a Pfizer-sponsored program. A contactable consumer reported for a female patient (aunt) of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The medical history and concomitant medications were not reported. The consumer reported her aunt just had the PFIZER covid vaccine but ended up getting the delta variant then died. The patient died on 06Aug2021. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Her aunt just had the Pfizer Covid vaccine but ended up getting the delta variant then died; Her aunt just had the Pfizer Covid vaccine but ended up getting the delta variant then died


VAERS ID: 1646822 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-02-26
Onset:2021-05-23
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Anosmia, Decreased appetite, Fatigue, Subdural haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL; PROAIR HFA; PRAVASTATIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood cholesterol abnormal; Blood pressure abnormal; COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101023376

Write-up: Subdural hem; Tiredness; Loss of appetite; Loss of smell; This is a spontaneous report from two contactable consumers (one of was patient''s wife). A 76-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Deltoid Left on 26Feb2021 16:00 (Lot Number: EN6205) as dose 2, single (at age of 76-year-old) for covid-19 immunisation. Prior Vaccinations was none. Medical history included blood pressure abnormal, chronic obstructive pulmonary disease (COPD), cholesterol abnormal. Concomitant medications included lisinopril taken for blood pressure abnormal from an unspecified date to 22May2021; salbutamol sulfate (PROAIR HFA) via Inhalation route taken for COPD from an unspecified date to 22May2021; pravastatin taken for cholesterol abnormal from 2019 to 21May2021. Historical Vaccine included the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number: EL9265) Intramuscular administered in Right deltoid on 02Feb2021 08:45 AM for COVID-19 immunisation (at age of 76-year-old) and experienced flu like, sweats, chills, fever, vomiting, extreme tiredness, ill. The patient experienced subdural hem (death, medically significant) on 23May2021, week long tiredness on 2021, loss of appetite on 2021, loss of smell on 2021. The second dose resulted in week long tiredness, loss of appetite, loss of smell. The event subdural hem required visit to Emergency room and had no treatment. The patient died on 24May2021. An autopsy was not performed. Outcome of the event subdural hem was fatal, of the events tiredness, loss of appetite, loss of smell was unknown. Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Subdural hem


VAERS ID: 1646847 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101024552

Write-up: developed widespread bloodclots; This is a spontaneous report from a contactable consumer for female patient (mother). A female patient of an unspecified age received bnt162b2 (COVID-19 vaccine), dose 2 via an unspecified route of administration on Mar2021 (Batch/Lot number was not reported) as dose 2, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Historical Vaccine included first dose bnt162b2 for covid-19 immunisation on Feb2021. The patient developed widespread bloodclots on 2021 with fatal outcome. The patient died on 2021. It was not reported if an autopsy was performed. The clinical course was reported as follows: patient received the COVID-19 vaccine and developed widespread blood clots. Her first dose was in February, her second dose in March and 13 days later she was gone. The lot number for the vaccine, bnt162b2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: Developed widespread bloodclots


VAERS ID: 1646859 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cytokine storm, Inflammation, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101026335

Write-up: heart attack; cytokine storm; inflammation; This is a spontaneous report from a contactable consumer reporting for a friend. A 61-years-old female patient received bnt162b2 (BNT162B2) at the age of 61-years-old, dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. Historical Vaccine included first dose of BNT162B2 for COVID-19 immunization at the age of 61 years. After the second dose, the patient had inflammation, a cytokine storm, a heart attack and then died on an unspecified date. It was not reported if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: heart attack; cytokine storm; inflammation


VAERS ID: 1646861 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101026586

Write-up: killed my roommate; This is a spontaneous report from a Pfizer- sponsored program. A Non-contactable consumer reported for a patient (reporters friend) that a patient of unspecified age and gender received bnt162b2 (BNT162B2, the Pfizer COVID Vaccination), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The consumer reported that "you killed my roommate, My friends death is worth nothing to you" on an unspecified date. The patient died on an unspecified date. The outcome of the event was fatal. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: killed my roommate


VAERS ID: 1646884 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101028198

Write-up: suddenly died of a stroke; suddenly died of a stroke; This is a spontaneous report from a non-contactable consumer. This consumer reported for a patient (reporter''s uncle) that a male patient of unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. It was reported that same thing happened to the patient. Healthy, and suddenly died of a stroke after the vaccine. No previous blood clots. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: suddenly died of a stroke; suddenly died of a stroke


VAERS ID: 1646931 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-06
Onset:2021-05-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Open heart surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101029724

Write-up: patient passed away; This is a spontaneous report from a non-contactable consumer. A 78-year-old male patient received bnt162b2 (Pfizer-Biontech Covid-19 vaccine), dose 2 via an unspecified route of administration in the right arm on 06May2021 (Batch/Lot number was not reported) as dose 2, single for covid-19 immunisation. Medical history included open heart surgery on an unknown date. Concomitant medication includes unspecified blood clot medication/heart medication. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient previously received dose 1 of bnt162b2 at the age of 78 years old on unspecified date in 2021 for Covid-19 immunization. Prior to vaccination, the patient was not diagnosed with COVID-19 and since the vaccination, the patient has not been tested for COVID-19. On 09May2021 02:00, (reported as 2 days after the second shot of Pfizer Vaccine), the patient passed away. The patient did not receive treatment. The patient died on 09May2021. It was unknown if an autopsy was performed. The event occurred in a country different from that of the reporter. This may be a duplicate report if another reporter from the country where the event occurred has submitted the same information to his/her local agency. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: passed away 09May2021. He passed away 2 days after the second shot of Pfizer Vaccine.


VAERS ID: 1646975 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, 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: USPFIZER INC202101033683

Write-up: passed away; heart problem; This is a spontaneous report from a contactable consumer. A 73-year-old male patient (reporter''s father) received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient passed away from taking Covid vaccine. He never had a heart problem until he took the first Covid vaccine shot. The outcome of event heart problem was unknown. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for the vaccine, bnt162b2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away


VAERS ID: 1647045 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder
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: USPFIZER INC202101036031

Write-up: heart problems; This is a spontaneous report from a contactable consumer (not the patient) via telephonic activity. A 43-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) (batch/lot number was not reported) via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date for COVID-immunization. The patient experienced heart problems (seriousness criteria: death, medically significant) on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for the BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), was not provided and will be requested during follow up.; Reported Cause(s) of Death: heart problems


VAERS ID: 1647060 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USPFIZER INC202101038521

Write-up: female died 3 days after receiving the first COVID vaccine shot of a massive stroke; This is a spontaneous report from two contactable consumers. A 81-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose 1, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. It was reported the female died 3 days after receiving the first COVID vaccine shot of a massive stroke. Healthy patient. It was not reported if an autopsy was performed. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: female died 3 days after receiving the first COVID vaccine shot of a massive stroke.


VAERS ID: 1647160 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
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: USPFIZER INC202101042649

Write-up: passed away from the Delta Variant; passed away from the Delta Variant; This is a spontaneous report from a contactable consumer (relative) from a Pfizer-sponsored program . A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) dose 1 and 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient daughter had just received an email from Pfizer stating that the patient should come in for a third dose to cover for the Delta Variant. The patient passed away from the Delta Variant on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for BNT162B2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away from the Delta Variant; passed away from the Delta Variant


VAERS ID: 1647170 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-03
Onset:2021-03-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, General physical health deterioration, Neoplasm progression
SMQs:, Malignancy related conditions (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 59
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: REVLIMID; GABAPENTIN; ASPIRIN [ACETYLSALICYLIC ACID]
Current Illness: Myeloma (remission)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: blood work; Result Unstructured Data: Test Result:Indicated cancer had come out of remission
CDC Split Type: USPFIZER INC202101044817

Write-up: tumor grow to the size of a soft ball/ grow a tumor that size that fast (history of ongoing multiple myloma); She steadily declined every day after getting the shot and died May 3rd./ she could not get out of bed without help; This is a spontaneous report from a contactable consumer (patient''s son). A non-pregnant 83-year-old female patient received her first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration as a single dose in her left arm, on 03Mar2021 10:00, at the age of 83-year-old of vaccination, for Covid-19 immunization. The patient had a history of ongoing multiple myloma. Concomitant medications included lenalidomide (REVLIMID), gabapentin, and acetylsalicylic acid (ASPIRIN). The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient had multiple myeloma and was informed in late February that her blood work numbers indicated her cancer had come out of remission. She received the Covid shot on 03Mar2021. Within 3 weeks she had a tumor grow to the size of a soft ball. She steadily declined every day after getting the shot and died 03May2021. Before the shot she was walking 2 mi per day by the end of March she could not get out of bed without help. The reporter considered that the events started on 04Mar2021. Unspecified chemotherapy was received for her condition. Her condition resulted in Doctor or other healthcare professional office/clinic visit, and Emergency room/department or urgent care. It was unknown if an autopsy was performed. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. It was the reporter''s belief that no one grew a tumor that size that fast without help. The reporter believed that the combination of the timing of the cancer coming out of remission and getting the Covid shot was the cause of her fast decline. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: tumor grow to the size of a soft ball/ grow a tumor that size that fast; She steadily declined every day after getting the shot and died May 3rd./ she could not get out of bed without help


VAERS ID: 1647304 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiovascular disorder, Internal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
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: USPFIZER INC202101057880

Write-up: internal bleeding; cardio issues; This is a spontaneous report from a non contactable consumer. An 86-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. It was reported: "Consumer calling about her Mother in law dying from the side effects of the Pfizer Covid Vaccine at 3:00 am Sunday, 15Aug2021. Caller asked How many deaths have there been called that they believe was caused by the Pfizer vaccine? My MIL was 86 y/o and she had just started PT in the hospital. She started having cardio issues and internal bleeding and now she is dead. She had started PT and was up walking, so her doctor suggested she get the this because she was having PT, then she started having internal bleeding and cardio issues and now she''s dead. With in 48 hours of taking that vaccine. She developed symptoms where there was blood gushing out of her mouth and my father in law saw this. They couldn''t stop the bleeding because of her health condition." The patient experienced internal bleeding, cardio issues on an unspecified date. The outcome of events was fatal. The patient died on 15Aug2021. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: internal bleeding; cardio issues


VAERS ID: 1647314 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101058096

Write-up: Died from the Pfizer Covid-19 vaccine; This is a spontaneous report from a non-contactable consumer or other non hcp. A male patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient died from the pfizer covid-19 vaccine on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Died from the Pfizer Covid-19 vaccine


VAERS ID: 1647350 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetic; Surgery (heart surgery).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101065092

Write-up: Passed away; This is a spontaneous report from a contactable consumer (patient''s sister, caregiver). A 72-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date in 2021 as dose 2, single for COVID-19 immunisation. Medical history included the patient was diabetic and had heart surgery. The patient''s concomitant medications were not reported. The patient previously took first dose of bnt162b2 for COVID-19 immunization in Apr2021. The reporter stated she needed help and the patient (her sister) passed away in Jul2021 and she had the cards that Pfizer got proving and had gotten the shot and they need to find out and get copies of the proof that they all received the Pfizer COVID vaccine. The reporter stated this is the card that Pfizer get signed and they need another copy. The reporter stated the family had been going through her sisters drawers and they can''t find it and they were in her wallet but they were not there either. The reporter stated she didn''t really need her sisters since she was dead but she needed her sisters daughter withheld and her husband withheld proof that they have been vaccinated and they received the first and second dose of the Pfizer COVID vaccine. The reporter stated her sister did not die right after her first treatment which was in Apr2021 and she just passed away in Jul2021. The reporter stated she knew for a fact that it was not related to the vaccine and did not see the need to be transferred. The patient died in Jul2021. It was not reported if an autopsy was performed. The lot number for BNT162B2 was not provided and will be requested during follow up.; Sender''s Comments: Death of unknown cause is assessed related as a cautionary measure and for reporting purposes. The underlying disease may provide an alternative cause.; Reported Cause(s) of Death: Passed away


VAERS ID: 1647364 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101067685

Write-up: died within 24 hours of the vaccine; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE Solution for injection), via an unspecified route of administration, on an unspecified date (Batch/lot number and expiration dates unknown), as dose number unknown, single, for COVID-19 immunisation. Relevant medical history and concomitant medications were not reported. On an unspecified date, the patient died within 24 hours of the vaccine. The patient never had a problem in his life. The reporter stated that the patient died from the vaccine. It was unknown if an autopsy was done. The lot number for the vaccine BNT162B2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: died within 24 hours of the vaccine


VAERS ID: 1647372 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101068945

Write-up: another person died; This is a spontaneous report from a contactable consumer. A patient of unspecified gender and age received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on unspecified date at unknown dose single for COVID-19 immunization. Medical history includes historical vaccine. No concomitant medications reported. Reporter reports that after receiving the second dose, another person died. The outcome of Event was Fatal. Information about lot/batch number has been requested. Follow-up attempts have been completed, Batch/lot number not available. No further information is expected.; Reported Cause(s) of Death: another person died


VAERS ID: 1647379 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 48
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: Medical History/Concurrent Conditions: Overweight (but she was not big).
Allergies:
Diagnostic Lab Data: Test Date: 202107; Test Name: Covid-19 test; Test Result: Positive; Test Date: 20210725; Test Name: Covid-19 test; Test Result: Negative.
CDC Split Type: USPFIZER INC202101070355

Write-up: passed away of COVID19; passed away of COVID19; This is a spontaneous report from a contactable consumer (patient''s son). A 53-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included a little overweight but she was not big. The patient''s concomitant medications were not reported. The patient had the COVID vaccine and she recently passed away of COVID19. Patient got tested for Covid-19 on 25Jul2021 and was negative at that time. But then 3 days to 4 days later (Jul2021) she was sick and he had to call the ambulance, that was on a Monday going into Tuesday morning, 27Jul2021 or so and she was admitted to the hospital with COVID. Then 3 days later patient stopped texting and answering and she passed away on 18Aug2021. Covid-19 tested positive in Jul2021. Reporter seriousness for COVID-19 was death. The outcome of the events was fatal. The patient died on 18Aug2021. It was not reported if an autopsy was performed. The lot number for BNT162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away of COVID19; passed away of COVID19


VAERS ID: 1647382 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-10
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210810; Test Name: Covid; Test Result: Positive
CDC Split Type: USPFIZER INC202101070815

Write-up: Tested positive for COVID; Tested positive for COVID; This is a spontaneous report from a contactable consumer. A 67-year-old male patient received BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date, at 67-year-old, as single dose(Batch/Lot number was not reported) for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Prior to vaccination the patient had not been diagnosed with COVID-19. It was unknown if the patient had received any other vaccines within 4 weeks prior to the COVID vaccine. On 10Aug2021, the patient was tested positive for COVID. This event resulted in emergency room/department or urgent care and hospitalization, and the patient died. The patient got hospitalization for 7days from 10Aug2021 to 17Aug2021. The patient was on a ventilator for 5 days and died last night( on 17Aug2021). The outcome of events was fatal. It was unknown if an autopsy was performed. The lot number for BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: COVID; COVID


VAERS ID: 1647389 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-04-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Feeling abnormal
SMQs:, Dementia (broad)

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? No
Previous Vaccinations:
Other Medications: LISINOPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (Verbatim: Blood pressure high); Penicillin allergy (Verbatim: The patient was allergic to Penicillin).
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101075069

Write-up: not feeling well; not feeling well; This is a spontaneous report from a contactable consumer. A 83-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for Injection, Batch/Lot number: Unknown) via an unspecified route of administration on 09Apr2021 as DOSE 2, SINGLE (at the age of 83-years-old) for covid-19 immunisation. The patient''s medical history included hypertension, drug hypersensitivity (allergic to Penicillin). The patient''s concomitant medications included lisinopril (LISINOPRIL) taken for blood pressure measurement. The patient had hip surgery 11 years earlier and was now an inch shorter. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The reporter''s brother died after getting the second shot. It was reported that, the patient was not feeling well and the reporter talked to him on the 07Apr2021 and then on 11Apr2021. The patient didn''t complain and didn''t sound well and didn''t feel well when the reporter spoke to him. By 15Apr2021 the patient died. It appears the patient had some kind of reaction to the vaccine. The patient was well before he took any vaccines. The patient had his blood pressure under control, low cholesterol, and walked every day. The reporter tried to get an autopsy but was unable because of the condition of the body. The reporter had a welfare check done on the patient on 06May2021 and that''s when they found his body in his home. The patient was alive until the 15Apr2021. The reporter knew this because the patient wrote on his calendar daily but it abruptly stopped on 15Apr2021. They did not have the official cause of death for the patient, the reporter will have to look at the patient''s death certificate. Everything about the patient was healthy and had his blood pressure under control for a while. The patient died on 15Apr2021. An autopsy was not performed. The outcome of the patient was reported as fatal. Information about Lot/Batch number has been requested.; Reported Cause(s) of Death: not feeling well


VAERS ID: 1647409 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram, Echocardiogram, Electrocardiogram, Myocarditis, SARS-CoV-2 test
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Coronary angiography; Result Unstructured Data: Test Result:revealed no corocoronary artery disease; Test Name: transthoracic echocardiogram; Result Unstructured Data: Test Result:showed global biventricular dysfunction; Comments: (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy.; Test Name: electrocardiogram; Result Unstructured Data: Test Result:showed diffuse ST-segment elevation; Test Name: COVID-19 Test; Result Unstructured Data: Test Result:Negative
CDC Split Type: USPFIZER INC202101076981

Write-up: biventricular myocarditis; This is a literature report. The reporter reported two reports for same events for 2 patients, this is the second of the report. The Centers for Disease Control and Prevention recently reported cases of myocarditis and pericarditis after coronavirus disease 2019 (Covid-19) messenger RNA (mRNA) vaccination.1 In recently published reports, diagnosis of myocarditis was made with the use of noninvasive imaging and routine laboratory testing. Here, authors report two cases of histologically confirmed myocarditis after Covid-19 mRNA vaccination. Patient 2, a 42-year-old man, presented with dyspnea and chest pain 2 weeks after mRNA- 1273 vaccination (second dose). He did not report a viral prodrome, and a PCR test was negative for SARS-CoV-2 He had tachycardia and a fever, and his electrocardiogram showed diffuse ST-segment elevation. A transthoracic echocardiogram showed global biventricular dysfunction (ejection fraction, 15%), normal ventricular dimensions, and left ventricular hypertrophy. Coronary angiography revealed no coronary artery disease. Cardiogenic shock developed in the patient, and he died 3 days after presentation. An autopsy revealed biventricular myocarditis. An inflammatory infiltrate admixed with macrophages T-cells, eosinophils, and B cells was observed, a finding similar to that in Patient 1. In these two adult cases of histologically confirmed, fulminant myocarditis that had developed within 2 weeks after Covid-19 vaccination, a direct causal relationship cannot be definitively established because we did not perform testing for viral genomes or autoantibodies in the tissue specimens. However, no other causes were identified by PCR assay or serologic examination. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: A contributory role of BNT162B2 to the event myocarditis cannot be fully excluded based on temporal relationship and since it is part of the product safety profile. This case will be reassessed if additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-202101076911 Same reporter/drug/event, different patient; Autopsy-determined Cause(s) of Death: biventricular myocarditis


VAERS ID: 1647415 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective
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: USPFIZER INC202101082857

Write-up: fully vaccinated father died from COVID-19 / lack of efficacy; fully vaccinated father died from COVID-19 / lack of efficacy; This is a spontaneous report from a non-contactable consumer. This consumer reported for an adult male patient received bnt162b2 (COVID-19 vaccine), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose, dose 1 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The medical history and concomitant medications were not reported. The patient experienced lack of efficacy. The reporter''s fully vaccinated father died from COVID-19. The patient died on an unspecified date. It was not reported if an autopsy was performed. Doctors said the condition of the father could have been worse if he was not vaccinated at all. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: fully vaccinated father died from COVID-19 / lack of efficacy; fully vaccinated father died from COVID-19 / lack of efficacy


VAERS ID: 1647424 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-19
Onset:2021-04-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       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: 2021-04-21
   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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Kidney failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091113

Write-up: He couldn''t breathe/ husband passed away after receiving the 2nd dose; This is a spontaneous report from a contactable consumer (wife). A 73-year-old patient (husband) received BNT162B2 (COMIRANTY; Formulation: Solution for injection; Batch/Lot number: was not reported, Expiration date: was not reported, Age at vaccination: 73-year-old) via an unspecified route of administration on 19Apr2021 11:00 AM as dose 2, single for COVID-19 immunization. Medical history included kidney failure. Concomitant medications were not reported. Historical vaccine included BNT162B2 on an unspecified date for covid-19 immunization. It was reported that her husband had passed away, 21Apr2021 around 8:00AM, because he couldn''t breathe even with the ventilator. She stated they both received the 2nd dose of the covid vaccine on 19Apr2021 around 11:00 am. On tuesday, the following day, around 1:00 pm, he couldn''t breathe, so he went to the hospital at about 1:30 pm. They said he had to go to the big hospital downtown as they did not have dialysis and her husband had had kidney failure. In the morning, she was told that her husband had passed away, 21Apr2021 around 8:00AM, because he couldn''t breathe even with the ventilator.; Reported Cause(s) of Death: He couldn''t breathe/ husband passed away after receiving the 2nd dose


VAERS ID: 1647426 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101093096

Write-up: died two weeks ago after his 2nd dose; This is a spontaneous report from a non-contactable consumer. A male patient of unspecified age received the 2nd dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date as single dose for COVID-19 Immunization. Medical history and concomitant medications were unknown. The patient previously received the 1st dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) for COVID-19 Immunization. The reporter knew their personal situation where a man died two weeks ago after his 2nd dose so, the reporter was horrified that they will not considered the safety of the public before taking that emergency FDA approval because they know that it took more than just a minute of the time to determine the safety and the reporter would hope that have the integrity too consider that over the money at this point in time. When probed if the concern is with Pfizer COVID-19 vaccine, reporter stated, "Yes of course." It was unknown if autopsy was performed. Outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: died two weeks ago after his 2nd dose


VAERS ID: 1651218 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-10
Onset:2021-08-03
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07B21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Infarction, Intensive care, Neurological symptom, Thrombosis, Vascular operation
SMQs:, Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 24
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:
Current Illness: Diabetes and CHF.
Preexisting Conditions: Diabetes and CHF.
Allergies:
Diagnostic Lab Data: Left Heart Cath likely 8/4 or 8/5/21, CT of brain 8/8/21, Vascular surgery 8/25 or 8/26/21
CDC Split Type:

Write-up: Patient with history of diabetes and CHF came in for non-ST elevated myocardial infarction on 8/3/21 for Left Heart Cath. Another admission on 8/8/21 for stroke-like symptoms, CT scan of head revealed acute-subacute infarction. Patient had extended stay in hospital, suffering a second stroke. Then underwent vascular surgery on either 8/25/21 or 8/26/21 to remove thrombus (blood clot) in one leg. After surgery went to ICU for recovery, and was transferred to floor bed after one day. He expired (passed away) on 8/27/21.


VAERS ID: 1651302 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-30
Onset:2021-05-30
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lactulose, other unknown medication for liver cirrhosis Oxygen by Nasal cannula Previously received Flu vaccine
Current Illness: liver Cirrhosis
Preexisting Conditions: liver cirrhosis
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose of covid 19 moderna vaccine March 30 2021 and he died exactly 2 months after that second dose. He died in the shower chair during his shower.


VAERS ID: 1651415 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-29
Onset:2021-04-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6201 / 1 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Dizziness, Fatigue, Malaise, Mitral valve prolapse, Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy and associated testing
CDC Split Type:

Write-up: Patient felt unwell - dizzy and tired on the evening of April 5, 2021. She went to bed and died in her sleep, likely early in the morning April 6, 2021. Medical Examiner recorded her cause of death "Sudden Cardiac Death associated with Mitral Valve Prolapse


VAERS ID: 1651434 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-02-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Cold sweat, Decreased appetite, Dizziness, Dyspepsia, Faeces discoloured, Fall, Feeling cold, Gait inability, Haematocrit decreased, Influenza like illness, Lethargy, Malaise, Multiple organ dysfunction syndrome, Oesophageal pain, Oral herpes, Pruritus, Pyrexia, Tremor, Upper gastrointestinal haemorrhage
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin 3 ml levemir 40 u qhs, Metformin 850 mg tid, januvia 100 mg qd, synthroid 100 mcg. qd, spironolactone 10 mg qd, plavix 75 mg qd., atorvastatin 40 mg qd., niaspan 1000mg qd, potassium ER 20 meq mid day, asprin 160 mg qd., al
Current Illness: cardiomyopathy ,15 % ejection fraction, Heart failure, DM type 11, Glaucoma, Hypothyroid, Lumbar back pain, suspected pulmonary toxicity related to MTX use ( for skin rash - diffuse puritus nodularis ), Bumex for dyspnea ( both dry and productive cough for 2 - 3 months)
Preexisting Conditions: DM type 2, controlled, CHF , CABG 15 year prior, hypokalemia, HTN,
Allergies: no known allergies. however patient had a preexisting skin disorder ( round red rashes over body ) of unnown origin. on anti epilepsy and Methotrexate ( MTX) med for skin pain/ rash
Diagnostic Lab Data: not available to me,, HCT was severely low
CDC Split Type:

Write-up: Patient died 2 weeks following the 2nd dose of Moderna vaccine, Pt died of upper G.I bleed and multi system organ failure in ER at Hospital on feb 19. . Ist day following vaccine, pt experienced fever of 101, shaking chills, feeling like the "flu". Over the next several days, pt c/o lethargy, "No energy", GI distress, esophageal and stomach " burning". He had decreased appetite, and took tums daily. He complained that his 60yr old smallpox and polio site in arm was "itching." He had an outbreak of a cold sore on mouth. ( not experience for over 15 years). Pt on Feb 19 was not feeling well, felt dizzy, became cold, clammy before calling ambulance. He was not able to walk to bathroom, he fell and had dark colored stools when medics arrived. He was awake and oriented.


VAERS ID: 1651541 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood thinner and daily vitamins
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother passed away less than two days after the covid vaccine. She had it on April29th and died on May 1.


VAERS ID: 1654025 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-10
Onset:2021-01-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Abnormal behaviour, Cognitive disorder, Confusional state, Death, General physical health deterioration, Hallucination, Pain, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 208
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: Prescriptions for high blood pressure and antibiotics due to a surgery. Garden of Life Meal Replacement vitamin supplements.
Current Illness: Patient had had a colostomy surgery within 2 weeks prior to the injection.
Preexisting Conditions: Bacterial meningitis was discovered in February 2017
Allergies: I do not know of any.
Diagnostic Lab Data: No treatments were ever done as follow ups from my conversations with personnel at the facility. They never even responded to my overwhelming evidence of how she changed.
CDC Split Type:

Write-up: Injection was given with no immediate outward sign of an adverse affect. I, as her sister, noticed an affect when I tried to talk to her on the phone calling from California. She hardly talked which was unusual since we talked or texted everyday. She said she did not feel like texting. From that Sunday (1/10/21) through Thursday (1/14/21), she only texted one time. On Thursday, she said it hurt to text, that her mind could not figure out how to text. From that time on, she had many, many times when she could or would not text. She could not figure out how to operate her phone. She got more and more UTI infections and was hospitalized in acute facilities from then on, numerous times. She even said people were trying to kill her. She went downhill cognitively as well as physically until she passed on 8/07/21.


VAERS ID: 1654078 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-05-16
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Cardiomegaly, Death, Hypertensive heart disease, Mitral valve prolapse, Myocardial fibrosis
SMQs:, Cardiac failure (broad), Hypertension (narrow), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother who was completely healthy, alert and active on the morning on May 16 was found by me at approximately 12:30pm deceased on the floor in her bathroom. There were no signs or symptoms prior. Coroners autopsy concluded: hypertension type cardiovascular disease with myrocardial fibrosis, mitral valve prolapse and severe cardiomegaly (in which she was never diagnosed prior)


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