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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 65 out of 150

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VAERS ID: 1654195 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-27
Onset:2021-08-12
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Brain stem syndrome, Cerebral haemorrhage, Cerebral thrombosis, Cerebrovascular accident, Death, Myocardial infarction
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/19/2021-08/20/2021
CDC Split Type:

Write-up: Blood clots resulting in many strokes, brain bleeding due to strokes resulting in crushing the Brain Stem, heart attacks and death


VAERS ID: 1654999 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Military       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: Blood pressure abnormal; High cholesterol.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Friend died 2 days after receiving the 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 (Friend died 2 days after receiving the 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 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. Treatment information not provided. Concomitant medications were reported as statins and blood pressure medication. This a report of dead, two days after Moderna COVID-19 vaccination in a patient of an unknown age and gender. Autopsy was not performed. Very limited information regarding the event has been provided for inferring causality. Further information is not expected; Sender''s Comments: This a report of dead, two days after Moderna COVID-19 vaccination in a patient of an unknown age and gender. Autopsy was not performed. Very limited information regarding the event has been provided for inferring causality. Further information is not expected; Reported Cause(s) of Death: unknown cause of death.


VAERS ID: 1655084 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-06
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Gait disturbance, Neoplasm malignant
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 79
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101081648

Write-up: a very rare cancer; couldn''t walk after 2 weeks; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received the second dose of BNT162B2 (PFIZER COVID-19 VACCINE, lot number: unknown) on 06Jun2021 at single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was unknown whether the patient was diagnosed with COVID-19 prior to vaccination. It was unknown whether the patient received other vaccines within 4 weeks prior to the COVID vaccine. The patient previously received the first dose of BNT162B2 (lot number: unknown) on an unspecified date at single dose for COVID-19 immunisation. After the second shot on 06Jun2021, the patient couldn''t walk after 2 weeks, and was diagnosed with a very rare cancer in Jul2021. The event rare cancer resulted in doctor or other healthcare professional office/clinic visit, death, life-threatening and caused hospitalization. It was unknown whether the patient had been tested for COVID-19 since the vaccination. Therapeutic measures were taken as a result of rare cancer and couldn''t walk. The patient died on 19Aug2021. It was not reported if an autopsy was performed. Reported cause of patient death was cancer. The outcome of event rare cancer was fatal. The outcome of event couldn''t walk was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: a very rare cancer


VAERS ID: 1655091 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-08-07
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Drug ineffective, Suspected COVID-19
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101083659

Write-up: Covid-19 like symptoms; Covid-19 like symptoms; died; This is a spontaneous report from a contactable consumer (patient''s wife). A male patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on Apr2021 as single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. On 07Aug2021, the patient started having Covid-19 like symptoms. He rapidly progressed to similar symptoms to the 12Apr2021. Patient''s wife took him to the same hospital on unspecified date in 2021 and she was not allowed to go in. Within 8 hours her husband died. The outcome of the event died was fatal, for other events was unknown. The patient died on 2021. 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: Death


VAERS ID: 1655100 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
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 INC202101091051

Write-up: dead from second dose of Pfizer Covid 19 vaccine; This is a spontaneous report from a Pfizer-sponsored program by a non-contactable consumer. This report reported same event for two patients. This is the first dose of two reports. A 13-year-old female patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE at the age of 13-year-old for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received the first dose of bnt162b2 (BNT162B2) for covid-19 immunisation. A 13 years old female is dead from second dose of Pfizer Covid 19 vaccine. Both had no prior conditions with the heart and now are dead. The patient died on an unspecified date. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101091793 same report/drug/AE, different patients; Reported Cause(s) of Death: dead from second dose of Pfizer Covid 19 vaccine


VAERS ID: 1655103 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: Medical History/Concurrent Conditions: Smoker.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091195

Write-up: Died; Felt bad all day Saturday and Sunday/wasn''t feeling good; This is a spontaneous report from a contactable consumer or other non hcp. A 63-years-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot number and expiry date was not reported), via an unspecified route of administration on 09Apr2021(at the age of 63- year-old) as dose 2, single for covid-19 immunization. Medical history included Smoker user from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. History of all previous immunization with the Pfizer vaccine considered as suspect and Additional Vaccines Administered on Same Date of the Pfizer Suspect was reported as none. The patient did not receive any other vaccines within four weeks prior to the vaccination. AE(s) following prior vaccinations were none. Family Medical History Relevant to AE(s) and Relevant Tests were reported as none. Patient previously received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot number and expiry date was not reported), via an unspecified route of administration on 11Mar2021 as dose 1, single for covid-19 immunization. Reporter stated his wife received the first dose on 10Mar and the second on 09Apr2021, which was a Friday evening. He stated she felt bad all-day Saturday(10Apr2021) and Sunday, and she was going to go to the doctor on Monday. The patient went to sleep that night and the last time she spoke to anyone was 11:00 or 11:30 that evening, 11Apr2021. Then no one could get a hold of the patient and was found dead on 12Apr2021. The reporter believed that the patient died that night of 11Apr2021. The patient did not visit to emergency room or physician office. The patient died on 12Apr2021. An autopsy was not 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


VAERS ID: 1655104 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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 INC202101091230

Write-up: blood clot to the brain; This is a spontaneous report from a contactable consumer (patient''s relative). A female patient (mother-in-law) of an unspecified age received unknown dose of BNT162B2 (PFIZER-BIONTECH 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. Medical history and concomitant medications were not reported. The patient died from a blood clot to the brain on an unspecified date. The reporter personally think that it was from the Pfizer shot. The patient died on an unspecified date. It was not reported if an autopsy was performed. Information about lot/batch number not available despite the follow-up attempts made. Follow-up attempts have been completed and no further information is expected.; Reported Cause(s) of Death: blood clot to the brain


VAERS ID: 1655105 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Condition aggravated, 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: Heart disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101091316

Write-up: 2 family''s members of hers died after receiving the Pfizer BioNtech covid 19 vaccine; One person who already had heart damage the vaccine exacerbated it and the spike proteins in their heart.; One person who already had heart damage the vaccine exacerbated it and the spike proteins in their heart.; This is a spontaneous report from a Non-contactable consumer. This consumer reported for 2 other patients that a patient of unspecified age and gender 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. Medical history included cardiac disorder from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. The patient experienced 2 family''s members of hers died after receiving the pfizer biontech covid 19 vaccine on an unspecified date , one person who already had heart damage the vaccine exacerbated it and the spike proteins in their heart on an unspecified date with outcome of unknown. The patient died on an unspecified date. It was not reported if an autopsy was performed. The clinical course was reported as follows: Caller stated common knowledge that your vaccine and moderna create spike protein within the body, how do you as a company plan to fix that? It doesn''t stay in the arm, the spike protein is whats causing the excess problems. Caller reported 2 family''s members of hers died after receiving the Pfizer BioNtech covid 19 vaccine. One person who already had heart damage the vaccine exacerbated it and the spike proteins in their heart. She also reports various adverse events...damage to the heart , Guillen barre, women miscarrying their babies, other women starting periods after menopause. Caller stated that creator of the mRNA stated that its going to kill people within 3 years. Caller also states that white coat summit states its dangerous and unsafe. How you plan on helping theses people who have financial responsibility who can no longer work, care for their families, no longer here for their families or the Comirnaty vaccine damaged them unrecognizably. Caller states that the Comirnaty vaccine is not preventing or saving anybody from the covid 19 infection. No follow-up attempts are possible; information about lot/batch number cannot be obtained; Reported Cause(s) of Death: 2 family''s members of hers died after receiving the Pfizer BioNtech covid 19 vaccine


VAERS ID: 1655107 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
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 INC202101091793

Write-up: a 19 year old female is dead from second dose of Pfizer Covid 19 vaccine; This is a spontaneous report from a Pfizer-sponsored program. This report reported similar events for two patients. This is the second of two reports. A female patient of 19-years-old received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE at the age of 19-years-old for covid-19 immunisation. The patient medical history and concomitant medications were not reported. A 19 years old female is dead from second dose of Pfizer Covid 19 vaccine. Both had no prior conditions with the heart and now are dead. 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; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101091051 same report/drug/AE, different patients; Reported Cause(s) of Death: a 19 year old female is dead from second dose of Pfizer Covid 19 vaccine


VAERS ID: 1655111 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-19
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Renal disorder, Renal failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), 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:
Preexisting Conditions: Medical History/Concurrent Conditions: Stroke (before 2020 so he was weak); Weakness
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101093322

Write-up: pass away/he died; couldn''t breathe; kidney dialysis fail; kidney stops; This is a spontaneous report from a contactable consumer (patient''s wife). A 73-year-old male patient received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 19Apr2021 as DOSE 2, SINGLE for COVID-19 immunization. Medical history included had a stroke year before 2020 so he was weak. Concomitant medications were not provided. The patient previously received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), on an unspecified date as single dose for COVID-19 immunization. The patient''s wife called on behalf of the patient seeking compensation due to the Pfizer-BioNTech Covid-19 Vaccine. It was stated patient 19Apr2021 they had the second vaccine together. And on Tuesday 1pm (in 2021) ambulance came in and got patient cause he couldn''t breathe, and they sent him to privacy hospital cause the kidney dialysis fail. They went in the morning 8''clock they go in there and they call 8:30 patient pass away in 2021. Patient had a stroke year before 2020 so he was weak they push him, and walk him, exercise and all kind of things. They didn''t warn that not supposed to have a second vaccine so patient and wife went no more a week later, 2 weeks, patient and wife had first and second shot and then patient went #. When patient died and his kidney stopped. Events reported as hospitalized in 2021. The outcome of the event pass away/he died was fatal, while of the other events was unknown. 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: pass away/he died


VAERS ID: 1655112 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
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: Medical History/Concurrent Conditions: Chemotherapy (patient that was going through chemotherapy at age 80 for prostate cancer); Prostate cancer (patient that was going through chemotherapy at age 80 for prostate cancer.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101093359

Write-up: This person got the Covid 19 vaccine and died 3 days later; This is a spontaneous report from a contactable consumer. An 80-years-old male patient received dose of BNT162B2 (reported as 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. Medical history included prostate cancer and chemotherapy. The patient''s concomitant medications were not reported. The reporter stated she knew a radiology technician who mentioned the patient that was going through chemotherapy at age 80 for prostate cancer. This patient got the Covid 19 vaccine and died 3 days later. She thought it was a bad call for this patient to get the Covid 19 vaccine. She stated some people might think that because of being immune compromised those people might succumb to the Covid 19 virus. She asked in certain patient populations, like if someone is receiving chemotherapy, is it recommended that the Covid 19 vaccine be given. The report was serious with seriousness criteria-results in death. 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: This person got the Covid 19 vaccine and died 3 days later


VAERS ID: 1655113 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
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 INC202101093384

Write-up: 2 family''s members of hers died after receiving the Pfizer BioNtech covid 19 vaccine; This is a spontaneous report from a non-contactable consumer. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), 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 and concomitant medications were not reported. Reporter''s 2 family''s members of hers died after receiving the pfizer biontech covid 19 vaccine on an unspecified date. 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: 2 family''s members of hers died


VAERS ID: 1655115 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-27
Onset:2021-02-12
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Controlled hypotension
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101093903

Write-up: Pulmonary embolism; This is a spontaneous report from a contactable consumer (patient''s cousin). An 83-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL9261), via an unspecified route of administration on 27Jan2021 (at the age of 83-year-old) as dose 1, single for covid-19 immunisation. Medical history included controlled hypotension. The patient''s concomitant medications were not reported. The patient experienced pulmonary embolism on 12Feb2021. The consumer is calling about the Covid 19 vaccine, on behalf of her cousin (the patient) that used to live with her when they were children. The patient received the Covid 19 vaccine in Jan2021 and he died afterward of a pulmonary embolism. This has been a touchy subject talking to the patient''s wife. The patient did not have any other health issues. He was getting ready for work and he died. The only reason he got the Covid 19 vaccine was so he could visit the caller''s 97 year old mother. An autopsy was performed by the funeral home and it states cause of death, pulmonary embolism. She reports the coroner with Rolling Hills has the autopsy information. The patient only received one dose of the Pfizer Covid 19 vaccine. The caller reports that the patient was very good at going to his doctor''s appointments. She reports the patient did have controlled hypertension on medications, no big deal. He wasn''t overweight or diabetic or even prediabetic. His death just seems very random. She reports the date of death as 12Feb2021 early in the morning. The patient was in the bathroom getting dressed for work. The caller is glad the patient''s children wanted an autopsy because the patient did not have any preexisting conditions. The evet did not require a visit to Emergency Room or Physician Office. There is no relevant tests. The patient died on 12Feb2021. An autopsy was performed, autopsy-determined cause of death was pulmonary embolism. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Pulmonary embolism


VAERS ID: 1655116 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
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 INC202101093930

Write-up: Passed away after being vaccinated; This is a spontaneous report from a Pfizer sponsored program from a Non-contactable consumer (reporter''s cousin). A patient of unspecified age and gender 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 for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The reporter stated his cousin pass away after being vaccinated. 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: Passed away after being vaccinated


VAERS ID: 1655117 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, 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: 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: Covid; Test Result: Positive
CDC Split Type: USPFIZER INC202101094144

Write-up: Died due to the fact he received the Covid shot; Tested Positive for Covid after Vaccine; Tested Positive for Covid after Vaccine; This is a spontaneous report from a contactable consumer (patient''s friend). 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 DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The consumer stated she knew that a friend (the patient) died due to the fact he received the Covid shot. The consumer stated all of the patient''s body and organs were spiked with proteins, and they were elevated from Covid. The patient was tested Positive for Covid after Vaccine on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of the event tested Positive for Covid was unknown. The lot number for [bnt162b2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: died due to the fact he received the Covid shot


VAERS ID: 1655118 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-05
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoplastic left heart syndrome
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRIN [ACETYLSALICYLIC ACID]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac operation NOS; Heart disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101095126

Write-up: Hypoplastic left heart syndrome; This is a spontaneous report from a contactable consumer (patient''s father). A 33-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 05Feb2021 (reported as in the afternoon, after 1400) (Batch/Lot Number: EN5318) (at the age of 33-years-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included heart issue with her heart from an unknown date, several heart surgeries from an unknown date. There were no additional vaccines administered on same date of the Pfizer Suspect. Prior Vaccinations (within 4 weeks) was none. There was no family medical history relevant to AE. Concomitant medication included ASPIRIN [acetylsalicylic acid] tablet taken for an unspecified indication, start and stop date were not reported. The consumer stated he did not keep close contact on all her medications since she was not living with her parents. The patient experienced hypoplastic left heart syndrome on an unspecified date and died for it on 08Feb2021. The consumer was reporting that his daughter passed away after she got the first Pfizer covid shot. She passed away in February. She got her shot on a Friday and passed away Monday evening. She did have a heart issue with her heart. At the time she had been through several heart surgeries and they did not realize the covid vaccine had issues for cardiac patients. The vaccine was recommended by her doctors. He reported she had hypoplastic left heart syndrome and that was the cause of death. She died on 08Feb2021. She died in her sleep, between 12:30am and 7:30am on 08Feb2021. She did not have an autopsy done at the time. He reported she had just got the shot and he was not sure if she died from natural causes or from the shot. In his heart he felt like she had been cut up enough and did not have an autopsy done. If he knew then the information that he knew now, then he would have had an autopsy done. She received vaccine basis that of her doctor''s recommendation and her mother''s panic about her covid and dyeing an ugly death, she had two cardiovascular surgeons that both recommended to get the covid vaccine. There was no Emergency Room visit and no physician office visit. The patient died on 08Feb2021. An autopsy was not performed. The outcome of the event hypoplastic left heart syndrome was fatal.; Reported Cause(s) of Death: Hypoplastic left heart syndrome


VAERS ID: 1655120 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101095685

Write-up: had a heart attack and died; This is a spontaneous report from a Pfizer-sponsored program from a contactable consumer (patient''s wife). A male patient of unknown age received first and second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), both on unknown date at single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The patient was fully vaccinated with the Pfizer Covid 19 vaccine, had a heart attack after both vaccine. The patient died due to heart attack. It was unknown if autopsy was done. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: had a heart attack and died.


VAERS ID: 1655136 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-08-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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: Seroquel / Ventolin inhaler
Current Illness: chronic asthma
Preexisting Conditions: asthma
Allergies: animal dander and certain plants
Diagnostic Lab Data:
CDC Split Type:

Write-up: He was found dead in his home by friends who went looking for him after he didn''t show up for work... possible suicide?


VAERS ID: 1655677 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Ageusia, Anosmia, Arrhythmia, Asthenia, Blood creatinine increased, Blood potassium, Blood urea increased, Bronchopleural fistula, COVID-19, COVID-19 pneumonia, Cardiac failure, Cardioversion, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Computerised tomogram thorax, Cortisol increased, Cough, Critical illness, Death, Diarrhoea, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Endotracheal intubation, Fatigue, General physical health deterioration, Haemodynamic instability, Hypoxia, Inflammatory marker increased, Intensive care, Loss of consciousness, Lung infiltration, Lung opacity, Mechanical ventilation, Metabolic acidosis, Metabolic function test, Peritoneal catheter insertion, Pneumomediastinum, Pneumonia, Pyrexia, Renal replacement therapy, Respiratory distress, SARS-CoV-2 test positive, Seizure like phenomena, Sepsis, Shock, Sinus tachycardia, Transaminases increased, Ventricular hypokinesia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (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), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, allopurinol, amlodipine, calcitriol, ergocalciferol, sodium bicarbonate, Tamsulosin
Current Illness: exposed to covid 7/20, received first vaccine 7/23
Preexisting Conditions: CKD4, HTN, gout, Stage IV (CMS/HCC)
Allergies: NKDA
Diagnostic Lab Data: 8/7/2021 Radiology: personally reviewed unless stated otherwise. Chest XR: post intubation and OETT 5 cm above carina, stable pneumomediastinum and pneumopericardium present
CDC Split Type:

Write-up: patient vaccinated 7/23/2021, admitted 7/29/2021, tested positive for covid 7/29/2021. discharged 8/14/2021, patient expired Patient received Pfizer vaccine L deltoid lot numberFA6780 on 7/23/2021. Tested positive on 7/29/2021 after exposure. Writing report since patient received vaccine and now critically ill and intubated to follow procedure. Patient intubated 8/7/2021 History Of Present Illness Patient is a 53-year-old patient with a PMH of CKD4 and HTN who presented to ED on 7/29 with complaints of fatigue, diarrhea, weakness, and loss of taste and smell. Patient stated he was exposed to COVID on 7/20 and received his 1st COVID-19 vaccine on 7/23. On presentation to the ED the Pt stated on 07/24 he began to have subjective fevers, weakness and fatigue, and the following day began having diarrhea and "passed out" 4 times since symptoms developed. While on the floor the patient had been treated with dexamethasone 6 mg daily, remdesivir, and tocilizumab, and had been improving, weaned from HFNC to 4L NC on 8/5. On 8/6 the patient had worsening shortness of breath and was transition back to high-flow nasal cannula. Today, 8/7, the patient had worsening respiratory distress and increasing oxygen requirements 100% & 70L HFNC as well as 100% non-rebreather with persistent hypoxia. MICU was called and the patient was emergently intubated for acute hypoxic respiratory failure. Past Medical History He has a past medical history of CKD (chronic kidney disease), stage IV (CMS/HCC), Gout, and Hypertension. Assessment and Plan: The patient is a 53 yo M with CKD4,HTN that presents to UKMC on 7/29 and was diagnosed with COVID at this time. Progressive hypoxic RF that required HFNC, and on 8/7/21 required intubation with mechanical ventilation. Hospital course complicated by pneumomediastinum, transaminitis, and AKI secondary to COVID. ARDS COVID-19 PNA (POA) Pneumomediastinum, worsening -XR chest with B/L peripheral and bibasilar opacities -Inflammatory markers were up trending, will continue to monitor -CXR 8/6: showed air around heart borders and into mediastinum suggestive of pneumomediastinum -8/6: CT chest: significant pneumomediastinum, multifocal pulmonary infiltrates likely 2/2 COVID-19 pneumonia, official read pending -Thoracic surgery consulted: no interventions at this time unless the patient was to clinically decline. -S/p 5-day course of remdesivir finished on 8/6 -ID consulted, tocilizumab 800 mg one dose given 8/2/21 - PF ratio at time of transfer to the unit: 124 PLAN: - Evaluate to repeat CT chest with patient clinical decline. - Low PEEP ventilation with CT imaging indicating likely BPF at the area of the lingula. - Minimize coughing and desynchrony while on mechanical ventilation: Propofol and Dilaudid gtts. - ABG -Continue dexamethasone 6 mg daily (D6/10) -Albuterol inhaler Q 4 hrs. -Heparin 7500 U q8hrs for DVT ppx AKI on CKD stage V not on Dialysis (POA) Hyperkalemia (POA) Mixed AGMA and NAGMA (POA) -Unknown baseline Cr, close to 6.8 upon admission with peak at 7.5, now stable/improving - Multifactorial acidosis: BUN, diarrheal illness, and -K stable with lokelma as recommended per renal -Follows up with his nephrologist OP and was supposed to be referred for kidney transplant PLAN: -Nephrology following on floor, will notify of transfer to the ICU - Place Udall-- $g IHD to start 8/7. -Continue sodium bicarb 1300 TID, calcitriol and vitamin D2 at same doses -Strict I&O, Daily weights - Foley Seizure-like activity - Patient with right-sided upper extremity and lower-extremity tonic activity following intubation. - Prior to intubation, patient had EMV 15, appropriate and no focal deficits. - Likely metabolic in nature, patient with BUN $g100, sepsis, COVID - No past history of seizures. PLAN: - TSH, B12, ammonia - EEG Newly diagnosed HFrEF (POA) -TTE with 40-50% EF and global LV hypokinesis PLAN: -STOP coreg , HOLD home amlodipine -OP follow up with cardiology for further workup given COVID positive status Transaminitis (POA) - Possibly multifactorial 2/2 volume depletion but also possible drug effect from remdesivir PLAN: - CMP today and as needed. Suspected orthostatic syncope related to COVID-19 infection -Started prior to admission in the setting of ongoing diarrhea, nausea and poor PO intake -No episodes since, symptoms improved with adequate fluid resuscitation -EKG on admission with sinus tachycardia with no significant ST-T changes -PT/OT, recs home with assistance Obesity (POA) - BMI 35.8, complicates all aspects of care. Hospitalization Admit Date/Time: 7/29/2021 3:55 PM Admitting Attending: Discharge Date: 08/14/21 Discharge Attending Physician: 8/9/2021 Assessment and Plan The patient is a 53 yo M with CKD4, HTN that presents to UKMC on 7/29 and was diagnosed with COVID at this time. Progressive hypoxic RF that required HFNC, and on 8/7/21 required intubation with mechanical ventilation. Hospital course complicated by pneumomediastinum, transaminitis, and AKI secondary to COVID. Acute Respiratory Failure Requiring Mechanical Ventilation Moderate ARDS COVID-19 PNA (POA) Pneumomediastinum, stable Pneumopericardium, stable HAP -XR chest with B/L peripheral and bibasilar opacities -CXR 8/6: showed air around heart borders and into mediastinum suggestive of pneumomediastinum -8/6: CT chest: significant pneumomediastinum, multifocal pulmonary infiltrates likely 2/2 COVID-19 pneumonia -Thoracic surgery consulted: no interventions at this time unless the patient was to clinically decline. -S/p 5-day course of remdesivir finished on 8/6 -ID consulted, tocilizumab 800 mg one dose given 8/2/21 - PF ratio at time of transfer to the unit: 127 - Started NMB on 8/8 PLAN: - Low PEEP ventilation with CT imaging indicating likely BPF at the area of the lingula. - Minimize coughing and desynchrony while on mechanical ventilation: Propofol and Dilaudid gtts. - DC nimbex today, PF ratio increased to 164 after paralytic -Continue dexamethasone 6 mg daily (stop date 8/11) -Albuterol inhaler Q 4 hrs. -Heparin 7500 U q8hrs for DVT ppx -Empiric Cefepime for HAP--Follow up cultures from 8/7 - DC vanc AKI on CKD stage V(POA) Hyperkalemia (POA)--resolving Mixed AGMA and NAGMA (POA) -Unknown baseline Cr, close to 6.8 upon admission with peak at 7.5, now stable/improving - Multifactorial acidosis: BUN, diarrheal illness, and -K stable with lokelma as recommended per renal -Follows up with his nephrologist OP and was supposed to be referred for kidney transplant -8/7: udall, failed IHD and converted to CRRT. PLAN: - Nephrology following, appreciate recs - Continue CRRT with goal net even - Dose meds for CRRT -Strict I&O, Daily weights Shock, multifactorial - Medication and sepsis related, stress induced CM - Received approx. 2 L IVF - Cortisol 9.7 on 8/7 PLAN: - Levophed for MAP $g65 - Treatment of infections - Defer stress steroids while on Dex, can evaluate to start stress HC Once steroids complete for Dex-ARDS. Newly diagnosed HFrEF (POA) -TTE with 40-50% EF and global LV hypokinesis PLAN: -OP follow up with cardiology for further workup given COVID positive status Transaminitis (POA) - Possibly multifactorial 2/2 volume depletion but also possible drug effect from remdesivir PLAN: - CMP improving, weekly checks. DM type 2 (POA) - Diet controlled at home. PLAN: - Start insulin gtt today, monitoring per protocol. Hypertension - Hold Home meds until clinically appropriate. Obesity (POA)- BMI 35.8, complicates all aspects of care discharge note Chief Concern, Brief History of Present Illness, and Hospital Course Patient is a 53-year-old patient with a PMH of CKD4 and HTN who presented to UK ED on 7/29 with complaints of fatigue, diarrhea, weakness, and loss of taste and smell. Patient stated he was exposed to COVID on 7/20 and received his 1st COVID-19 vaccine on 7/23. On presentation to the ED the Pt stated on 07/24 he began to have subjective fevers, weakness and fatigue, and with reported syncopal events. Patient was treated with dexamethasone 6 mg daily, remdesivir, and tocilizumab. On 8/6 the patient had worsening shortness of breath with increasing oxygen requirements. On 8/7, the patient had worsening respiratory distress and increasing oxygen requirements 100% & 70L HFNC as well as 100% non-rebreather with persistent hypoxia ultimately requiring intubation. Furthermore, a dialysis catheter was placed and CRRT was initiated. Broad spectrum ABX were continued. On 8/8, he required addition of NMB for continued ventilator dys-synchrony. He completed the dex-ARDS protocol on 8/10. The patient had a decline on 8/11 with a fever, worsening shock. He was started back on broad spectrum antibiotics, vasopressin in addition to levophed, and stress dose steroids. Unfortunately, Pt remained with persistent and profound hemodynamic instability. His response to aggressive live saving measures was minimal. WBC up to 80 with no infectious source able to be identified, escalation of ABX still continued. CT scans unable to be obtained secondary to risk of fatal event occurring if moved and/or transported to scanner. On 8/13, Pt going into arrythmias which further exacerbated further instability, required cardioversions X 3 and antiarrhythmic medications. Goals of care discussions completed with wife. Despite attempting to give Pt more time to possibly respond to treatments, his status remained critical. Wife came to see her husband at bedside to be with him briefly before he passed away. Pt passed away on 8/14 at 8:11.


VAERS ID: 1655701 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-17
Onset:2021-08-06
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Bronchial disorder, COVID-19 pneumonia, Dyspnoea, Inflammatory marker increased, Pneumomediastinum
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HF, CAD, recurrent mantle cell lymphoma s/p chemo 2 months ago
Allergies: Ciprofloxin, levaquin, lyrica
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was in hospital initially on 8/6-10 with covid pneumonia. Treated with antibiotics and steroids with improvement. Discharged with antibiotics, steroids, and home oxygen. Readmitted on 8/14 with worsening shortness of breath. Elevated inflammatory markers (fibrinogen,, D-dimer and CRP). Developed pneumomediastinum with peribronchial preponderance. CT surgery evaluated and did not recommend surgical intervention. Treated with broad spectrum antibiotics and steroids.


VAERS ID: 1655721 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-17
Onset:2021-08-02
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Condition aggravated, Death, Haemodialysis, Ileus, Mechanical ventilation, Renal failure, SARS-CoV-2 test positive, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 24
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 + August 2 nad had been hospitalized elsewhere for 2 days and discharged on rooma ir and decadron. Presented to Medical Center on 8/16/21 with )2 sat of 50% on room air. Admitted and completed course of decadron and 5 day course of remdesivir. Aslo given broad spectrum antibioitcs and anifungal. Complications of renal failure with hemodialysis started on 8/23/21 and ileus. Unable to wean from ventilator. Decision for comfort care. Expired from COVID pneumonia with severe sepsis with shock.


VAERS ID: 1655728 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-06-22
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute cardiac event, Cardiomegaly, Chest pain, Death, Electrocardiogram abnormal
SMQs:, Cardiac failure (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HBP
Allergies: Unknown
Diagnostic Lab Data: EKG 06/28/2021
CDC Split Type:

Write-up: Pt.''s Brother states that after receiving the 2nd dose of Phizer (May Unknown), started experiencing symptoms of chest pains shortly after. EKG 06/28/2021 preformed. Cardiac Event, Heart Enlargement 3x ( Passed Away 08/22/2021 ). Undetermined cause of Death.


VAERS ID: 1655796 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-31
Onset:2021-08-15
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Death, Nausea, SARS-CoV-2 test positive, Systemic inflammatory response syndrome, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir, atorvastatin, Calcium+D, cyanocobalamin, cyclosporine, duloxetine, everolimus, ferrous sulfate, Flonase, insulin glargine, losartan, magnesium oxide, multivitamin, fish oil, prednisone
Current Illness:
Preexisting Conditions: Diabetes mellitus, hypertension, heart transplant (2010)
Allergies: Contrast Dye, OxyContin, povidone iodine topical, tacrolimus
Diagnostic Lab Data: Coronavirus 2019 PCR detected 8/15/21
CDC Split Type:

Write-up: 8/15/21: Patient arrived at the ER due to nausea, vomiting and generalized weakness for the past 5 days. Patient tested positive for COVID on 8/15/21. Diagnosed with: COVID-19 pneumonia, acute hypoxic resp failure, SIRS Note: patient previously vaccinated with Pfizer COVID-19 vaccine in March 2021. Please note: Patient received first dose Pfizer vaccine on 3/11/2021 Lot # EN6199 and the second dose on 3/31/2021 Lot # ER8737 8/18/21: Patient discharged to hospice care 8/19/21: Patient expired. Time of Death 1710


VAERS ID: 1655806 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-09
Onset:2021-08-18
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Mechanical ventilation, Vaccine breakthrough infection
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DM
Preexisting Conditions: DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had a breakthrough case of COVID 19 in August 2021 required hospitalization, mechanical ventilation and then he expired on 8/29/21


VAERS ID: 1655831 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-08-19
Onset:2021-08-27
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: According to the ambulance crew member that called the patient had started having COVID 19 symptoms on Sunday 08/15/2021 and was tested for COVID on 08/19/2021. However when he was here filled out his paperwork and stated that he didn''t have any symptoms and hadn''t been tested.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy done. I don''t think I will be informed of the results
CDC Split Type:

Write-up: The patient died from COVID 19 symptoms. His body was being taken to be autopsied on 08/27/2021. I was notified after he had passed.


VAERS ID: 1655833 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-08-15
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute cardiac event, Apnoeic attack, Blood creatine increased, Brain herniation, Brain oedema, COVID-19, Cardiac arrest, Death, Endotracheal intubation, Hunt and Hess scale, Mechanical ventilation, SARS-CoV-2 test positive, Subarachnoid haemorrhage, Syncope, Unresponsive to stimuli, Ventricular cisternostomy
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, aspirin, atorvastatin, clonidine, clopidogrel, hydralazine, lisinopril, metoprolol
Current Illness:
Preexisting Conditions: Coronary artery disease, Coronary stents, hypertension
Allergies: Unable to obtain
Diagnostic Lab Data: COVID19 PCR detected 8/15/21
CDC Split Type:

Write-up: 8/15/21: Patient arrived at the ER due to sudden collapse. EMS was called at 1349 and on arrival the patient was in asystole and apneic. Patient underwent emergent right frontal ventriculostomy. COVID-19 PCR came back positive on 8/15/21. Serum creatinine on admission was 1.39 which has gotten worse at 2.67. Patient intubated/mechanically ventilated, sedated; on 3 vasopressors. Stage 5 [Hunt and Hess] SAH associated with diffuse brain edema/herniation. 8/17/21: patient expired. Note: Spouse did not report symptoms of COVID-19 prior to cardiac event. Unknown if COVID-19 was symptomatic or asymptomatic due to patients unresponsive at admission. Please note: Spouse reports 2 doses of Pfizer vaccine in March 2021. Patient received first dose Pfizer vaccine on 3/31/2021 Lot # EN6198 and the second dose on 4/21/2021 Lot # ER8732


VAERS ID: 1655858 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-10
Onset:2021-08-28
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS A BREAKTHROUGH CASE OF COVID; EXPIRED 8/28/2021.


VAERS ID: 1655864 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-15
Onset:2021-08-13
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, Intensive care, Loss of consciousness, Mechanical ventilation, Renal replacement therapy, SARS-CoV-2 test positive, Syncope, Toxic encephalopathy, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ambrisentan, atorvastatin, azelastine nasal spray, bumex, vitamin D3, Trelegy Ellipta, folic acid, gabapentin, methimazole, methotrexate, pantoprazole, Uptravi, tadalafil, tizandine,
Current Illness:
Preexisting Conditions: COPD (on 3L O2), GERD, HTN, h/o thymoma resection, smoker, HLD
Allergies: No Known Allergies
Diagnostic Lab Data: COVID PCR positive 8/13/2021
CDC Split Type:

Write-up: 8/13/21: Admit Hospital. COVID breakthrough. Patient arrived at the ER due to shortness of breath and syncope. EMS were called by the patient''s family after they found her unconscious on the floor. Her initial O2 saturation was in the 60''s. Patient was brought to ICU and intubated. 8/26/21 remains in hospital intubated on vent. CRRT started. Diagnosed with: Severe ARDS, multifocal Pneumonia due to COVID-19, acute toxic metabolic encephalopathy, acute COPD exacerbation (likely 2/2 multi-focal pneumonia). Note: patient previously vaccinated with Pfizer COVID-19 vaccine in Jan/Feb 2021. 8/27/2021: patient died. Please note: Patient received first dose Pfizer vaccine on 1/23/2021 Lot # EL1283 and the second dose on 2/15/2021 Lot # EL9265


VAERS ID: 1655865 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-07-31
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Candida infection, Cardiogenic shock, Catheter placement, Coagulopathy, Culture urine positive, Death, Intra-aortic balloon placement, Pneumonia staphylococcal, Pyrexia, Renal impairment, Renal replacement therapy, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban 5 mg BID, Carvedilol 4.6875 mg BID, Duloxetine 60 mg QD, GLipizide 5 mg QD, Hydralazine 25 mg TID, Insulin aspart 10 units TID, Isosorbide dinatrate 10 mg BID, Pioglitazone 15 mg QD, Potassium chloride 20 mEq BID, Spironolactone 25
Current Illness:
Preexisting Conditions: CHF, Diabetes Mellitus, Hypertension
Allergies: Codeine (Hallucinations), Morphine (Hallucinations)
Diagnostic Lab Data: COVID-19 Positive test on 8/17/2021 @ 1109
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/21/2021 and 5/18/2021. Patient admitted on 7/31/2021 for cardiogenic shock complicated by acute renal failure, coagulopathy and acute respiratory failure. To assist in management of the cardiogenic shock pt was placed on axillary IABP and dobutamine for inotropic support. Pt was decongested with combination of aquadex and diuretics with improvement in filling conditions. Unfortunately, patient developed persistent fever on 8/11 and was placed on broad spectrum antibiotics, ID was consulted and underwent extensive infectious evaluation.She did have MRSA in pneumonia PCR and candida albicans has grown in urine culture. On 8/16/21 morning pt decompensated hemodynamicallly requiring levophed and vasopressin and continued evaluation revealed that pt had positive IgM COVID antibodies and it was suspected that pt developed a new COVID infection. She continued to decline over the next 48 hours with worsening hemodynamics and renal function and therefore a dialsysis catheter was placed and pt was started on renal replacement therapy. Family was kept uptodate about the patients clinical status and at this point decided to transition focus of care to comfort. Pt then expired the morning of 8/18/21.


VAERS ID: 1655888 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-03
Onset:2021-08-29
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Death, Electrocardiogram, Laboratory test, Pneumonia, SARS-CoV-2 test positive
SMQs:, 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: 2021-08-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Unknown
Preexisting Conditions: Hyponatremia, chronic airway obstruction
Allergies: Penicillin
Diagnostic Lab Data: Multiple labs, chest xray, ekg completed
CDC Split Type:

Write-up: Patient was admitted to Medical Center 8-29-21. Previously diagnosed with right upper lobe pneumonia and was started on Levaquin. Was tested for COVID with admission, test result is positive. 8-30 patient compensated quickly and did pass away. Pt was vaccinated with the Moderna Vaccine 02-03-2021 and 03-03-2021.


VAERS ID: 1655908 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not available
Current Illness: unknown
Preexisting Conditions: HTN, cardiac stents
Allergies: none know
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to the ED in cardiac arrest day after vaccine, patient expired.


VAERS ID: 1655925 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-08-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: crestor, prozac, nefazondone, lopressor
Current Illness: unknown
Preexisting Conditions: CAD, HTN, HYPERLIPIDEMIA, S/P CABG
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient came to the ED in cardiac arrest, patient expired


VAERS ID: 1655956 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-27
Onset:2021-08-13
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cough, Death, Dizziness, Dyspnoea, Endotracheal intubation, Pulmonary embolism, Renal replacement therapy, SARS-CoV-2 test positive, Septic shock, Vena cava thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 17
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: atorvastatin, carvedilol, lorazepam
Current Illness:
Preexisting Conditions: Hypertension, CHF, HLD, s/p aortic valve replacement
Allergies: No Known Allergies
Diagnostic Lab Data: COVID-19 PCR + on 8/13/2021
CDC Split Type:

Write-up: 8/13/21: Patient arrived at the ER due to shortness of breath since 1 week ago. Associated symptoms include dry cough and dizziness. Intubated in the ER. Diagnosed with: acute hypoxic resp failure, COVID-19 pneumonia, septic shock, oliguric AKI requiring CRRT, partial proximal IVC thrombosis, emboli in the lingula Note: patient previously vaccinated with J&J COVID-19 vaccine on 4/27/21. 8/30/21: patient died this morning.


VAERS ID: 1655959 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-19
Onset:2021-08-01
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Bilevel positive airway pressure, COVID-19, Convalescent plasma transfusion, Cough, Death, Dyspnoea, Endotracheal intubation, Intensive care, Malaise, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol MDI 2 puffs Q6H prn, Amlodipine 10 mg QD, Augmentin 875 mg BID, Atorvastatin 40 mg QD, Z-Pack, Polysporin Ophthalmic ointment 0.25 inches into left eye TID, Clopidogrel 75 mg QD, Glimepiride 4 mg QD, Isosorbide Dinitrate 30 mg QD,
Current Illness:
Preexisting Conditions: CAD, Hypertension, Hyperlipidemia, History of kidney cancer, history of MI (1985), Corneal transplant
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/24/2021 and 2/19/2021. Presented to ED on 8/4/2021 with 4 day history of feeling ill, and diagnosis of COVID on 8/3/2021. Presented with worsening shortness of breath and cough, also weakness, and vomiting. Initially admitted to telemetry unit requiring 15 L O2, and within 24 hours of presentation was requiring Airvo 60L/90%. Patient quickly decompensated further and was transferred to the ICU on 08/06 on BiPAP. He required intubation overnight on 08/06. Patient treated with convalescent plasma, remdesivir x5 days, dexamethasone, ascorbic acid, and zinc. Family requested comfort care on 8/21/2021, patient was extubated and expired 8/21/2021.


VAERS ID: 1656005 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-02
Onset:2021-08-06
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Body temperature increased, Bundle branch block right, COVID-19, Chest X-ray abnormal, Coronary arterial stent insertion, Cough, Death, Electrocardiogram ST segment depression, Fall, Gastritis erosive, Lung consolidation, Muscular weakness, Oesophagogastroduodenoscopy abnormal, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Conduction defects (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific inflammation (narrow), Hypertension (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (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: 2021-08-21
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5 mg QD, Aspirin 81 mg QD, Carvedilol 25 mg BID, Clopidogrel 25 mg QD, Ferrous sulfate 325 mg QD, Gabapentin 300 mg TID, Glipizide 20 mg BID, Metformin 500 mg BID, Levothyroxine 75 mcg QD, Nitroglycerin 0.4 mg SL PRN, Pantoprazol
Current Illness:
Preexisting Conditions: Type 2 Diabetes, Hyperlipidemia, Hypertension, Hypothyroidism, CAD, GERD, Stage 3 kidney disease, Acute blood loss, anemia, History of renal cell carcinoma s/p left nephrectomy, elevated troponin, history of CHF, Melena, Acute gastritis, prostate cancer with bone metastases, left lumbar radiculopathy, MI, heart artery stent (2002, 2017).
Allergies: NKDA
Diagnostic Lab Data: Positive COVID-19 test on 8/6/2021 @ 1602 utilizing the Roche LIAT SARS assay platform
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/13/2021 and 2/2/2021. Presented to ED on 8/6/2021 with complaints of acute worsening of weakness of bilateral extremities s/p fall. Of note patient reports he has had a cough since the last week of July. In the emergency room vital signs was slightly elevated blood pressure and temperature up to 101.1? F, saturating well on room air. EKG reviewed with slightly worsened ST depressions in inferior lateral leads with a known right bundle branch block. Patient underwent an EGD on 8/7 which revealed erosive gastritis. Patient oxygen requirement increased on 8/12/2021. Dexamethasone started on 8/12/2021. LLL early consolidation seen on CXR on 8/12/2021 that was not present on admission. Remdesivir started on 8/13/2021. On 8/21/2021 patient''s family requested to transition to comfort care. Patient expired on 8/21/21.


VAERS ID: 1656016 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-08-27
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke
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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, SAH
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 02/05/2021 lot # 016M20A Pt died 8/27/2021 from hemorrhagic stroke


VAERS ID: 1656025 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-05
Onset:2021-08-28
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke
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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: dementia, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 01/05/2021 Lot # 037K20A Pt died of hemorrhagic stroke 8/28/2021 Non Covid realted death


VAERS ID: 1656073 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-23
Onset:2021-08-10
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 013M20A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 006B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood culture positive, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Computerised tomogram abdomen normal, Computerised tomogram pelvis, Cough, Fibrin D dimer, Glomerular filtration rate decreased, Hypoxia, Lung infiltration, Pneumonia, Pulmonary oedema, SARS-CoV-2 test positive, Toxicity to various agents, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Drug abuse and dependence (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   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:
Allergies:
Diagnostic Lab Data: WBC 6K. GFR 23. D-Dimer 0.52. BNP 7327. CRP 19. COVID-19 PCR positive on 8/10. Blood cx from 8/10 are now growing GNR. CXR image & report from 8/10 reviewed: bilateral pulmonary infiltrates, ? pneumonia vs edema. CT A/P on 8/10: no acute GI pathology.
CDC Split Type:

Write-up: This is an 86 year old male with O2-dependent COPD (on 2 L NC), CHF, atrial fibrillation, obesity, CKD. We are consulted for COVID-19 infection. SNF resident. This is his third hospitalization in the past few weeks. He was recently admitted to hospital from 8/1-8/7 & also admitted then discharged from hospital 7/23 after prior admission for pneumonia & Coumadin toxicity. He presented to this ER on 8/10 with upper abdominal pain, as well as cough and possibly mild shortness of breath. His daughter called EMS, who noted that the patient was hypoxic on patient''s baseline 2 L nasal cannula. No reported vomiting, diarrhea, fever, chills.


VAERS ID: 1656114 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-25
Onset:2021-08-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

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

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: Pt was going to dialysis 3x weekly
Current Illness: Chronic kidney disease, Diabetes, Heart Disease
Preexisting Conditions: Chronic kidney disease, Diabetes, Heart Disease
Allergies: Lisinopril, PCN, Vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


VAERS ID: 1656124 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-04
Onset:2021-08-09
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Hypoxia, Infection
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough infection 8/10/2021; patient died 8/15/2021 - hypoxia


VAERS ID: 1656127 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-08-14
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Anaemia, Brain cancer metastatic, COVID-19, COVID-19 pneumonia, Continuous positive airway pressure, Dyspnoea, Endometrial cancer, Endotracheal intubation, Intracranial mass, Respiratory distress, SARS-CoV-2 test positive, Sepsis, Transfusion, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Uterine and fallopian tube malignant tumours (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Result Type: History and Physical Date: August 14, 2021 2:17 Result Status: Auth (Verified) Result Title: Admission H & P Performed By: MD on August 14, 2021 2:21 Verified By: MD on August 14, 2021 2:21 Encounter info: Inpatient, 08/14/2021 - 08/25/2021 * Final Report * Date of Admission 08/14/2021 Chief Complaint for resp distress, COVID+, intubated by EMS and given 4mg versed, 20mg etomidate, 100mg ketamine, 125mg solumedrol History of Present Illness 75-year-old female sent from secondary to respiratory distress. Patient is intubated in the ER therefore history is taken from ER records and chart. Patient had recent admission at hospital rib patient had been initially admitted with symptomatic anemia and abnormal vaginal bleeding. At that time patient was found to have brainstem mass likely metastatic cancer secondary endometrial cancer. Patient required blood transfusion. Patient presents today with acute worsening of shortness of breath at 11:30 a.m. this evening. patient has known covid-19. Per EMS patient''s initial O2 sats were in the 70s. Patient started on CPAP with no improvement. Patient intubated in the field. Course of symptoms constant degree at onset severe degree of present severe. No known exacerbating alleviating factors. No known other associated symptoms. Patient by emergency department patient started IV pressors given IV antibiotics. Pneumonia due to COVID-19 virus U07.1 Acute hypoxemic respiratory failure Respiratory failure J96.90 Severe sepsis R65.20 Recent diagnosis metastatic CA likely endometrial History of Abnormal vaginal bleeding CM Ongoing Assessment AH NEW Patient: Age: 75 years Sex: Female DOB: Associated Diagnoses: None Author: Professional Services CM Contact Information: Discharge Planner . Discharge Planner Phone . Assessment Ongoing Assessment Situation: was advised that pt expired this morning 8/25/21. contacted (ex-spouse) to inform him of this information. Pt was not under hospice services as ex-spouse only returned part of the paperwork..


VAERS ID: 1656237 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-08-29
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Death, Dyspnoea, Nausea, Oxygen saturation decreased, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 81 y.o. female with history of COPD/emphysema on oxygen at home who presents with shortness of breath, chest pain, and nausea. She states her symptoms started this past Thursday. They progressively worsened with time. She normally wears 2 L of oxygen at home at night at baseline. However, her oxygen needs have had to increased since this past Thursday and she was up to 10 L oxygen at home today prior to coming to the emergency department. She came to the emergency department on Saturday 08/21/2021 and was positive for COVID-19. She did not require any more oxygen to be admitted at that time. She did have her COVID-19 vaccine and was fully vaccinated well over a month ago. She denies any other complaints today. Of note, she states only 1 of her lungs is working at 100% as the other 1 is being collapse by an uneven diaphragm. She had a car accident recently and had a ruptured sternum with diaphragmatic rupture. Hospital Course: Patient was treated for COVID-19 protocol. Unfortunately, her respiratory status continued to decompensate. She began telling staff that she was ?done ?and ?ready to go to the lord.? After difficult discussion, patient elected to make herself comfort measures only. Aggressive measures were discontinued and her family was allowed to visit say goodbye. She passed away 08/29/2021 at 1007. May she rest in peace.


VAERS ID: 1656270 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-05
Onset:2021-08-04
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case was fully vaccinated with COVID 19 vaccine. Last dose administered on 2/5/21. Case tested positive for COVID 19 on 8/4/2021. and was admitted to Medical Center with covid signs and symptoms on 8/11/2021. Case expired while still hospitalized on 8/26/2021.


VAERS ID: 1656294 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-03
Onset:2021-08-16
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Computerised tomogram thorax abnormal, Dyspnoea, Endotracheal intubation, Lung hyperinflation, Lung opacity, Mechanical ventilation, Multiple organ dysfunction syndrome, Pneumonia pseudomonal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   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: COPD, lung cancer, heroin use, cirrhosis, Hepatitis C
Allergies: Aspirin, codeine
Diagnostic Lab Data: CT chest showed right upper lobe groundglass opacities, mild lingular atelectasis since hyper inflated hyperlucent left lower lobe.
CDC Split Type:

Write-up: Presented to ED with difficulty breathing, O2 saturation 60% on room air. continued to have increased work of breathing and intubated and placed on mechanical ventilation. + Covid-19 test. Required vasopressor support with levophed. Found to have pseudomonas pneumonia. Multisystem organ failure and family requested transition to comfort care and passed on 8/29/21.


VAERS ID: 1656401 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-10
Onset:2021-07-11
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 50
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No cause of death found on autopsy
CDC Split Type:

Write-up: Pt died on July 11, 2021


VAERS ID: 1656402 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-27
Onset:2021-08-05
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiomegaly, Chest X-ray abnormal, Cough, Death, Dyspnoea, General physical health deterioration, Headache, Malaise, Mechanical ventilation, Pleural effusion, Pyrexia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: 2021-08-17
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Carvedilol 12.5 mg BID on non-dialysis days, Cholecalciferol 2000 units QD, Coenzyme Q10 QD, Creon 12K/38K/60K @ caps TID, Gabapentin 200 mg QHS, Pantoprazole 40 mg BID, Dialyvite QD, Fluconazole 100 mg QD x 9 days, Insul
Current Illness:
Preexisting Conditions: Hisotry of CVA, CHF, A-Fib, T2DM, ESRD, Pulmonary Hypertension, Allergic rhinitis, Anemia, diabetic peripheral neuropathy, Elevated PSA, GERD, Hyperlipidemia, Hypertension, nodular basal cell carcinoma of left cheek, stroke
Allergies: Nifedipine (Swelling)
Diagnostic Lab Data: on 8/7/2021 @ 1911 COVID-19 positive test
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/6/2021 and 1/27/2021. Presented to ED on 8/7/2021 after developing dry cough for about 2 days associated with dyspnea, started using his home oxygen 2-3L continuously though previously was using very infrequently. He endorses mild fevers, headache, and generalized malaise.In the ED, COVID PCR was positive. CXR shows stable cardiomegaly; stable blunting of constophrenic angles either trace effusion vs scarring; no focal consolidation. He received Decadron x 1 dose, reports some improvement after. Patient was DNR/DNI during this hospitalization and progressed with worsening combination. respiratory failure which was not amenable to NIPPV x3 days, and dexamethasone. Discussion was held with patient''s wife and decision was made to withdraw artificial support and focus on comfort. Patient expired at 1630 8/17/2021.


VAERS ID: 1656482 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-29
Onset:2021-02-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062G20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arteriosclerosis, Autopsy, Blood chloride normal, Blood creatinine normal, Blood immunoglobulin E normal, Blood ketone body, Blood potassium normal, Blood sodium normal, Cardiac failure congestive, Condition aggravated, Congestive hepatopathy, Death, Hepatic cirrhosis, Hypertensive heart disease, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Laboratory test normal, Myocardial fibrosis, Obesity, Oedema mucosal, Platelet count normal, Pulmonary congestion, Pulmonary hypertension, Pulmonary oedema, Red blood cell count increased, SARS-CoV-2 test negative, Tryptase, White blood cell count increased
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Angioedema (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), Pulmonary hypertension (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen PO q 6 hours PRN Tramadol PO q 6 hours PRN
Current Illness: Atherosclerotic and hypertensive cardiovascular disease Congestive heart failure Obesity, class 1
Preexisting Conditions: Atherosclerotic and hypertensive cardiovascular disease Congestive heart failure Obesity, class 1
Allergies: Metoprolol - unknown reaction Naproxen - ulcer Scopolamine - vision disorder
Diagnostic Lab Data: Vitreous fluid analysis (Na+, K+, CL-, UN, Cr, Glc, BHB) within normal limits. Nasopharyngeal viral studies negative (COVID, influenza A, influenza B). No significant elevation of blood IgE or tryptase levels. CMC with normal platelet count; elevated WBC and RBC labs. Histology: Larynx- submucosal edema; lungs- edema and congestion with vascular changes consistent with early pulmonary hypertension; liver- Chronic congestive hepatopathy with early cirrhosis (cardiac sclerosis).
CDC Split Type:

Write-up: Death occurred; I performed an autopsy (I''m a Medical Examiner/forensic pathologist) and ultimately certified the death as follows: Cause of death: Congestive Heart Failure due to Atherosclerotic and Hypertensive Cardiovascular Disease. Other significant conditions: Class 1 Obesity. Manner of death: Natural. There is NO evidence to indicate that the vaccination is related to her death.


VAERS ID: 1656531 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-08
Onset:2021-08-11
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: breakthrough Covid infection, acute resp failure, patient died


VAERS ID: 1656552 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-08-04
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Bradycardia, COVID-19, COVID-19 pneumonia, Cardiac pacemaker insertion, Chest X-ray abnormal, Death, Dialysis, Dyspnoea, Endotracheal intubation, Leukocytosis, Lung infiltration, Oxygen saturation decreased, Pulmonary oedema, SARS-CoV-2 test positive, Thrombocytopenia, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 2 puffs q4; alfuzosin 10mg daily, amlodipine 5mg BID, Vitamin C 500mg daily, aspirin 81 daily, atorvastatin 10mg 1/2 tab nightly, combigan 1 drop left eye q12h, vitamin b-12 1000mcg daily, dutasteride 0.5mg daily, ergocalciferol 1
Current Illness: UTI (8/14/21)
Preexisting Conditions: COPD, sick sinus syndrome, anemia, heart failure with preserved ejection fraction, HTN, CAD, HLD, hypothyroidism
Allergies: Hydralazine, Clonidine, Diltiazem, Metoprolol Succinate, Floxin in D5W
Diagnostic Lab Data: COVID positive (8/4/21)
CDC Split Type:

Write-up: Pfizer BionCOVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer BionNTech Vaccine on 03/05/2021 and 04/02/2021. Patient presented to ED on 8/4/21 for shortness of breath. Patient reported progressive worsening of shortness of breath which started 3 days prior. EMS found pt to have O2 sats at 70% RA and temp of 104F. Patient tested positive for COVID-19 infection in the emergency room. Patient had a chest x-ray done in the emergency room which revealed bilateral infiltrates consistent with COVID pneumonia versus pulmonary edema. Patient''s requirement for oxygen started to increase. He was on high-flow oxygen. He also has thrombocytopenia. Required pressor support. Treated with Rocephin for UTI for Klebsiella. Pt also recieved decadron and remdesivir during stay. Patient had severe bradycardia and had a external pacemaker placed on 8/11/2021. Patient was then intubated for airway support. He also developed some acute kidney injury with the history of CKD. Patient condition slowly worsened requiring pressors. His leukocytosis increased. Patient went on to need dialysis and additional measures and family opted for comfort care. Patient expired on 8/21/21


VAERS ID: 1656556 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-03-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, Arteriogram carotid, Barium swallow, Blood lactic acid, Chest X-ray abnormal, Computerised tomogram abdomen, Computerised tomogram head, Death, Ear pain, Echocardiogram, Electrocardiogram, Full blood count, Headache, Hepatitis, Laboratory test, Lumbar puncture, Magnetic resonance imaging head, Meningitis, Metabolic encephalopathy, Metabolic function test, Muscle spasms, Noninfective encephalitis, Platelet count, Pneumonia, Ultrasound Doppler, X-ray of pelvis and hip
SMQs:, Hepatitis, non-infectious (narrow), Dystonia (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Immune-mediated/autoimmune 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? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Seroquel; Viibryd; Gabapentin; Aricept; Namenda; Trazadone; Cardura; Proscar; Lipitor; Plavix: Latanoprost; Fluticasone Propionate; Ipratopium Bromide
Current Illness:
Preexisting Conditions: MCI/Dementia; essential tremor; Parkinsonism; depression-controlled with treatment; glaucoma; high cholesterol; arthritis; rhinorrhea; TIA (3 during past 5 years); BPH-corrected by surgery and medication
Allergies: Sulfa MSG
Diagnostic Lab Data: Laboratory tests; Metabolic Panel; CT Head; MRI Brain; Us carotid duplex; Transthoracic Echocardiogram Complete; ECG; XR chest; XR abdomen; CT Abdomen; CT Head; IR Lumbar Puncture; Modified Barium Swallow; XR hip.
CDC Split Type:

Write-up: *** SEVERE NEUROLOGICAL IMPACT*** *** MASSIVE BRAIN INFLAMMATION*** *** DEATH *** 3/07/2021: Intractable stabbing pain in head at ears every 3-4 seconds. Pain level 10. 3/10/2021: Intractable stabbing pain in head at ears every 3-4 seconds. Pain level 10. ER visit Urgent Care ER Treatment: morphine IV ER Tests: CT brain w/o IV contrast; CTA carotid; Basic Metabolic Panel; CBC w platelet count Diagnosis: Neck muscle spasm Rx: tramadol (not helpful after morphine wore off) 3/12/2021: Intractable stabbing pain in head at ears every 3-4 seconds continues. Pain level 10. ER visit Urgent Care: ER Treatment: morphine pills - twice; Tylenol; Colace; Lidocaine ER Tests: XR 2 views; Basic Metabolic Panel; CBC w platelet count; Lactic acid, venous Diagnosis: Left ear pain; pneumonia due to infectious organism, unspecified laterality, unspecified part of lung Rx: amoxicillin-clavulanate; neomycin-polymyxin-hydrocortisone (did not fill these prescriptions) 3/14/2021: Intractable stabbing pain in head at ears every 3-4 seconds continues. Pain level 10. ER visit Hospital: admitted to hospital; treatment for 14 days; Discharge diagnosis: ACUTE METABOLIC ENCEPHALOPATHY and HEPATITIS 3/28/2021: Transferred to Hospice. 3/31/2021: Transferred to Home Hospice. 4/10/2021: Death occurred Death Certificate: PRESUMED MENINGITIS


VAERS ID: 1656560 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-10
Onset:2021-07-31
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, Computerised tomogram thorax abnormal, Death, General physical health deterioration, Lung infiltration, Mechanical ventilation, Pulmonary embolism, SARS-CoV-2 test positive, Troponin increased
SMQs:, Interstitial lung disease (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 18
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: Multiple sclerosis
Allergies: No known allergies
Diagnostic Lab Data: COVID positive 8/2/2021; CTA revealed bilateral pulmonary embolisms and extensive bilateral pulmonary infiltrates; Troponin 1.33 on 8/6/2021
CDC Split Type:

Write-up: Janssen (J&J) COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 07/10/2021. Patient started having symptoms on 7/31/2021 and presented to ED on 8/2/2021. Patient received dexamethasone and enoxaparin at outside hospital. Patient rapidly declined eventually requiring mechanical ventilation and was then transfered to ED on 8/5/2021. Patient was diagnosed with bilateral pulmonary embolisms. Patient received dexamethasone, enoxaparin, remdesivir, & ceftriaxone. Hospital course progressed without meaningful recovery of lung function ad patient expired on 8/18/2021.


VAERS ID: 1656565 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-09
Onset:2021-08-16
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Angiogram normal, Asymptomatic COVID-19, COVID-19, Chest X-ray abnormal, Computerised tomogram abdomen normal, Cough, Death, Diarrhoea, Dysphagia, Haematochezia, Mental status changes, Rectal haemorrhage, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), 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: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325mg 2 tab q4; albuterol nebulizer cont. 1.25 mg/3mL 1 vial Q6H prn; albuterol HFA inhaler 90 mcg/actuation 1 puff Q6H; calcium acetate, phosphate 667 mg capsule 1 cap TID, cephalexin 500mg 1cap qd; cetirizine 10mg ? tab qd;
Current Illness: UTI (8/14/21)
Preexisting Conditions: Diabetes mellitus, Hypertension, Hyperlipidemia, Depression, GERD, cirrhosis, anemia in chronic kidney disease, CHF, COPD, kidney transplant, squamous cell carcinoma (2011), thyroid disease.
Allergies: Amlodipine, Codeine, Amiodarone, Fentanyl, Allopurinol cont. Benadryl, Levofloxacin
Diagnostic Lab Data: COVID positive (8/14/21)
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 01/14/2021 and 02/09/2021. Pt presented to ED on 8/16/21 with c/o rectal bleeding, hematochezia, onset of the previous night. States she had 5-6 episodes last night of bright red rectal bleeding which has continued into today, including diarrhea. She had an episode of BRBPR in the ED. Patient was diagnosed with Covid on 8/13 but is largely asymptomatic. Patient was on 2L NC in the ED which is the same amount of O2 at home. Diagnostic colonoscopy was attempted twice, however, due to tortuous colon with acute angulations in the sigmoid, scope could not traverse area. IR was consulted, however cont., both CTA abdomen and angiogram were negative for any active bleeds. Surgery was consulted but determined that patient was too high risk for surgery. It was discussed with both IR and GI that if pt has significant bleed again, will consider potential repeat angiogram. Patient''s cough worsened throughout the course of hospitalization and CXR showed worsening opacities and dexamethasone and remdesivir were started. Patient also received vancomycin. Patient also began to display worsening mental status, became minimally responsive with agonal breathing, and difficulty swallowing. Pt status was changed to DNAR/COT and eventually patient''s son decided to make patient comfort care. Patient expired on 8/24/21.


VAERS ID: 1657248 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-19
Onset:2021-02-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 024M2 / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Fatigue, Nausea
SMQs:, Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Resolved atrial fibrillation Mitral valve repair CABG x1 Diabetes II
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received second dose of Moderna on 2/19/21. On 2/20/20 my father said he felt fatigue and nauseated but thought that was normal side effects. On 2/21/21 @ 0100, my father suffered a massive stroke. He passed away on 3/27/21.


VAERS ID: 1657576 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Fatigue, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Patient was very ill after her second dose and died two weeks later. Symptoms-fever, muscle aches, fatigue


VAERS ID: 1657896 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-13
Onset:2021-02-20
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cardiac failure, Pericarditis, Pyrexia, Renal failure, SARS-CoV-2 test, Urinary tract infection, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: XARELTO; ALLOPURINOL; ASPIRIN 81
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy (Known allergies: NKDA); Atrial fibrillation; Chronic kidney disease; Hyperlipidemia; Stroke
Allergies:
Diagnostic Lab Data: Test Name: Nasal Swab; Test Result: Negative ; Test Name: urinalysis; Result Unstructured Data: Test Result:normal
CDC Split Type: USPFIZER INC202101096776

Write-up: treated for suspected UTI (though urinalysis was normal) with antibiotic; kidney failure; He passed away on 24Mar2021 due to heart failure; diagnosed with pericarditis; Developing fever; weakness; This is a spontaneous report from a contactable consumer. A 81-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 13Feb2021 12:00 (Batch/Lot number was not reported) (at age of 81-year-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included atrial fibrillation, stroke, kidney disease, hyperlipidemia and Known allergies: NKDA. There was no other vaccine in four weeks. Concomitant medications included rivaroxaban (XARELTO); allopurinol; and acetylsalicylic acid (ASPIRIN 81). On 20Feb2021, The patient started developing fever, weakness. Saw family Dr on 26Feb2021, treated for suspected UTI (though urinalysis was normal) with antibiotic. On 01Mar2021 high fever returned with extreme weakness. Admitted to hospital from 01Mar2021 to 18Mar2021 and diagnosed with pericarditis. He was sent home on Hospice. He passed away on 24Mar2021 due to heart failure. Prior to the vaccination, he was having no symptoms of infection, he was active and healthy, and he was seeing a cardiologist regularly.AE resulted in: Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization, Life threatening illness (immediate risk of death from the event), Patient died on 24Mar2021. Death cause: heart failure, kidney failure. AE treatment: numerous medications given during hospitalization. No covid prior vaccination.Covid tested post vaccination: was Yes. Covid test type post vaccination: Nasal Swab, Covid test result: Negative. No autopsy performed. The outcome of the events heart failure and kidney failure was fatal, of the rest of events was unknown. The lot number for BNT162b2, was not provided and will be requested during follow up; Reported Cause(s) of Death: kidney failure; heart failure


VAERS ID: 1657901 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-31
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 INC202101097920

Write-up: death; This is a spontaneous report from a Pfizer-sponsored-program. A contactable consumer reported that a male patient of unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on unspecified date at single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter stated "You are despicable. Your VAX caused my dad''s death. Apparently, lives are disposable as long as you make your money. I hope your family members don''t die slow, agonizing deaths from this vax like my dad did". It was unknown if autopsy was done. The outcome of the event was fatal. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: death


VAERS ID: 1657902 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-31
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 INC202101098146

Write-up: died; This is a spontaneous report from a contactable consumer. An 18-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number and expiration date not provided) via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died on an unspecified date due to unknown cause of death. Unknown treatment received. 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: died


VAERS ID: 1657906 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-31
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 INC202101100059

Write-up: lost a friend; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend. The cause of death was unknown. It was unknown if autopsy was done. The 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100128 Same reporter/event/drug, different patient;US-PFIZER INC-202101100129 Same reporter/event/drug, different patient;US-PFIZER INC-202101100127 Same reporter/event/drug, different patient; Reported Cause(s) of Death: lost a friend


VAERS ID: 1657907 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-31
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 INC202101100127

Write-up: I have lost 3 friends in Spain; This is a spontaneous report from a non-contactable consumer. This consumer reported similar events for twelve patients. This is one of twelve reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter stated "I have lost 7 friends in , 3 in , 1 in and a friend of my son 14 years." The cause of death was unknown. It was unknown if autopsy was done. The 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/product, different patient; Reported Cause(s) of Death: lost 3 friends


VAERS ID: 1657909 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-31
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 INC202101100129

Write-up: lost a friend of my son 14 years; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified routed of administration on unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend of the reporter''s son 14 years (seems the reporter''s son''s age who is not the patient). The cause of death was unknown. It was unknown if autopsy was done. The 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 Same reporter/event/drug, different patient; Reported Cause(s) of Death: lost a friend of my son 14 years


VAERS ID: 1658364 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-12
Onset:2021-08-06
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 36 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM, CKD3
Allergies:
Diagnostic Lab Data: covid PCR positive on 7/31/2021
CDC Split Type:

Write-up: Death from Covid Pneumonia


VAERS ID: 1658385 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-08-13
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold 8/14/21 = 16.2.
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine


VAERS ID: 1658443 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-11
Onset:2021-08-17
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, hypertension, prostate cancer
Allergies:
Diagnostic Lab Data: Cycle threshold 8/16/21 = 26.4
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine EUA


VAERS ID: 1658459 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-13
Onset:2021-05-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Cardiac disorder, Death, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Autopsy shows previously unidentified/ undiagnosed heart issues.
CDC Split Type:

Write-up: Specifically unknown, but patient (he''s now deceased) was concerned about throwing up so much that he''d lose his stomach lining.


VAERS ID: 1658487 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-14
Onset:2021-08-09
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Gangrene, Myocardial infarction, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: DIABETES MELLITUS, CARDIOVASCULAR DISEASE
Preexisting Conditions: DIABETES MELLITUS, CARDIOVASCULAR DISEASE
Allergies: Unknown
Diagnostic Lab Data: PCR + COVID on 08/09/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 60 year old male patient. The patient received two doses of the Moderna vaccine on 5/17 and 6/14. On 8/9/21, the patient tested positive via a PCR test for COVID-19 (vaccine breakthrough). The patient died on 8/26 and the cause of death is listed as ?Cardiac arrest, myocardial infarction, gangrene LLE, Covid pneumonia.? Pre-existing conditions are listed as DIABETES MELLITUS, CARDIOVASCULAR DISEASE.


VAERS ID: 1658499 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-25
Onset:2021-08-12
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Pneumonia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, 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: 2021-08-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: + PCR COVID 8/12/21 + PCR COVID 8/13/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 79-year-old female patient. The patient received two doses of the Pfizer vaccine on 3/04 and 3/25. On 8/12/21 and again on 8/13/21, the patient tested positive via a PCR test for COVID-19 (vaccine breakthrough). The patient died on 8/25 and the cause of death is listed as ?Pneumonia; COVID 19.? Pre-existing conditions are unknown.


VAERS ID: 1658515 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-18
Onset:2021-08-16
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B1-2A / 2 LA / IM

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: 2021-08-27
   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: UNKNOWN
Current Illness: CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD), CARDIOVASCULAR DISEASE, CHRONIC RENAL DISEASE
Preexisting Conditions: CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD), CARDIOVASCULAR DISEASE, CHRONIC RENAL DISEASE
Allergies: UNKNOWN
Diagnostic Lab Data: The patient took three antigen tests. The first two were on 8/16 (one was negative and one was positive) and the third was on 8/17 (positive).
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 88-year-old male patient. The patient received two doses of the Moderna vaccine on 3/21 and 4/18. The patient later took three antigen tests. The first two were on 8/16 (one was negative and one was positive) and the third was on 8/17 (positive). The patient died on 8/27 and the cause of death is not listed although it is considered a probable COVID-19 death according to state guidance. Pre-existing conditions are listed as ?CHRONIC LUNG DISEASE (ASTHMA/EMPHYSEMA/COPD), CARDIOVASCULAR DISEASE, CHRONIC RENAL DISEASE.?


VAERS ID: 1658553 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-17
Onset:2021-08-31
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen on 8/17. Positive 8/29. death at end hospital stay


VAERS ID: 1658556 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-08-30
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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:

Write-up: Moderna on 2/12 and 3/12. Positive on 8/27 hospital stay ended with death


VAERS ID: 1658663 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-03
Onset:2021-07-25
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, Bilevel positive airway pressure, COVID-19, Computerised tomogram thorax abnormal, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Intensive care, Lung opacity, Oxygen saturation decreased, Pneumonia, Pulse absent, Renal failure, Respiratory failure, Respiratory rate decreased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 16
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: HTN, HLD, obesity, tobacco use
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated 75-year-old male with past medical history significant for HTN, HLD, obesity, tobacco use, and prior DVTs admitted to Hospital on 07/27/2021 for shortness of breath. Patient was seen at urgent care on 07/25/2021 and found to be COVID-19 positive. CT angiogram performed to assess for pulmonary embolism. Imaging was equivocal but demonstrated bilateral patchy ground-glass opacities suggestive of bilateral pneumonia. Patient was administered and completed azithromycin, ceftriaxone, dexamethasone. Initially on 6L of oxygen by nasal cannula on admission. During his admission, patient''s respiratory status worsened and he was placed on humidified high-flow nasal cannula at 60 L and 100% O2. Despite being on high-flow nasal cannula patient desaturated to the 70s and a rapid response was called. Patient was placed on BiPAP with some improvement in his respiratory status and was admitted to the hospital on 08/01/2021. On 8/7, his respiratory status progressively worsened and he was sedated and intubated. On 8/8, code status was changed to DNR. He developed progressively worsening renal failure and increased vasopressor requirements to maintain his blood pressure. 08/01 Rapid response called for patient desaturating in the 70s while on 60L. Transferred to Hospital. 8/07 Intubated and sedated due to worsening respiratory failure. 08/08 Worsening hypoxemia, renal failure, Code status changed to DNR. 08/10 Family elects palliative extubation, withdrawal of care with comfort measures. On 8/10/21 following adequate time to say their goodbyes. Palliative extubation performed by RT at 1823 with Nurse and family at bedside. Loss of palpable pulses appreciated by Nurse.


VAERS ID: 1658828 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-08-13
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trelegy ellipta, flonase
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data: Cycle threshold 8/14/21 = 24.4
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine EUA


VAERS ID: 1658837 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-08-08
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: mycophenolate
Current Illness:
Preexisting Conditions: kidney transplant recipient
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization with COVID-19 Reported per vaccine EUA


VAERS ID: 1658848 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-16
Onset:2021-07-21
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic heart disease High blood pressure Prostate Cancer
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 07/18/2021
CDC Split Type: 4298463

Write-up: Patient died of COVID-19 on 07/21/2021


VAERS ID: 1658891 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-03
Onset:2021-08-21
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Percocet, Coreg, Aspirin, Plavix, Dulcolax, Zyloprim, Cymbalta, Crestor, Tylenol, Prinivil, Kenalog, Desyrel
Current Illness:
Preexisting Conditions:
Allergies: Cephalosporins, levofloxacin, environmental and seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/21/2021.


VAERS ID: 1658899 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-08-20
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Milk of Mag, Maalox, Dulcolax, Roxanol, Lorazepam, Synthroid, Proscar
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 08/20/2021


VAERS ID: 1658903 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-07-27
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 11
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: AAA.
Allergies: Oxycontin
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Pt came to ER 7/27 with CP and 7/28 with difficulty breathing.


VAERS ID: 1658911 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-25
Onset:2021-07-25
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyloprim, Tenoretic, Viagra, Valtrex, albuterol, Symbicort, Vit D, Prilosec
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/25/2021.


VAERS ID: 1658919 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-05
Onset:2021-05-21
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: High blood pressure meds
Current Illness: None
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death- 7-24-2021 Myocarditis


VAERS ID: 1658929 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-13
Onset:2021-07-25
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-31
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: 2021-07-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Roxanol, Zofran, Lasix, Hibiclens, Tylenol, Milk of Mag, Maalox, Celexa, Benadryl, Coreg, Methotrexate, Eliquis, Dulcolax, Plavix, Mycostatin, Glycolax, Senokot, Klor-Con, Zetia, Neurontin, Plaquenil, Folic acid, Loperamide, Multi vit
Current Illness:
Preexisting Conditions:
Allergies: Codeine, Statins, Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 07/25/2021.


VAERS ID: 1659129 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-28
Onset:2021-07-29
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown. Patient contract pneumonia as a result of COVID-19 illness.
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 test on 7/24/2021
CDC Split Type: 2942563

Write-up: Patient died of COVID-19 illness on 07/29/2021


VAERS ID: 1659134 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Clostridium test positive, Death, Dyspnoea, Hypoxia, Mechanical ventilation, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (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: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aripiprazole 10 mg daily, pepto-bismol 262 mg every 6hrs PRN, lisinopril 5 mg daily, omeprazole 20 mg daily, sertraline 25 mg daily, zolpidem 5 mg daily at bedtime, Tylenol #3 1-2 tabs every 6 hours as needed.
Current Illness:
Preexisting Conditions: Diabetes mellitus, Hypertension, Hyperlipidemia, Depression, GERD, cirrhosis
Allergies: No known allergies
Diagnostic Lab Data: COVID positive 8/1/2021, 8/20/2021, and 8/24/2021. Clostridium difficile positive 8/14/2021
CDC Split Type:

Write-up: Janssen (J&J) COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 04/01/2021. Patient presented to ED with complaints of shortness of breath x 3 days. On arrival he was placed on high flow nasal cannula. Patient was mechanically ventilated on 8/5/2021 due to worsening hypoxia. Patient received dexamethasone & remdesivir. Patient was transferred to hospital on 8/5/2021. Patient received methylprednisolone, cefepime, meropenem, metronidazole, & vancomycin IV and PO. Hospital course progressed without meaningful recovery of lung function. On 8/24/2021, family decided to move to comfort care. Patient expired on 8/24/2021.


VAERS ID: 1659148 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-28
Onset:2021-08-01
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes mellitus Organ transplant Immunosuppressive therapy or condition, or disease Chronic heart disease High blood pressure
Allergies: Unknown
Diagnostic Lab Data: Patient tested positive for COVID-19 on 07/27/2021
CDC Split Type: 4325376

Write-up: Patient died of COVID-19 illness on 08/01/2021


VAERS ID: 1659238 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-19
Onset:2021-08-21
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 RNA, 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: 2021-08-30
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, PO, qDay atorvastatin 80 mg oral tablet 80 mg = 1 tab(s), PO, qHS clonazePAM 1 mg oral tablet 1.5 mg = 1.5 tab(s), PO, qHS docusate calcium 240 mg oral capsule 240 mg = 1 cap(s), PO, qDay docusate sodium 100 mg oral capsule 1
Current Illness: Acid reflux Acute right-sided low back pain with right-sided sciatica Anxiety Chest wall pain Chronic low back pain Concussion Coronary artery disease Depression Dyslipidemia Grief reaction H/O motion sickness History of BPH HOH (hard of hearing) Hx of CABG Hypertension Insomnia Lung adhesion Panic attacks TBI (traumatic brain injury) Unstable angina Vision loss of left eye
Preexisting Conditions: See section 11
Allergies: morphine Anxiety, Itching
Diagnostic Lab Data: SARS-CoV-2 (COVID19) RNA NAA+probe Ql (Resp) detected Specimen Source: Nose (nasal passage) Specimen Site: Bilateral Nares Specimen Collection Date/Time: 08/17/2021 SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (COVID-19)) Positive (LOCAL) Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (In House)) Ordered Test Codes: 94500-6 (LN LOINC)/7339056049 (L LOCAL) Status: Final Specimen Source: Nasopharynx Specimen Site: Specimen Collection Date/Time: 2021-08-21 19:31:00.0
CDC Split Type: 1300793

Write-up: Patient completed Covid vaccination series on 2/19/2021, then was hospitalized for Covid on 8/21/2021 and died of Covid 8/30/2021.


VAERS ID: 1659269 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-24
Onset:2021-08-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bacteraemia, COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, Extubation, General physical health deterioration, Hypoxia, Mechanical ventilation, Pneumonia staphylococcal, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 19
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: biotin 5000mcg daily, calcium carbonate 600mg 2 tab daily cont vitamin d3 1,000mcg daily, docusate daily, duloxetine 60mg BID, famotidine 20mg daily, Norco 10-325mg 1 tab Q6 prn; levothyroxine 137mcg daily, lidocaine 2% 15ml prn, losartan 5
Current Illness:
Preexisting Conditions: RA, OSA, Morbid Obesity, HTN, Hypothyroidism, Insomnia, GERD
Allergies: Zomaxx, Codeine,Gabapentin, Penicillins cont. sulfa antibiotics, sulfasalazine, enbrel
Diagnostic Lab Data: Covid positive (7/30/21)
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer BionNTech Vaccine on 06/18/2021 and 07/24/2021. Patient presented to ED on 8/1/21 for shortness of breath. Pt tested positive for COVID-19 on 7/30/21 and was positive for cough x 3 days. Pt was in respiratory distress in ED with worsening hypoxia requiring higher HFNC O2.Upon admission to the hospital she rapidly declined and required intubation and mechanical ventilation. Patient recieved lovenox for dvt ppx, decadron, remdesivir, and vancomycin. Her course was complicated by MSSA pneumonia and bacteremia. She had persistent bacteremia and her lines were exchanged.She decompensated on the cont. ventilator and required continued paralytics and proning. Patient did not recover. Family decided to withdraw care and patient was extubated. Patient expired on 8/20/21.


VAERS ID: 1659294 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-07-10
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Confusional state, Death, Dyspnoea, Headache, Myalgia, Nausea, Pyrexia, Respiratory viral panel
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   Days after onset: 14
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: Acetaminophen allopurinol amiodarone aspirin cored cymbalta decadron docusate sodium eliquid ferrous sulfate folic acid levemir magnesium oxide metolaxone mirapex novolog plexpen pantoprazole potassium chloride ranolazine sodium chlo
Current Illness: Congestive heart failure, COPD, Coronary artery disease, Diabetes, CKD-Stage 3, Hyperlipidemia, Hypertension, Renal Cancer
Preexisting Conditions: Congestive heart failure, COPD, Coronary artery disease, Diabetes, CKD-Stage 3, Hyperlipidemia, Hypertension, Renal Cancer
Allergies: Unknown
Diagnostic Lab Data: Biofire - respiratory panel
CDC Split Type:

Write-up: Patient tested positive for Covid-19 on July 10, 2021. Patient was complaining of being confused, had a fever, muscle aches, and headache. Patient also complained about nausea and abdominal pain. Patient was admitted to Medical Center on 07/24/2021 for confusion, SOB, nausea, and abdominal pain. Patient expired before they could be moved from ED to ICU.


VAERS ID: 1659313 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-05-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cardiac arrest, Catheterisation cardiac, Chest pain, Death, Electrocardiogram, Myocardial infarction, Pulseless electrical activity, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, lipitor, wellbutrin, glucotrol, hygroton, insulin, lopressor, metformin, lyrica, nitrogylcerin prn
Current Illness:
Preexisting Conditions: IDDM, NSTEMI 2014 and 2004
Allergies: jardiance, latex, morphine analogues, oxycodone, amlodipine, codeine, hydrocodone, januvia, lisinopril, metformin, protonix, insulin glargine
Diagnostic Lab Data: blood tests, EKG, cardiac cath
CDC Split Type:

Write-up: She had a heart attack and died. Vaccine received on 5/7/2021, per notes chest pain began 5/8/2021, presented to the ED on 5/11/2021, diagnosed with anterior STEMI, directly to cath lab where she had a PEA and then V fib arrest. She passed away on 5/12/2021.


VAERS ID: 1659476 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-31
Onset:2021-04-24
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Acute myeloid leukaemia, Asthenia, Blood test, Blood urine present, Fatigue, Laboratory test, Platelet count, Urinary tract infection, White blood cell count
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Guillain-Barre syndrome (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 77
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril Multi-Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Full blood work up and when she was transferred to the hospital they did their blood work up on her White Blood Cell counts, Platelet count and everything else that indicated she had Leukemia
CDC Split Type:

Write-up: she became very tired after the shot and never regained her energy and ended up in the ER for a UTI but there was a lot of blood in her urine. After running blood work and multiple tests she was diagnosed with AML just shy of 4 weeks from the time the shot was administered.


VAERS ID: 1659718 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-03-01
Onset:2021-08-16
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary Embolism, Acute Respiratory Failure, and Death


VAERS ID: 1659931 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-16
Onset:2021-08-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Epistaxis, Induration, Mobility decreased, Nausea, Pain, Pallor, Peripheral coldness, Skin discolouration
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: COVID, HTN, hypothyroidism
Preexisting Conditions: HTN, hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after shot she began to feel, nausea, hurting, lying in bed a lot, refused to go to doctor thought she would get better. Husband left home about 15 minutes to find her dead sitting on chair, right lower leg hard and cold to touch, purple in color, blood in bilateral nares and upper body white.


VAERS ID: 1659940 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-09
Onset:2021-08-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Resuscitation, Skin discolouration, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   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: Metoprolol Succinate
Current Illness: N/A
Preexisting Conditions: Recently diagnosed with COPD, also had High Blood Pressure, were running tests for heart issues
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After the 1st 24 hours from his shot, he was having trouble breathing, by the third day his skin color was looking grayish, but he thought this was all from him being recently diagnosed with COPD. He did not show up for work on Friday and when his coworker went to his home to check on him and found him unresponsive, she called 911. They tried to revive him, but was unable to. I sadly have to report he passed away.


VAERS ID: 1659951 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-24
Onset:2021-04-09
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   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: Heart Problems
Preexisting Conditions: Heart Problems, Smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1660313 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-06
Onset:2021-03-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cognitive disorder, Death, Gait inability, Peripheral swelling, Platelet count decreased, Renal failure, Transfusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 148
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: Went to Emergency and Tests taken on 3/25/21 at Hospital results came back normal Went to Hospital again on 4/2/21 and stayed until 4/5/21 tests showed low platlet levels and kidney failure
CDC Split Type:

Write-up: Swollen legs, could no longer walk, low platlet levels, needed a blood transfusion, cognitive decline, kidney failure, death


VAERS ID: 1660318 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-24
Onset:2021-02-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood gases, Computerised tomogram, Death, Dyspnoea, Pneumonia, SARS-CoV-2 test negative, X-ray
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), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: mechanical mitral valve
Allergies:
Diagnostic Lab Data: Covid negative, multiple diagnostic tests (including radiographs, CT, blood gasses)
CDC Split Type:

Write-up: Difficulty breathing began approx 8 days post Vx, progressed to pneumonia after 10 days, deceased at 12 days


VAERS ID: 1660763 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Accidental overdose, Death, Gastrooesophageal reflux disease, Interchange of vaccine products, Lymphoma, Victim of abuse
SMQs:, Drug abuse and dependence (broad), Gastrointestinal nonspecific dysfunction (narrow), Malignant lymphomas (narrow), Medication errors (narrow), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 94
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hiv
Current Illness:
Preexisting Conditions: Hiv
Allergies:
Diagnostic Lab Data: So many I need a book please contact me for these about 20 in a few months 60 on 1 yr
CDC Split Type:

Write-up: Wrong diagnosis Dr told us hiv barely detectable then said gallbladder then walked in ov stating well good news its not cancer . he told patient he had no choice but to get the covid vaccine even tho he didn''t want or understand it at all he offered no info no time and threatened patient he would not prescribe his hiv pills unless he was vaccinated fully . patient had too much trust . Dr gave him two different types and he was scheduling athird patient side affects were ignored and told it was normal due to injection he soon after was hospitallzed having lymph nodes cancer and all the tests ran by Dr were not found abbott said well I never looked at imaging and we we re sure it is acid reflex . another doctor a specialist said he shpuld not have given him that type of vaccine with his medical jistory and allergies. Dr told us at hospital dont try goodbye because patient had only 6 months if that to live he walked put two weeks later we went to specialost who said he was wrong and didnt know why Dr said that but to cover his butt because of the wrong dying of covid vaccines. Patient died and the hospital staff said either vaccine caused this or overdose when shift change happened because he was given too many pain meds and three kinds . no one even knew je was in the room he was peed even tho they said he couldnt he had food on him all over and he was on liquod diet he was dirty no water no machines hooled up not even an IV help we need justice story gets more detailed I have pics and med rec this doctor wwas wrong abiut it all even vaccine .


VAERS ID: 1660971 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-07-27
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Haematoma, Internal haemorrhage, Oxygen saturation, Oxygen saturation decreased, SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 31
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: Abstains from alcohol; Blood pressure high (Patient was on CPAP machine.); Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and no drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20210727; Test Name: COVID-19 virus test; Result Unstructured Data: Positive; Test Name: Oxygen saturation; Result Unstructured Data: Low; Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210857346

Write-up: DEATH; INTERNAL BLEEDING; HEMATOMA; LOW BLOOD OXYGEN; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID -19 INFECTION; This spontaneous report received from a consumer concerned a 69 year old white non- hispanic or latino male. Initial information was processed along with the additional information received on 30-AUG-2021. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure and was on CPAP (Continuous positive airway pressure ) machine, non-alcohol user, and non-smoker. The patient had no known allergies and no drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and expiry: 21-SEP-2021) dose was not reported, 1 in total administered to left arm on 30-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 27-JUL-2021, the patient developed shortness of breath and fever (Suspected covid -19 infection) and was taken to emergency room. There patient tested positive for covid-19 infection (suspected clinical vaccination failure). The patient was transferred to other hospital and was on CPAP machine along with Bi-PAP. The patient had low blood oxygen. The patient was put on oxgyen. On unspecified date the patient become negative for covid-19 infection. The patient had internal bleeding and was on blood thinner. The patient had hematoma and could not breath. On 19-AUG-2021 the patient was again transferred to another hospital and was intubated which made him worse. On 27-AUG-2021 the patient passed away. The number of days hospitalized was 32. It was unknown whether the cause of death was due to covid-19 infection or due to vaccine. It was unknown whether an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on 27-AUG-2021, recovered from suspected covid -19 infection, had not recovered from hematoma, internal bleeding, and low blood oxygen, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, and Life Threatening). This report was associated with a product quality complaint 90000191347.; Sender''s Comments: V0: 20210857346-covid-19 vaccine ad26.cov2.s-Death, internal bleeding, suspected covid -19 infection, hematoma and low blood oxygen. 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). 20210857346-covid-19 vaccine ad26.cov2.s- suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1660988 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210860032

Write-up: DEATH; This spontaneous report received from a consumer via social media concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date spike protein was found in every organ of the patient and patient died after 7 days of vaccination from an unknown cause. It was unknown whether autopsy was done or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210860032-COVID-19 VACCINE AD26.COV2.S-DEATH. This event is considered unassessable. The event 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.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1661247 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Facial paralysis, Feeling abnormal, SARS-CoV-2 test negative
SMQs:, Supraventricular tachyarrhythmias (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy (known allergies hay fever, environmental allergies); Environmental allergy; Neurological disorder NOS
Allergies:
Diagnostic Lab Data: Test Date: 202103; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101098980

Write-up: foggy brain; atrial fibrillation; facial paralysis; This is a spontaneous report from a contactable Nurse. This contactable 36-year-old female Nurse (patient) reported for herself that: A 36-years-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on Mar2021 (at the age of 36-years-old) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. Medical history included nervous system disorder from an unknown date, hay fever, environmental allergies, known allergies hay fever, environmental allergies. Patient had no concomitant medications. Patient received any other vaccines within 4 weeks prior to the COVID vaccine was unknown. Patient had not received any other vaccines within 2 weeks. Prior to vaccination, patient was not diagnosed with COVID-19. Post vaccination, the patient was tested for COVID-19On Mar2021 at 15:45, the patient experienced facial paralysis, foggy brain, atrial fibrillation. The patient underwent lab tests and procedures which included Nasal Swab: negative on Mar2021. The patient died on Mar2021. 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.; Sender''s Comments: Based on the information provided, known drug safety profile and plausible temporal association, the causality between BNT162B2 and the events Facial paralysis, Feeling abnormal, Atrial fibrillation cannot be completely excluded. The impact of this report on the benefit-risk profile of the Pfizer product and on the conduct of the study 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: side effect of Covid-19 inoculation


VAERS ID: 1661263 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Extra dose administered, Off label use
SMQs:, Medication errors (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101109335

Write-up: Died; Her sister in law received a booster dose the day before yesterday; Her sister in law received a booster dose the day before yesterday; This is a spontaneous report from a contactable consumer (patient''s caregiver) via medical information team. A 70-year-old female patient received third dose BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), via an unspecified route of administration on 24Aug2021 (Batch/Lot number and expiry date was not reported, age at vaccination: 70-year-old) as dose 3, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Previously, the patient received first and second dose of BNT162B2 (Batch/Lot number and expiry date was not reported) on an unknown date as dose 1, single and dose 2, single for covid-19 immunization. On 24Aug2021, the patient received a booster dose and went home first. No one lives with her and she lives alone. The reporter''s brother went to see her, and she was almost at her death. He called 911 and they took her to the hospital, and she died on 25Aug2021. An autopsy was not performed. The reporter wanted to know why did this happen to her and what caused her death and what happened to her. She was just trying to help the public after this happened. Doctors should be informed and the public needs to be informed on when to take the shot and when not to take the shot. She doesn''t have all that information on when the patient received the first and second dose and just know that patient took it at the doctor''s office, she went home, and she died after getting the vaccine. The caller asked if adverse reaction/experience may be related to the product or not and response was provided that Pfizer cannot assess causality and doctor/healthcare provider is in the best position to assess and advise as your doctor/healthcare provider was most familiar with your medical condition, clinical history, how your treatment has been conducted and any relevant information to your specific case. And also informed that Pfizer was unable to make recommendations or diagnoses on a case-by-case basis for individual patients. It was the healthcare professional''s discretion with their use of clinical judgment to determine the safety of their patients. The caller was offered to provide CICP information and offered to provide Pfizer legal teams address and fax number. The reported that it was her sister in law so she doesn''t have all the information, she doesn''t have the doctors name or what was going on with her. She doesn''t know a lot of information to give at this time. She said there was type of website to get some compensation. Do they reimbursement right after or when? She talked to someone in VAERS. She really doesn''t know what to report, or why or what happened. She doesn''t know if it was a blood clot or what. The doctor just gave her the shot. Maybe the patient needed the booster because her immune system was not up to par. She would like to know more information from the doctor. The caller asked who is capable of getting the booster shot? Is it just people that are immunocompromised or is it specific ages like people above 65 years old? The caller asked if people taking certain medications that don''t allow the vaccine to work properly would be included in this group or not. The caller stated the way they have it on TV and everywhere she was thinking that everyone is able to get a booster. She stated the understanding is that certain ages over 65 can get it. (documenting as potential Pfizer complaint because she was commenting on how the guidance is not clear). The caller asked how long it will take to get the email from, agent (she just spoke with her prior to getting transferred. She stated everything is important in regard to timing, this needs to be handled quickly. She was not sure if Pfizer would want an autopsy, but they cannot afford it. She had spoken with (withheld) about wanting compensation and (withheld) was going to send an email because she asked for this in writing and not verbally. She stated she could take this information verbally now. The caller stated she has another family member that takes medication that is on the list of meds that keeps the covid vaccine from working and wanted to know if they could get a booster dose. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: unknown


VAERS ID: 1661264 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-01
Onset:2021-04-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose abnormal, Blood pressure abnormal, COVID-19, Cerebrovascular accident, Death, Myocardial infarction, SARS-CoV-2 test
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), 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), Hypertension (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Diabetes
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: Test Result:High; Test Date: 20210406; Test Name: Covid test; Test Result: Positive
CDC Split Type: USPFIZER INC202101109649

Write-up: Uncontrollable sugar levels; stroke; heart attack; My father passed away.; Covid test date was on 06Apr2021 with result positive; This is a spontaneous report from a contactable consumer (patient). A 72-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 01Apr2021 08:00 (at age of 72-year-old) (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included diabetes, high blood pressure. No known allergies. No other vaccine in four weeks. Other medications in two weeks included diabetes injections and high blood pressure meds. The patient experienced uncontrollable sugar levels, stroke, and heart attack, all on 06Apr2021. The patient was hospitalization for 7 days. Treatment received was reported as unknown. The patient passed away on an unknown date. The events resulted in Emergency room/department or urgent care, Hospitalization, Life threatening illness (immediate risk of death from the event). No covid prior vaccination. Covid was tested post vaccination, covid test type post vaccination was unknown. Covid test date was on 06Apr2021 with result positive. The event outcome for uncontrollable sugar levels, stroke was not recovered. The outcome for "Covid test date was on 06Apr2021 with result positive" was unknown. 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: My father passed away


VAERS ID: 1661267 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-01
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 INC202101110314

Write-up: recently died from covid; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received bnt162b2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN), 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 reporter had a good friend who was fully vaccinated and didn''t know which vaccine he got, who recently died from covid. The reporter knew nothing was 100%. The patient died on an unspecified date in 2021. It was not reported if an autopsy was performed. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: recently died from covid


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