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

Found 14,925 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

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VAERS ID: 1661268 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
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: Aneurysm
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 INC202101110596

Write-up: aneurysm; This is a spontaneous report from a non-contactable consumer. A patient of unspecified age and gender may received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. Caller claimed that some guy she knows got an aneurysm and died but she was not sure if that person took the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. 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.; Reported Cause(s) of Death: aneurysm


VAERS ID: 1661269 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
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 - / 1 - / -

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 INC202101110737

Write-up: passed away; This is a spontaneous report from a contactable consumer. A 51-year-old male patient received 1st dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. It was stated that patient passed away one week after receiving the 1st Pfizer covid vaccine injection. He was young and healthy. The patient died on an unspecified date due to unknown cause of death. 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: passed away


VAERS ID: 1661270 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
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 INC202101111871

Write-up: died at 36 years old.; This is a spontaneous report from a non-contactable consumer. A 36-years-old male patient received bnt162b2 (BNT162B2), on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and the concomitant medications were not reported. The patient died at 36 years old. 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: died at 36 years old


VAERS ID: 1661272 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
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: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101113182

Write-up: stroke; This is a spontaneous report from a contactable consumer (patient''s brother). 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 medical history and concomitant medications were not reported. The reporter said that his brother passed away after receiving the vaccine and had a stroke on an unspecified date, and there was nothing wrong with him prior to that. The patient died on an unspecified date. It was not reported if an autopsy was performed. The reporter would like to know what exactly is in the shot and what the chemicals are that are in the shot. He has been recently notified that the FDA has approved the booster and wants to know what is in that one too. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up. ; Reported Cause(s) of Death: stroke


VAERS ID: 1661273 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-24
   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 - / 2 - / -

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101114354

Write-up: She took her second dose and she died five days after; This is a spontaneous report from a contactable consumer. This female patient of unspecified age received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 19Aug2021 as DOSE 2, SINGLE for COVID-19 immunization. The patient''s medical history and 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. It was reported that the patient took her second dose and she died five days after on 24Aug2021. No prior health issues (further not clarified). The reporting consumer had coffee with patient that morning and she died hour and a half later. In moment reporting consumer find her on ground because of the vaccine. The reporting consumer asked how you guys can give a vaccine that kills people. Like it killed patient two days back (further not clarified) when she took it. Covid was not even that serious. The reporting consumer was going to file a huge lawsuit against you guys, a huge law site. But patient didn''t have to die if you guys didn''t fear among her and taking your stupid vaccine. She only died because she took up the vaccine. You know that right! because she took Pfizer. There''s more than 11 thousand deaths (not clarified) because of that shit. The very system was wrong, they are probably knowing that people are dying because of your stupid vaccine. There''s no way that could be approved if it is killing over 11 thousand people. The outcome of the event was fatal. 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: She took her second dose and she died five days after


VAERS ID: 1661274 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
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 - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase, Antibody test, Aspartate aminotransferase, Blood creatine phosphokinase MB, Blood fibrinogen, Blood lactic acid, Blood pressure measurement, C-reactive protein, Cardiac arrest, Catheterisation cardiac, Echocardiogram, Electrocardiogram, Fibrin D dimer, Haemoglobin, Heart rate, Interleukin level, International normalised ratio, Investigation, Myocarditis, Platelet count, Polymerase chain reaction, SARS-CoV-2 antibody test, Serum ferritin, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Speech impairment NOS; Trisomy 21 (complicated by speech impairment)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: alanine transferase; Result Unstructured Data: Test Result:7995 IU/l; Comments: u/l; Test Name: anti-nucleocapsid IgG; Test Result: Negative ; Test Name: aspartate transferase; Result Unstructured Data: Test Result:9003 IU/l; Comments: u/l; Test Name: creatine kinase myocardial band level; Result Unstructured Data: Test Result:252 ng/ml; Comments: normal value less than 5; Test Name: fibrinogen; Test Result: 100 mg/dl; Comments: dropped to 100 mg/dL; Test Name: Lactic acid; Result Unstructured Data: Test Result:6 mmol/L; Test Name: Lactic acid; Result Unstructured Data: Test Result:28 mmol/L; Comments: increased (NV - Less than 2); Test Name: blood pressure; Result Unstructured Data: Test Result:77/54 mmHg; Test Name: Cardiac catheterization; Result Unstructured Data: Test Result:showed no coronary obstructions; Test Name: CRP; Test Result: 13.1 mg/dl; Comments: highly elevated on admission; Test Name: Transthoracic echocardiogram; Test Result: 20 %; Comments: showed severe left ventricular systolic dysfunction (LVEF 20%) and a small circumferential pericardial effusion without tamponade; Test Name: electrocardiogram; Result Unstructured Data: Test Result:diffuse ST segment elevation; Comments: found to have diffuse ST segment elevation; Test Name: D-dimer; Result Unstructured Data: Test Result:4.21 ug/ml; Test Name: D-dimer; Result Unstructured Data: Test Result:greater than 20 ug/ml; Comments: increased critically high greater than 5.0; Test Name: hemoglobin; Result Unstructured Data: Test Result:11.5; Test Name: hemoglobin; Result Unstructured Data: Test Result:8.7; Comments: decreased; Test Name: heart rate; Result Unstructured Data: Test Result:133; Comments: per min; Test Name: Interleukin-6; Result Unstructured Data: Test Result:333 pg/mL; Comments: (NV less than 13); Test Name: INR; Result Unstructured Data: Test Result:2.0; Test Name: INR; Result Unstructured Data: Test Result:10.0; Comments: increased; Test Name: other respiratory virus; Test Result: Negative ; Comments: other common respiratory viruses more frequently associated with myocarditis was negative; Test Name: thrombocytes; Result Unstructured Data: Test Result:223 x10 9/l; Test Name: thrombocytes; Result Unstructured Data: Test Result:21 x10 9/l; Comments: developed progressively; Test Name: Polymerase chain reaction; Test Result: Negative ; Comments: for SARS-CoV2; Test Name: SARS-CoV2 NC igG; Test Result: Negative ; Test Name: SARS-CoV2 spike igG; Result Unstructured Data: Test Result:62.8; Comments: a.u./ml; Test Name: SARS-CoV2 spike protein IgG antibody; Test Result: Positive ; Comments: (62.8 arbitrary units/ml [NV less than 15.0]); Test Name: Ferritin; Result Unstructured Data: Test Result:23000 ng/ml; Comments: highly elevated on admission
CDC Split Type: USPFIZER INC202101116136

Write-up: fulminant myocarditis; recurrent cardiac arrest; refractory shock; This is a literature report from the International Journal of Cardiology, 2021, DOI:10.1016/j.ijcard.2021.08.018 entitled Fulminant myocarditis and systemic hyperinflammation temporally associated with BNT162b2 mRNA COVID-19 vaccination in two patients. This author reported similar events for two patients. This is first of two reports. A 27-year-old male with trisomy 21 complicated by speech impairment without history of cardiovascular disease presented in cardiogenic shock 2 days after his second vaccine dose. He had received the first dose without adverse effects. Approximately 36 h after the second dose, he developed nausea and vomiting. He presented to another hospital in shock (blood pressure 77/54 mmHg and heart rate 133/min) and found to have diffuse ST segment elevation in electrocardiogram (Fig. 1). Cardiac catheterization showed no coronary obstructions. Initially, creatine kinase myocardial band level (CK-MB) was 252 ng/mL (normal value [NV] < 5). Transthoracic echocardiogram showed severe left ventricular systolic dysfunction (LVEF 20%) and a small circumferential pericardial effusion without tamponade. A diagnosis of presumed fulminant pericarditis was made and methylprednisolone 1000 mg and human immunoglobulin (IVIG) 60 g were given. The course was complicated by hemodynamically unstable ventricular tachycardia refractory to electrical cardioversion followed by pulseless electrical activity. He was resuscitated with veno-arterial extracorporeal mechanical oxygenation (VA-ECMO). After return of circulation, he was supported by multiple vasopressors, mechanical ventilation, and renal replacement therapy (RRT). Despite these interventions, multiorgan failure and refractory shock persisted. Lactic acid increased from 6 to 28 mmol/L (NV less than 2), D-dimer increased from 4.21 to greater than 20 ug/mL (critically high $g5.0), INR increased from 2.0 to 10.0, and fibrinogen dropped to 100 mg/dL. C-reactive protein (CRP) and ferritin were highly elevated on admission at 13.1 mg/dL (NV less than 0.5) and 23,000 ng/mL, respectively, leading to a decision to administer anakinra (Kineret). Interleukin-6 level eventually came back highly elevated at 333 pg/mL (NV less than 13). thrombocytopenia developed progressively from 223x10 9 /L to 21x10 9 /L, while hemoglobin decreased from 11.5 to 8.7 g/dL. The patient demonstrated acute liver injury (ALI) with alanine transferase (ALT) and aspartate transferase (AST) at 7995 and 9003 u/L. Polymerase chain reaction (PCR) for SARS-CoV2 and other common respiratory viruses more frequently associated with myocarditis was negative. SARS-CoV2 spike protein IgG antibody was positive (62.8 arbitrary units/ml [NV less than 15), and anti-nucleocapsid IgG was negative, consistent with immunization status. Approximately 21 h after admission, patient died due to recurrent cardiac arrest and refractory shock. Family declined request for autopsy. In summary, both cases presented features of fulminant myocarditis with a temporal association with the BNT162b2 mRNA Covid-19 vaccination, in absence of other apparent causes and with unique features of systemic hyperinflammation associated with refractory shock. These cases identify the need for awareness of a potential, albeit extremely rare, link of BNT162b2 mRNA Covid-19 vaccination associated with fulminant myocarditis as part of a severe systemic hyperinflammatory syndrome, requiring mechanical cardiac support and, most importantly, immunosuppressive therapy. The degree of the inflammatory biomarkers and multiorgan dysfunction seen in the two cases described, as in some patients with Covid-19, is indeed out of proportion to with hemodynamic failure and shock and it is not rapidly resolved by cardiac mechanical support, reflecting a significant degree of vasoplegia. The optimal immunosuppressive treatment for systemic hyperinflammation associated with fulminant myocarditis is unknown. They chose a combination of high dose methylprednisolone, IVIG and anakinra (Table 1) as a strategy used across a variety of immunologic and rheumatologic diseases characterized with inappropriate macrophage activation. Table 1 Key biomarkers at admission and immunomodulating therapy: Patient #1: Presentation included Symptoms: Nausea and vomiting. Vaccine type was BNT162b2 mRNA Covid-19. Timing was 2 days after second dose. Hemodynamics included Hypotension and tachycardia. ECG: ST segment elevation. Echocardiogram: LVEF 20%. Biomarkers included: CRP: 13.1 mg/dl; Interleukin-6 : 333 pg/ml; Ferritin : 23,000 ng/ml; INR : 2.0; D-dimer : 4.21 ug/ml; Lactic acid : 6 mmol/l; CK-MB : 252 ng/ml; SARS-CoV2 spike IgG : 62.8 a.u./ml; SARS-CoV2 NC IgG : negative. Immunosuppressive Therapy included: Methylprednisolone : 1000 mg; Immunoglobulins : 60 mg; Anakinra : 100 mg (2 doses). Outcome was Deceased 21 h after admission. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on temporal association and known drug profile, a contributory role of the suspect drug cannot be excluded in the development of events myocarditis, cardiac arrest, and shock. This case will be reassessed upon receipt of additional information.,Linked Report(s) :PFIZER INC-202101116531 Same article/ drug/event and different patient; Reported Cause(s) of Death: recurrent cardiac arrest; refractory shock; fulminant myocarditis


VAERS ID: 1661277 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
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 INC202101127070

Write-up: she died; This is a spontaneous report from a contactable consumer (patient was reporter''s girlfriend). A 49-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as SINGLE DOSE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced she died (death, medically significant) on an unspecified date immediately, 49-year-old from Pfizer. 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: she died


VAERS ID: 1662120 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-08-31
   Days after vaccination:6
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: 2021-08-31
   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:
Current Illness: Myasthenia gravis Type 2 diabetes mellitus with diabetic chronic kidney disease Essential hypertension
Preexisting Conditions:
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


VAERS ID: 1662149 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-10
Onset:2021-07-24
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, SARS-CoV-2 test positive, Vaccine breakthrough 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 (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 37
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: The patient tested COVID + via rapid antigen test on 7/24/21 and again on 8/27/21 via both PCR and antigen test (vaccination breakthrough).
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 89-year-old female patient. The patient received two doses of the Pfizer vaccine on 1/20/21 and 2/10/21. The patient tested COVID + via rapid antigen test on 7/24/21 and again on 8/27/21 via both PCR and antigen test (vaccination breakthrough). The patient was reported as having died on 8/30/21. Cause of death is listed as acute hypoxic respiratory failure; COVID 19 pneumonia. Underlying health conditions are not provided in system.


VAERS ID: 1662188 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-02
Onset:2021-09-01
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS A BREAKTHROUGH CASE OF COVID-19 THAT EXPIRED ON 9/1/2021.


VAERS ID: 1662207 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-16
Onset:2021-08-29
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Adenovirus test, Bordetella test negative, COVID-19, Cardiac failure, Cardiac failure congestive, Chlamydia test negative, Condition aggravated, Coronavirus test negative, Cystitis, Death, Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Mechanical ventilation, Mycoplasma test negative, Pneumonia, Renal failure, Respiratory distress, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Sepsis, Viral test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (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), 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), Sepsis (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinoL (ZYLOPRIM) 100 mg tablet amiodarone (PACERONE) 200 mg tablet apixaban (ELIQUIS) 2.5 mg tablet aspirin 81 mg tablet B-complex with vitamin C (VITAMIN B COMPLEX WITH C ORAL) esomeprazole (NexIUM) 40 mg capsule ferrous sulfat
Current Illness:
Preexisting Conditions: Respiratory Acute respiratory distress Circulatory Essential hypertension Congestive heart failure Ischemic cardiomyopathy Paroxysmal atrial fibrillation HFrEF (heart failure with reduced ejection fraction) Digestive Gastroesophageal reflux disease Genitourinary CKD (chronic kidney disease) Endocrine/Metabolic Type 2 diabetes mellitus Pure hypercholesterolemia Hypothyroidism Hematologic Polycythemia vera Anemia Other Weakness Gait abnormality
Allergies: LevofloxacinShortness of breath / Dyspnea RamiprilCoughing
Diagnostic Lab Data: 08/29/21 0423 Respiratory virus detection panel Collected: 08/29/21 0301 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 8/29/2021 (20 hours) Hospital Acute respiratory distress Presenting Problem/History of Present Illness/Reason for Admission Acute respiratory distress [R06.03] Respiratory distress [R06.03] Acute cystitis without hematuria [N30.00] Congestive heart failure, unspecified HF chronicity, unspecified heart failure type [I50.9] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present [A41.9] COVID-19 [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] Hospital Course Patient admitted to monitored floor. She was started on non-invasive ventilation, found to have renal failure, and signs of severe sepsis. Upon admission goals of care meeting was held and family opted to withdraw active treatment and transition the patient comfort care. Active Issues Requiring Follow-up Not applicable patient expired


VAERS ID: 1662253 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-27
Onset:2021-08-21
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: Tacrolimus, Mycophenolate, chronic prednisone
Current Illness:
Preexisting Conditions: Renal transplant on immunosuppresive medications
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization/death due to COVID-19 Reported per Pfizer COVID-19 Vaccine EUA


VAERS ID: 1662348 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-18
Onset:2021-08-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Condition aggravated, Death, General physical health deterioration, Lung neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine Lorazepam
Current Illness: Neoplasm of Lung collapsed vertebrae
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 32 hours after patient obtained the 2nd vaccine, he began to seriously decline and died the next day. He was on hospice and his death was eventually inevitable due to his lung cancer, but I am reporting this event as his death occurred so close to administration of the vaccine.


VAERS ID: 1662371 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-02
Onset:2021-08-20
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Polymerase chain reaction, 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: 2021-08-25
   Days after onset: 5
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: COVID-19 PCR positive with cycle threshold of 18.6 on 8/16/2021
CDC Split Type:

Write-up: Hospitalization/Death due to COVID-19 Reported per Pfizer COIVID-19 Vaccine EUA


VAERS ID: 1662372 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-04
Onset:2021-08-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine Ativan
Current Illness: pneumonia
Preexisting Conditions: A-Fib and Heart Failure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient received 2nd covid vaccine and passed away 24 hours later. He was on hospice because he chose not to treat his pneumonia. We are reporting this event as the death was so close to the administration of the vaccine


VAERS ID: 1662411 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-08-08
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Bilevel positive airway pressure, Brain injury, COVID-19 pneumonia, Cerebral atrophy, Cerebral small vessel ischaemic disease, Computerised tomogram head abnormal, Culture positive, Death, Dyspnoea, Electroencephalogram abnormal, Encephalopathy, Endotracheal intubation, Hypotension, Intensive care, Mechanical ventilation, Pyrexia
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital on 8/9/2021 with shortness of breath. He was diagnosed with acute hypoxic respiratory failure with COVID-19 pneumonia. His symptoms started on 8/8/2021. He was on 40% on room air and then required BiPAP to follow over 630% FiO2 with baseline home oxygen of 4 L at rest and 5 L with activity. He was started on dexamethasone, IV antibiotics, and fluids. He had further worsening of respiratory status on the morning of 8/10/2021 and was transferred to ICU and was intubated. He was placed on Levophed for hypotension and was continued on full ventilator support. He also had infectious disease consultation with continued fever and cultures and was switched antibiotics along with addition of antifungal. He continued to stay encephalopathic with CT head showed diffuse mild to moderate atrophic changes and prominent periventricular small vessel disease change. With not further waking up on lightening of sedation patient had a neurology consultation had a EEG x2 and suggested concern for anoxic brain injury. Patient''s family including wife and son were discussed about overall prognosis and worsening neurologic status and they did not want him to continue full aggressive measures and switched him to comfort measures and had a vent withdrawal. He passed away in the afternoon of 8/15/2021


VAERS ID: 1662426 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-15
Onset:2021-08-17
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Blood gases abnormal, COVID-19, Carbon dioxide decreased, Cardio-respiratory arrest, Cellulitis, Chills, Culture wound positive, Death, Dyspnoea, Encephalopathy, Fall, Fibula fracture, Generalised oedema, Hypophagia, Lethargy, Malaise, Oedema, Pain in extremity, Peripheral venous disease, Pulse absent, Resuscitation, Seizure, Staphylococcal infection, Weight increased, X-ray limb
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet; albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler; aspirin EC 81 MG enteric coated tablet; atorvastatin (LIPITOR) 80 MG tablet; bumetanide (BUMEX) 1 MG tablet; buPROPion (WELLBUTRIN XL) 300 MG 2
Current Illness: Hospitalized 7.28.21; COVID positive; COPD (chronic obstructive pulmonary disease) (HCC) Uncontrolled type 2 diabetes mellitus with diabetic neuropathy, with long-term current use of insulin (HCC); Morbid obesity (HCC); Chronic hypoxemic respiratory failure (HCC) NSTEMI (non-ST elevated myocardial infarction) (HCC); Right fibular fracture; PAD (peripheral artery disease) (HCC)
Preexisting Conditions: CAD (coronary artery disease); Severe aortic stenosis; Coronary artery disease involving native heart; Lung nodule; COPD (chronic obstructive pulmonary disease) (HCC); Choledocholithiasis; Acute kidney injury superimposed on CKD (HCC); Poor dentition Uncontrolled type 2 diabetes mellitus with diabetic neuropathy, with long-term current use of insulin (HCC); Morbid obesity (HCC); Postoperative anemia due to acute blood loss Paresthesias; Acute on chronic diastolic congestive heart failure, NYHA class 3 (HCC); Constipation; Acute on chronic diastolic heart failure (HCC); Chronic hypoxemic respiratory failure (HCC); Chronic kidney disease, stage III (moderate Essential hypertension, benign; OSA on CPAP Chronic narcotic dependence (HCC); Chronic right-sided low back pain with right-sided sciatica Hypothyroidism; Acute kidney injury (HCC); NSTEMI (non-ST elevated myocardial infarction) (HCC); Right fibular fracture; PAD (peripheral artery disease) (HCC); Cellulitis of left leg COVID-19; History of stroke; History of aortic stenosis; Tobacco abuse; Venous stasis ulcer of other part of left lower leg with fat layer exposed with varicose veins (HCC)
Allergies: Thiopental Anaphylaxis; Adhesive Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized; positive for COVID-19 (after vaccinated); patient expired / died in hospital. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Cellulitis of left leg [L03.116] Cellulitis [L03.90] Cellulitis of left lower extremity [L03.116] HOSPITAL COURSE: Patient is a 66-year-old female with past medical history significant for multiple medical comorbidities including severe peripheral arterial disease, chronic obstructive pulmonary disease, pulmonary hypertension, history of TAVR, history of TIA, morbid obesity, OSA/CPAP, diabetes on insulin, CKD 3B, chronic diastolic heart failure, peripheral edema, chronic pain, ongoing tobacco abuse recent fall resulting in a right fibular fracture presents to hospital on 08/23 from subacute rehab facility due to worsening lower extremity pain, lethargy, chills, decreased oral intake for about 5 days prior to presentation and was incidentally noted to be COVID positive. Patient also recently had a hospital stay from 07/28 to 8/3 due to a right fibular fracture and was fitted with a cam boot with instructions to weight bear as tolerated. Patient was admitted with working diagnosis of acute encephalopathy and lower extremity cellulitis on the left and asymptomatic COVID-19 infection. Encephalopathy: Felt to be related to polypharmacy including sedating medications namely gabapentin, Norco and possibly also related to infection. VBG with CO2 of only 44. With supportive treatment alone, her encephalopathy improved over the next 24-48 hours and resolved completely. Only Norco was restarted. Gabapentin was planned to be discontinued due to ineffectiveness. Cellulitis: Patient was noted to have left leg cellulitis associated with changes consistent with venous stasis and edema. Patient was started on Ancef initially but surface cultures obtained at the time of admit showed MRSA and hence vancomycin was added on top. Ancef was discontinued on 08/24 with plans to continue vancomycin and eventually switch over to doxycycline to completed 10 day course. Cellulitis gradually was improving; COVID-19 infection: Incidentally noted at rehab on 08/22, patient without much respiratory symptoms and continued on 3 L baseline oxygen and hence no particular treatment was initiated. Right fibular fracture: due to previous fall/recent hospital stay at which time orthopedics recommended non operative management with a Cam boot and weight-bearing as tolerated. Patient had not had a chance to follow-up with orthopedics and hence consult was obtained here. Repeat x-ray showed improvement and possible healing, Orthopedics recommended continuation of Cam boot with weight-bearing as tolerated in outpatient follow-up. Peripheral arterial disease: With extensive nature of peripheral arterial disease noted on previous imaging studies with plans for following up with vascular surgery at Metro Hospital with upcoming plans for angiography/angioplasty. There was no concern for acute ischemia on exam. Anasarca, acute on chronic diastolic congestive heart failure with significant weight gain compared to previous hospital stay. Daughter did mention that subacute rehab did not really pay close attention to her salt intake and weight gain and she had gained significant amount await (close to 20 kilos) and hence aggressive IV Lasix/diureses were started. Her renal function mostly was holding in spite of aggressive diureses and slow weight loss. This was also noted in the lower extremities with improvement in the edema. On 08/28, during my interview patient had a unremarkable night, used her BiPAP in the night, noticed that she was slightly more short of breath ( while she had taken off her CPAP mask, had not put her oxygen on yet), a short while later when she was helped to the bedside commode for urination, patient became acutely short of breath, appeared unwell and lost her pulse is. All code was called and resuscitation efforts were continued for 29 minutes and and unsuccessful in obtaining ROSC, pronounced at 11:35 a.m.. Suspicion was that she may have had a PE or seizure (she did have seizures during resuscitation). Daughter was notified, discussed with a little bit later when she arrived at bedside. Not a ME case, daughter did not want autopsy; Death certificate signed.


VAERS ID: 1662469 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, Cardiac pacemaker insertion, Catheterisation cardiac, Death, Endotracheal intubation, Gastrostomy, Physical deconditioning, Tracheostomy, Unresponsive to stimuli, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 39 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patinet presented to the emergency department for evaluation after being found unresponsive at home prior to arrival. Unable to obtain history from patient due to intubated status. She was found down on the floor by a neighbor. It is unknown how she got on the floor or for how long she was down. She had an episode of emesis upon arrival of EMS, and was found to be bradycardic. She was given 3 mg Atropine en route. She denied any falls or injuries, chest pain, or SOB prior to intubation. She also denied any drug or alcohol use in the ED. She had received her second COVID vaccine on 4/8/2021, admitted to hospital on 4/10/2021. She was intubated and had placement of temporary pacemaker on 4/10/2021. Patient had a tracheostomy placed on 04/22/2021, a permanent pacemaker placed on 04/28/2021, & a PEG tube placed on 04/29/2021. She had episodes of ventricular tachycardia and underwent a cardiac cath on 5/11/21. With deconditioning and multiple comorbidities-family decided to switch her to comfort measures and patient expired on 5/19/2021.


VAERS ID: 1662503 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-24
Onset:2021-08-30
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 2/24/2021 Lot # 002A21A Pt dies 8/30/2021 of pneumonia, NOT a Covid relate death


VAERS ID: 1662542 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-31
Onset:2021-08-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

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

Life Threatening? Yes
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none on file
Current Illness: none on file
Preexisting Conditions: none of file
Allergies: none on file
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient recieved her 2nd moderna dose here on 8/31/21 at about 5:20pm. I recieved a call from my HCP asking us to fill out the Vaers report, she informed me that the patient had reported to hospital last night and had passed away.


VAERS ID: 1662602 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-12
Onset:2021-08-08
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, ASA, atorvastatin, clopidogel, ferrous sulfate, folic acid, isosorbide mononitrate, levothyroxine, lisinopril, mag ox, metoprolol, NTG, pantoprazole, KCl, prednisone, spironolactone, torsemide, tramadol, trazadone
Current Illness:
Preexisting Conditions: BPH, angina, CAD, CABG, CRT-D, osteoarthritis, CHF, GERD, Depression, Pacemaker, CKD, pacemaker, hyperlipidemia
Allergies: Rofecoxib, ciprofloxacin, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive for COVID 8/8/21 ED on 8/9 feeling could not get warm, dx sepsis most likely d/t COVID -19 moved to ICU pt expired 8/12/21


VAERS ID: 1662698 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-08
Onset:2021-08-18
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anaemia, Asthenia, Atrial fibrillation, Bilevel positive airway pressure, COVID-19, COVID-19 pneumonia, Cough, Death, Delirium, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypotension, Hypoxia, Intensive care, Lung infiltration, Lung opacity, Panic reaction, Pneumonia, Pneumonia bacterial, SARS-CoV-2 test positive, Septic shock, Sleep apnoea syndrome
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CORONAVIRUS (COVID 19) RT PCR Status: Final result 0 Result Notes Ref Range & Units 8/22/21 1240 CORONAVIRUS SARS COV 2 PCR (RESP) POSITIVE Panic
CDC Split Type:

Write-up: Admission Date: 8/22/2021 Date of Death: 8/31/2021 actual Time of Death: 9:35 am Autopsy Scheduled/Performed: No Manner of Death: Natural Cause of Death: COVID-19 pneumonia 9 days - interval between onset and death Acute hypoxic respiratory failure Obstructive sleep apnea on respiratory support patient has not been compliant with weight prior to this hospital stay Chronic osteomyelitis Quadriplegia Hospital Course: Patient presented with increased weakness hypoxia and hypotension. Patient has history of chronic osteomyelitis and also he has quadriplegia. Patient was admitted started on broad spectrum antibiotics and shortly after admission he required pressors so he was transferred to the intensivist service. Patient also required significant amount of oxygen and that was providing using BiPAP. Once the patient was off of pressors he was transitioned to hospitalist service. Patient developed A. fib with rapid ventricular response cardiology service was consulted and also he was treated with amiodarone. Patient developed worsening infiltrates with increased opacification of the left lung. Initial testing in the emergency room turned back positive for coronavirus. Patient did have the 2 doses of vaccine given approximately 6 months ago. Pulmonology service was consulted due to opacification of the left lung but patient refused bronchoscopy. To note even prior to this hospital stay patient has been declining regarding ability to function. Minimal activity was causing significant shortness of breath. Patient continued to deteriorate and he became hypoxic despite using BiPAP on a maximum settings with FiO2 of 100%. In view of her rapid deterioration patient was intubated but after discussing with family it became clear that patient does not want to be on prolonged mechanical ventilation and that would have been the best outcome in view of his previous deterioration in pulmonary function on top of his pneumonia and COVID-19 disease. Patient was extubated the same day and he died shortly after being extubated. Discharge Diagnoses: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia and bacterial pneumonia worsened by patient quadriplegia and decreased cough reflex Septic shock likely source multilobar pneumonia other possibilities UTI with chronic enduring catheter and chronic osteomyelitis COVID-19/SARS-CoV-2 viral infection patient treated with remdesivir and dexamethasone Partial quadriplegia from an old accident with neurogenic bladder and also with colostomy Anemia acute on chronic acute component likely related to present illness ICU delirium


VAERS ID: 1662753 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-28
Onset:2021-03-29
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Diarrhoea, Endotracheal intubation, Exposure to SARS-CoV-2, Nausea, Pneumonia bacterial, Productive cough, Pyrexia, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 144
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/27/2021: 76 year old male with PMH of CAD, CKD stage 3, HLD, PVD, hypothyroidism, bipolar, parkinson''s disease, and HTN who presented to the ED due to worsening COVID symptoms. Patient states that he was at a family party on the 18th which he feels is his possible exposure to Covid as his sister, brother-in-law, and niece were all diagnosed with Covid afterward. Patient states that his symptoms started on the 21st, which consisted of nausea, diarrhea, productive cough, wheezing, and fever. He presented to the ED on the 23rd and at that time was diagnosed with Covid. Patient was discharged home at that time with an inhaled steroid and decongestant and advised to hydrate and quarantine for 2 weeks.


VAERS ID: 1662781 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-28
Onset:2021-03-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Arthralgia, Chest X-ray abnormal, Computerised tomogram head normal, Mobility decreased, Obesity
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 145
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 83-year-old obese male with a past medical history of CKD 3, CAD s/p CABG, diabetes, hypothyroidism, GERD, hypertension with chronic shoulder pain who was on the floor and was not able to get up. He yelled at a neighbor who came and EMS was called. He adamantly denies that he fell. He initially said that he lays on the floor because it is more comfortable but then later retracted this. He says it is part of his routine. He had difficulty expressing himself of the reason why he lays on the floor. He said he "could not find the words". In the ED, CT of the head showed no acute intracranial abnormality. Chest x-ray showed blunting including left costophrenic angle possible pleural effusion. Patient had increased


VAERS ID: 1662832 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-03-22
Onset:2021-08-26
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Encephalopathy, Nervous system disorder, Pyrexia, Respiratory disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Respiratory failure (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: 2021-09-01
   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: lipitor
Current Illness: none
Preexisting Conditions: atherosclerosis and HTN
Allergies: pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of unknown origin and encephalopathy. Rapid neurological and respiratory decline of unknown origin.


VAERS ID: 1662858 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-08-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / IM

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

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: UNKNOWN
Current Illness: CHEMO TREATMENT
Preexisting Conditions: CANCER
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT BELIEVED TO HAVE HAD A STROKE PER DAUGHTER AND PASSED AWAY


VAERS ID: 1662882 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-30
Onset:2021-08-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: Prednisone, Tamsulosin, Thiamine, Valsartan, Albuterol, Gabapentin, Hydrochlorothiazide, Metoprolol, Trelegy Ellipta, Acetaminophen, Amlodipine, Atorvastatin
Current Illness: Unknown
Preexisting Conditions: Hypertension, Renal Insufficiency, Obesity, Pulmonary Embolism, Deep Vein Thrombosis, Asthma
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT was found unresponsive in the back of his vehicle. Last know alive when he spoke to mother regarding receiving the vaccination in the morning/early afternoon. ACLS resuscitative efforts performed. Not successful. NO recent health complaints known


VAERS ID: 1662915 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-04
Onset:2021-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration, Hallucination, Movement disorder, Urinary tract infection
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 48
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: Eliquis Metropolol
Current Illness: Peripheral neuropathy
Preexisting Conditions: A-fib
Allergies: None known
Diagnostic Lab Data: Hospital has all his records.
CDC Split Type:

Write-up: Within 12 hours of my father''s second Pfizer covid vaccine, he lost complete use of his legs. OVERNIGHT. He also began to hallucinate, which we suspected was due to a UTI but even after the UTI cleared, his hallucinations got worse. These two adverse events put him on a steady, relatively fast downward path and he died on 03/26/2021.


VAERS ID: 1662918 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-22
Onset:2021-03-21
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 13
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: cough, SOB, nausea x 7 days prior to hospital admission


VAERS ID: 1662980 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2020-12-22
Onset:2021-08-03
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   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: coughing, wheezing, O2 sat of 80%


VAERS ID: 1663091 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-27
Onset:2021-08-07
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Death, Pleural effusion
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus, Hypertension, former smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ACUTE RESPIRATORY FAILURE HYPOXIC, PLEURAL EFFUSION, COVID-19 PNEUMONIA, DEATH


VAERS ID: 1663119 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Bedridden, Death, Fatigue, Gait inability, General physical health deterioration
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Low dose amlodipine Preservision ARED Wixela inhaler
Current Illness:
Preexisting Conditions: mild asthma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: This was my mom. She began to feel extreme fatigue and not herself the day after the vaccination. Almost immediately she was unable to walk. She went into an immediate and extreme physical decline. Bed ridden. Hospice was called in on 1/30/2021, She passed away on 2/15/2021


VAERS ID: 1663204 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-13
Onset:2021-08-06
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Appendicitis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Death, Dyspnoea, Endotracheal intubation, Headache, Hypoxia, Intensive care, Lung opacity, Pulmonary oedema, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 5mg daily, aspirin 81mg daily, atorvastatin 40mg daily, basaglar inject up to 30 units daily, Os-cal 3tabs TID, ceterizine 10mg daily, Vitamin D3 4,000unit 2 tab daily, famotidine 20mg BID, folic acid 1mg daily, Norco 10-325mg q8
Current Illness:
Preexisting Conditions: Anemia, CAD, T2DM, GERD, HTN, RA, obesity, HLD, hypercalcemia, hyperparathyroidism s/p parathyroidectomy
Allergies: NKDA
Diagnostic Lab Data: Covid positive (8/6/21)
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 03/13/2021. On 8/6/2021, pt presented to ED with increasing diffuse abdominal pain that started 3 days prior. Pt reports he was diagnosed with COVID-19 on 8/5/21 and had increasing shortness of breath with cough and headache which began 8/1/21. CT showed acute uncomplicated appendicitis and confirmed patchy ground-glass opacities within the bilateral lung bases consistent with COVID pneumonia. He was given 1 g of Tylenol, 1 g of IV Rocephin, 6 mg of Decadron, 500 mg of IV Flagyl, 2 doses of 4 mg of morphine, 4 mg of Zofran and 40 mg of IV Protonix in the ED. Pt also received remdesivir. He developled hypoxia on HFNC 50/50 sating 84-87%. pO2 49. Patient was able to maintain sats in the lower 90''s CXR showed worsening pulmonary edema and he was given 20mg IV lasix. Patient transferred to MICU service for worsening respiratory status on 8/13. Patient was intubated and started on proning protocol. He continued to require pressors and sedation with propofol, versed, and dilaudid. Palliative was consulted and discussed with family comfort care. Patient expired on 8/24/21.


VAERS ID: 1663206 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-12
Onset:2021-08-01
   Days after vaccination:142
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK UN / UN
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, COVID-19, Cough, Death, Dyspnoea, Fibrin D dimer increased, General physical health deterioration, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: 2021-08-19
   Days after onset: 18
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: Aspirin 81 mg daily, cholecalciferol 50 mcg, clobetasol 0.05% apply to affected area(s) as directed, lotrisone cream apply to affected area(s) as directed for up to 2 weeks at a time, famotidine 20 mg daily, flonase 50 mcg/actuation spray 1
Current Illness:
Preexisting Conditions: Osteoarthritis, diabetes mellitus type 2, insomnia, hypertension, hypercholesterolemia, hypotyhyroidism
Allergies: Sulfa, clarithromycin, penicillin V potassium
Diagnostic Lab Data: COVID positive 8/1/2021 and 8/18/2021; WBC peaked at 35.6 on 8/14/2021; D-dimer peaked at 32.79 on 8/12/2021
CDC Split Type:

Write-up: Janssen (J&J) COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 03/12/2021 and 04/7/2021. Patient presented to another facility on 8/1/2021 for shortness of breath and cough. Patient received dexamethasone, remdesivir, levofloxacin with continuous BiPAP. Patient was then transfered to hospital on 8/5/2021 for higher level of care. Patient received remdesivir, dexamethasone, methylprednisolone, baricitinib, zinc, vitamin c, and ivermectin. Patient continued to decompensate and expired on 8/19/2021.


VAERS ID: 1663589 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-05
Onset:2021-08-22
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Aortic aneurysm, Apnoea, Atrial fibrillation, Atrioventricular block first degree, Blood creatinine increased, Blood gases abnormal, Blood lactic acid, Blood loss anaemia, Blood test abnormal, Bundle branch block right, COVID-19, Central venous catheterisation, Chest X-ray abnormal, Chronic kidney disease, Computerised tomogram abdomen abnormal, Computerised tomogram abnormal, Computerised tomogram pelvis abnormal, Computerised tomogram thorax, Condition aggravated, Death, Dependence on respirator, Electrocardiogram normal, Electrolyte imbalance, Endotracheal intubation, Explorative laparotomy, Extubation, Gastric ulcer perforation, Gastrointestinal fistula, Hypotension, Infusion, Inguinal hernia, Intensive care, Interstitial lung disease, Intracranial mass, Ischaemia, Lung opacity, Malaise, Metabolic acidosis, Metabolic encephalopathy, Oxygen saturation increased, Peritonitis, Physical deconditioning, Pleural effusion, Pneumonia bacterial, Pneumoperitoneum, Pulmonary fibrosis, Respiratory distress, Resuscitation, Septic shock, Supraventricular tachycardia, Troponin increased, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Conduction defects (narrow), Supraventricular tachyarrhythmias (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), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine (NORVASC) 2.5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 325 MG tablet Calcium Carb-Cholecalciferol (CALCIUM/VITAMIN D) 600-400 MG-UNIT TABS Camphor-Menthol-Methyl Sal (BEN GAY ULTRA STRENGTH) 4-10-30 % CREA extern
Current Illness: COVID-19 positive BLEPHAROPLASTY 7.28.21 dementia
Preexisting Conditions: Carotid artery narrowings RBBB (right bundle branch block with left anterior fascicular block) Hypothyroidism (acquired) Benign essential hypertension Tension headache Dizziness - light-headed History of CVA (cerebrovascular accident) ED (erectile dysfunction) GERD (gastroesophageal reflux disease) BPH (benign prostatic hyperplasia) Hyperlipidemia LDL goal < 100 CKD (chronic kidney disease), stage III Depression with anxiety Seasonal allergic rhinitis due to other allergic trigger Physical deconditioning COVID-19 virus infection
Allergies: Pravastatin Myalgia Lipitor [Atorvastatin] Myalgia Sulfa Drugs Nausea Only
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (fully vaccinated); Expired in hospital (likely due to COVID-19) BRIEF OVERVIEW: Admission Date: 8/22/2021 Discharge Date: 08/28/2021 Discharge Disposition: Deceased DISCHARGE DIAGNOSIS: 1. Deceased 2. Perforated Gastric Ulcer 3. Acute Blood loss anemia 4. COVID19 5. AKI with CKD stage III 6. Acute Metabolic Encephalopathy DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Respiratory distress HOSPITAL COURSE: Patient was a 94-year-old male who was initially hospitalized with signs of septic shock believed to be secondary to COVID-19 and possible bacterial pneumonia; as well as new onset AFib with RVR. Patient was admitted to the intensive care unit, he did have improvement initially with fluid resuscitation and Levophed as well as amiodarone infusion. Further workup did reveal a pneumoperitoneum patient desired aggressive treatment and went forward knowing high risk of death with exploratory laparotomy. This was done on 08/22/2021 and patient was found to have a pre pyloric perforation and peritonitis. Patient was returned back to the intensive care unit and remained intubated along with central line placements. Aggressive treatment continued, patient was extubated on 8/25 but not responding; further findings on repeat CT scans on 08/25 showed continued leaking from stomach as well as findings of a potential cancerous brain mass. On 08/26/21 family, along with son, mutually agreed on comfort care initiation. Today at 0300 patient passed away, attempted son x3 calls, but then did get through to other son who was to notify the family. HISTORY OF PRESENT ILLNESS: Patient is a 94-year-old man with a past medical history significant for CVA and mild dementia, CKD stage 3, hypertension and hypothyroidism who was admitted to intensive care unit on August 22, 2021 for COVID-19 infection and septic shock. The patient was recently hospitalized from April 11th through April 15th for physical deconditioning. During that time he was diagnosed with dementia with a MoCAa score of 6/30. He discharged to Rehab where he has been continued undergo rehabilitation. Today he presented to the emergency department in extremis. He was in profound respiratory distress and shock. He tested positive for COVID at his care facility a couple days prior. This unclear if he had been undergoing any kind of treatment for this. He had significant episodes of nonresponsiveness an apnea while in the ED. Additionally, he was profoundly hypotensive and tachycardia with new onset rapid atrial fibrillation and rapid ventricular response. He was hypothermic and placed on a Bair Hugger. Initial blood work revealed mild electrolyte abnormalities, lactic acid greater than 7, a creatinine of 1.9. Chest x-ray revealed mild scattered interstitial thickening and lung opacities. Patient was started on IV fluid and placed on phenylephrine infusion. Conversation with the patient''s son, as well as his other son reveal that the patient would not want CPR or to be placed on a ventilator but they would want to pursue all other aggressive measures. He was then transitioned up to the emergency department to the intensive care unit for further management. Intensive care unit course: After arrival to the intensive care unit the patient was aggressively fluid resuscitated. His blood pressures responded relatively well. Due to pharmacy shortage of the phenylephrine the patient was transitioned to norepinephrine. His cognitive status drastically improved from when I evaluated him in the emergency department. He is alert and oriented x3. Suspicious for ongoing COVID infection and possible pneumonia the patient''s antibiotics were transitioned to cefepime plus azithromycin plus vancomycin. He is started on remdesivir for COVID 19 treatment. ABG revealed compensated metabolic acidosis. The patient''s lactic acid has improved to 6.5 from 7. Initial troponins are elevated as expected from demand ischemia from septic shock. EKG does not reveal any ST segment changes in the patient does not complain of any chest pain. He is, however complaining of abdominal pain. He has a soft right inguinal hernia which is difficult to reduce and has no overlying skin changes. The patient has had increasing oxygen needs initially requiring 6 L of oxygen in the emergency department now on 100% oxygen via non-rebreather. At approximately 1630 while I was re-evaluating the patient and discussing his care to son the patient entered into a what appeared to be wide complex ventricular tachycardia with an initial heart rate of approximately 240. Nurse was in the room with me. The patient was not feeling well. His Levophed was shut off and fluids were started. A stat amiodarone infusion of 150 mg was begun. Patient was connected to defibrillator pads. Asked the patient and family if he required cardiac defibrillation if he would want that, and he very explicitly said "yes!". His heart rate responded to the amiodarone infusion, however, and he subsequently entered into what appeared to be a narrow complex supraventricular tachycardia with a heart rate of approximately 180. His blood pressure remained stable during this time. As we continued to monitor in supportive care and continued his amiodarone infusion the patient''s heart rate then entered into a normal sinus rhythm with a systolic rate of approximately 90. Unfortunately, strips of these rhythms were unable to be captured. EKG afterwards revealed normal sinus rhythm with a first-degree heart block and previously seen right bundle-branch block. After his amiodarone infusion I did not bolus further or start continued infusion for the patient but plan to continue monitoring. Stat CT of chest abdomen and pelvis was obtained. This revealed many things but specifically a pneumoperitoneum. The case was discussed with the on-call general surgeon who evaluated the patient with me in the intensive care unit. Along with the patient''s son and other son, it was decided the patient would want to pursue aggressive measures including exploratory laparotomy. Risks of surgery including death were shared with the patient. Furthermore was explicitly stated that he would likely return to the intensive care unit ventilator dependent with multiple drains and need for central line and continued resuscitation the ultimate outcome of which being still high likelihood of death. Understanding this the patient and his son still wanted to proceed. Alternatives, including comfort care were offered and declined. Of note additional findings on CT scan include nodular pulmonary opacities right with recommended CT follow-up in 3-6 months, left pleural effusion, and small abdominal aortic aneurysm and mild pulmonary fibrosis.


VAERS ID: 1663606 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-18
Onset:2021-08-25
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Bilevel positive airway pressure, COVID-19, Chest X-ray normal, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Death, Emphysema, Fall, Fat embolism, Femur fracture, Hip fracture, Oxygen saturation decreased, Pulmonary embolism, Renal impairment, Respiratory failure, SARS-CoV-2 test positive, Ventilation/perfusion scan normal
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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Hypersensitivity (broad), Tumour lysis syndrome (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: 2021-08-30
   Days after onset: 5
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: amLODIPine (NORVASC) 10 MG tablet aspirin 81 MG chewable tablet atorvastatin (LIPITOR) 20 MG tablet hydrochlorothiazide (HYDRODIURIL) 50 MG tablet lisinopril (PRINIVIL,ZESTRIL) 40 MG tablet metFORMIN (GLUCOPHAGE) 500 MG tablet omeprazole (P
Current Illness: NA
Preexisting Conditions: Atherosclerosis of native artery of both lower extremities with intermittent claudication COPD (chronic obstructive pulmonary disease) DMII (diabetes mellitus, type 2) Hyperlipidemia HTN (hypertension) Onychomadesis Acute CVA (cerebrovascular accident) AKI (acute kidney injury) Intertrochanteric fracture of right femur, closed, initial encounter Acute respiratory failure with hypoxia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (fully vaccinated); patient expired during hospitalization. Active Hospital Problems Diagnosis Date Noted POA ? Acute respiratory failure with hypoxia 08/30/2021 Unknown ? Intertrochanteric fracture of right femur, closed, initial encounter 08/25/2021 Unknown ? COPD (chronic obstructive pulmonary disease) 06/08/2021 Yes Date of Death: 8/30/21 Time of Death: 10:43 PM Preliminary Cause of Death: COVID-19 Discharge Disposition: expired HOSPITAL COURSE: The patient is an 87 year old male history of emphysema, MCA CVA, vascular dementia, hypertension admitted 8/25 to the orthopedic service for right comminuted hip fracture that occurred after a fall at his living facility. He tested positive for covid 19 on 8/20 after an exposure at his nursing facility. He received his J&J vaccine in June 2021. At the time of admission, he was fairly asymptomatic from covid 19 infection. Patient was initially stable with no significant chest x-ray findings. Patient was scheduled for OR on August 26th. Overnight on 8/25, patient had rapid escalation in his oxygen needs, going from room air to requiring 5-6 liters NC and later to HFNC. Unable to obtain CTA thorax due to kidney function, so CT thorax without contrast performed, only showed severe emphysema. VQ scan obtained which was not suspcious for PE. Patient was started on a heparin gtt due to concern for PE vs. Fat emboli. As V/Q scan came back negative for PE, heparin drip was discontinued. Orthopedic team transferred service to hospitalist team and were waiting for improvement in respiratory status before proceeding with surgery. Patient was started on decadron. As patient''s oxygen requirements increased, patient was placed on BiPAP to help with workup breathing. Code status confirmed with patient''s son wants patient to remain as do not resuscitate. He also reported that guardianship is being pursued patient was made incapacitated at nursing facility. Due to worsening oxygen requirements, Pulmonology was also consulted. Patient was continued on BiPAP with worsening respiratory status and eventually died.


VAERS ID: 1665394 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Parkinson''s disease
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210855586

Write-up: DEATH; SUSPECTED CLINICAL VACCINE FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a consumer via social media concerned an 87 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included Parkinson''s disease. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown)1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient was fully vaccinated still got covid-19 (suspected covid-19 infection and suspected clinical vaccine failure). Patient was finally tested negative for covid-19. It was too much for patient''s Parkinson body he died in his sleep. The cause of death was unknown. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected covid-19 infection and suspected clinical vaccine failure was not reported. This report was serious (Death).; Sender''s Comments: V0: 20210855586-COVID-19 VACCINE AD26.COV2.S-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210855586-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: 1665438 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-02
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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210860177

Write-up: DEATH; This spontaneous report received from a consumer via social media (medical journal) concerned multiple patients of unknown race and ethnicity. 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 and expiry: UNKNOWN) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The reporter read in journal that 22 people died after receiving the vaccine. The cause of death was unknown. It was unknown if autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20210860032.; Sender''s Comments: V0: 20210860177-Covid-19 vaccine ad26.cov2.s -Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1665632 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dermatosis
SMQs:, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: died; Dermatosis; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (died) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (died) (seriousness criteria death and medically significant) and DERMATOSIS (Dermatosis). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DERMATOSIS (Dermatosis) outcome was unknown. Concomitant medication and treatment drug were not reported. Company Comment: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1666080 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-02
Onset:2021-09-01
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 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: 2021-09-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS A BREAKTHROUGH CASE OF COVID-19 AND EXPIRED ON 9/1/2021.


VAERS ID: 1666125 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-04-09
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Cough, Death, Dyspnoea, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, SOB, hypoxia, confusion


VAERS ID: 1666166 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-25
Onset:2021-05-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-26
   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: Keppra Bromocriptine Omneprozel Baclofen Amantadine
Current Illness: None
Preexisting Conditions: Suffered a brain aneurism in 2006 Pacemaker put in 2018 High blood pressure
Allergies: Penicillin
Diagnostic Lab Data: Pending Autopsy -Medical Examiners Office
CDC Split Type:

Write-up: DEATH


VAERS ID: 1666193 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-05
Onset:2021-08-12
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), 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: 2021-08-21
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully vaccinated. Hospitalized and died due to COVID-19. She presented to the ER "acute onset shortness of breath with apparent hypoxia at home 45% on room air." The reason for admission was "Respiratory failure with hypoxia." Both of these statements were due respiratory distress from Covid-19.


VAERS ID: 1666200 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-07-19
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, brown sputum, positive covid test on 7/16/21; 1 yr post kidney transplant


VAERS ID: 1666226 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-24
Onset:2021-08-03
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, cough, SOB, positive covid test


VAERS ID: 1666245 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-08-15
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Small cell lung cancer metastatic
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, dyspnea, small cell lung CA with metastasis


VAERS ID: 1666264 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-07-20
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Headache, Mental disorder
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Altered mental state, cough, weakness, and headache.


VAERS ID: 1666292 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-07-28
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dementia Alzheimer's type, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Dementia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, dyspnea, severe Alzheimer''s disease


VAERS ID: 1666326 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-07-29
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary oedema, Somnolence, Weight increased
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hx of CHF, CAD; falling asleep, excessive weight gain, fluid in lungs


VAERS ID: 1666350 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-07-23
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad)

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

Write-up: cough and chest congestion x 1 week


VAERS ID: 1666378 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-08-21
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   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: Albuterol 2.5/3 mL QID Allopurinol 150 mg QD Amiodarone 200 mg QHS ASA 325 QD Vitamin D 1000U QD Famotidine 20 mg ii BID Ferrous Sulfate 325 QAM Advair 500/50 BID Gemfibrozil 600 mg QHS Guaifenesin 600 mg BID Norco 10/325 Q6H PRN Hydroxychl
Current Illness:
Preexisting Conditions: COPD Rheumatoid interstitial lung disease Chronic kidney disease
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient admitted to Hospital with acute hypoxic respiratory failure secondary to viral pneumonia from COVID-19 and exacerbation of COPD. Worsening of symptoms prompted Average Volume-Assured Pressure Support. Ventilation did not seem an option d/t HX of severe inflammatory interstitial lung disease.


VAERS ID: 1666404 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-02
Onset:2021-08-06
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST, SOB, O2 SAT 88%, ON O2 @ 3L/M.


VAERS ID: 1666413 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abnormal behaviour, Aspiration pleural cavity, Cardiac failure congestive, Choking, Computerised tomogram, Death, Delirium, Foot amputation, Limb operation, Poor peripheral circulation, Productive cough, Skin discolouration, Transfusion, Venous operation, White blood cell count abnormal, X-ray
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin; Gabapentin; VitD; Rosuvastatin; Lasik; Eliquis; Tresiba inj; insulin; at least 4 more for heart/diabetes/and organ protection; Type 1 diabetes/AFib/BFib/Amputee/etc
Current Illness: Was doing really well. Ventricular was stable, diabetes in control/ a little COPD uncontrolled/was doing well to lead to an implant to deal with new BFib heart. Lived-in 24-7 with since 11/2020. Was best ?stable time? health-wise, in my personal observation.
Preexisting Conditions: See above. Died June 3, 2021 (within 3 weeks of Moderna vaccination 1st dose)
Allergies: None known prior to last hospitalization 5/19/2021
Diagnostic Lab Data: Lung drain surgery, several dozens of lung treatments and new pulmonologist visitations, the two IV blood transfusions, several Xray and a CT scan. Venal operation on right leg , 2 days later a half-foot amputation on that leg?s foot. This was a perfect storm of every problem, amplified? together? with new and distinguishable health variances.
CDC Split Type:

Write-up: Right leg showed signs of blood flow stoppage away from groin. Heavyset cough, wet, began as well (both on Monday 2 days after vaccination). Fully in CHF (congested heart failure AND blackening of right foot) and told by STAT home health nurse on her visit Wednesday at 8:00am to get him IMMEDIATELY to the Emergency Room! Was at Hospital from May 19-June 2, 2021. Was given transfusions for White Blood count abnormalities, was clearly showing serious and repeated (as many as 3x daily/night for up to 2 hours each) cognitive ?sundowners? signs to nurses. Began to choke often, twice my use of back pats to clear when nurses unavailable. Not normal! Began talking of God and his beliefs for the first time, with me after a week In treatment. So many brand new issues there is no way this was not vaccine related!


VAERS ID: 1666414 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-23
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated with two vaccines. Developed symptoms of Covid 19 and admitted to hospital on 8/23/2021. Case expired while still hospitalized on 08/24/2021.


VAERS ID: 1666421 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-23
Onset:2021-08-04
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: CVA, HTN, CHF, MI, PAD, ARF, DMT2, Rheumatoid Arthritis
Allergies: N/A
Diagnostic Lab Data: Pt tested positive for COVID-19 by PCR on 08/04/2021
CDC Split Type:

Write-up: Pt was sent to the hospital from care facility on 08/04/2021 d/t weakness. Pt expired on 08/04/2021 @ hospital.


VAERS ID: 1666430 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-08-20
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated with two COVID 19 vaccines. Admitted to Hospital on 08/20/2021 with COVID 19. Case expired on 08/31/2021 while still hospitalized.


VAERS ID: 1666453 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-04-26
   Days after vaccination:90
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Oxygen saturation decreased, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough x 2 days, pneumonia, low oxygen saturation


VAERS ID: 1666464 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-08-25
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyloprim, norvasc, eliquis, biotin, calcium carbonate, lasix, furosemide, metaglip, cozaar, toprol, multivitamin, prilosec, esbriet, zocor,
Current Illness:
Preexisting Conditions: CVA, pulmonary fibrosis, stage 3 CKD, kyphoscoliosis, Type 2 diabetes, CAD, chronic gout
Allergies:
Diagnostic Lab Data: POS 8/25/2021
CDC Split Type:

Write-up: Admitted 8/25/2021 SOB, cough


VAERS ID: 1666568 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-16
Onset:2021-08-02
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bacterial infection, COVID-19, SARS-CoV-2 test positive, Shock, Urinary tract infection
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UTI, positive covid test, bacterial shock


VAERS ID: 1666579 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-06-23
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, COVID-19, Chronic obstructive pulmonary disease, Cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-11
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive covid test, asthma, COPD, fever, cough


VAERS ID: 1666592 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-08-07
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 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: SOB, fatigue, chills, loose stools.


VAERS ID: 1666640 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-08-29
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chest pain, Chills, Death, Decreased appetite, Dyspnoea, Endotracheal intubation, Fatigue, Influenza, Myocardial infarction, Nasopharyngitis, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Hypercholesterolemia, hypertension
Allergies: N/A
Diagnostic Lab Data: COVID-19 positive test
CDC Split Type:

Write-up: Diagnosed with COVID-19 on 8/25/2021 emergency room., s/sx of cold/flu symptoms, fever, chills, fatigue, decreased appetite, chest pain and shortness of breath. Patient ended up intubated after acute MI in ER, admitted to hospital. Intubated until 8/28/2021 when family decided to admit to hospice as "this was not her wishes". Patient expired on 8/29/2021 at 0415


VAERS ID: 1666642 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-18
Onset:2021-04-07
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, General physical health deterioration, Pneumonia, Sepsis
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not known
Current Illness: Elderly
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had several hospital visits after her second Pfizer dose, for symptoms including pneumonia. Her primary caretaker said that her rapid health decline happened immediately after this second dose. Finally she succumbed to death on April 7th, six weeks after her shot. It was reported that she died of sepsis.


VAERS ID: 1666664 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-20
Onset:2021-08-12
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Anticoagulant therapy, Blood gases abnormal, Blood pressure decreased, COVID-19, Cardiac arrest, Cardio-respiratory arrest, Chest X-ray abnormal, Chest tube insertion, Cough, Death, Endotracheal intubation, Fatigue, Hypoxia, Intensive care, Laboratory test normal, Mechanical ventilation, Microcytic anaemia, Oxygen saturation decreased, PO2, Pyrexia, Resuscitation, SARS-CoV-2 test positive, Tachyarrhythmia, Thalassaemia, Transaminases increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Lactic acidosis (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cholecalciferol, glucosamine-chondroitin, loratadine, metoprolol tartrate, multivitamin, warfarin, meloxicam
Current Illness:
Preexisting Conditions: thalassemia, mechanical AV on warfarin, HTN (controlled)
Allergies: NKDA
Diagnostic Lab Data: tested positive for COVID on 8/12/21 & 8/19/21
CDC Split Type:

Write-up: Patient received 2nd dose of COVID vaccine on 3/20/21, then tested positive for COVID on 8/12/21 & 8/19/21 Hospitalization Admit Date/Time: 8/19/2021 9:06 AM Discharge Date: 8/30/2021 Referring provider name and address: No referring provider defined for this encounter. Chief Concern, Brief History of Present Illness, and Hospital Course Patient is a 64 yo M with thalassemia and mechanical AV on warfarin who is presenting due to fatigue, cough, fever, and low oxygen saturation. On 8/10, pt started with mild symptoms of cough and fatigue that was generally manageable at home. He tested + for COVID on 8/12. On 8/14, started having fever (Tmax 102-103F) managed supportively. On 8/19, the pt was noted to be in the 80s in his pulse oximeter. He denied having shortness of breath but with a worsened cough. Hypoxia prompted presentation to the ED. Of note, pt is a generally healthy man except for a history of congenital AV disease warranting Ross procedure in 1998 and a mechanical AV replacement in 2018. He exercises regularly. Vaccinated with Pfizer 2/2021. The patient had been managed on the medicine team with progressively worsening chest x-rays and hypoxia requiring HFNC at settings high enough to require ICU care. Our service was consulted to evaluate the patient for ICU admission. On exam, he is calm, conversant and ATO x 3. ABG demonstrates profound hypoxia with a pO2 of 51 with a recheck of 53. He is hemodynamically stable. The remainder of his labs are relatively normal. We discussed these findings and his wishes to proceed with intubation, be FULL CODE and consents to tracheostomy if this is required. His wife was called with the above discussion as well and the patient conversed with her at length before intubation. AHRF/ARDS d/t COVID-19 requiring MV c/b Air Leak - pt was vaccinated man with Pfizer vaccine 2/21 - Treated with Dexamethasone 08/19- 08/29 for total of 10 days, with PPI prophylaxis Completed remdisavir (08/19 - 23) - admitted to MICU on day 11 of hospitalization, pO2 53 prior to intubation, PF ration prior to intubation 51 with severe ARDS - received Vanc/Cef for HAP coverage started 8/28 - Dex ARDS for 3d - Diuresed for pulmonary toilet Transaminitis - improving at time of death - likely d/t severe acute viral illness vs remdesivir CHD w/ Mech AVR on AC (warfarin at home) - received heparin gtt while in MICU Chronic Microcytic Anemia d/t Thalassemia - monitored Hb At approximately 5:30 p.m. on 08/30/2021 code blue was called on patient, high-quality compressions were initiated, nursing had reported that prior to cardiac arrest the patient developed tachyarrhythmia followed by precipitous drop in blood pressure followed by hypoxia, rhythm was consistently asystole, patient patient received approximately 17-18 rounds of compressions, doses of epinephrine every 3-5 minutes, bilateral chest tubes were placed due to concern for tension pneumothorax as patient had pre-existing pneumomediastinum with diffuse subcutaneous emphysema, hypoxia improved mildly after chest tubes were placed but return of spontaneous circulation was not achieved, patient also received multiple rounds bicarbonate, calcium, insulin and dextrose during the code, resuscitation was attempted for a total of 35 minutes when out of medical futility with overall poor neurologic prognosis the code was stopped, family had just arrived at the time of stopping resuscitation, patient''s family was informed and they voiced understanding of what had happened and the patient had expired, family thank team for excellent care despite outcome, time of death 1805


VAERS ID: 1666824 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-28
Onset:2021-08-19
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anemia, Cellulitis, High Cholesterol, Hypertension, Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown


VAERS ID: 1666949 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Arrhythmia, Atrial fibrillation, Carbon dioxide increased, Death, Dyspnoea, Endotracheal intubation, Hypercapnia, Hypotension, Hypoxia, Intensive care, Malaise, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 74
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Please check with PCP
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within hours was short of breath climbing stairs he climbed daily and it never happened before. Doctor diagnosed that his heart was out of rhythm at next appointment. He was treated with a few different drugs but it couldn''t be controlled and he never felt well again. On 4/19/21 he was transported to Hospital by ambulance with AFib. The next morning he was found unresponsive and moved to ICU. His oxygen level was low and carbon dioxide level was high. For 2 weeks he suffered greatly. Doctors tried to balance his high heart rate with his low blood pressure. He was intubated twice. He died on May 2, 2021. His cause of death was acute respiratory failure with hypercapnia and hypoxemia. He had never had heart or lung problems before that.


VAERS ID: 1666952 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-01
Onset:2021-08-21
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       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? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated individual expired on 08/21/2021


VAERS ID: 1666966 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-20
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired on 08/20/2021. 1st dose 02/09/2021 2nd dose 03/06/2021


VAERS ID: 1667100 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-09-01
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired on 09/01/2021


VAERS ID: 1667385 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-16
Onset:2021-07-14
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death, General symptom, Malaise, Myocarditis, Viral infection
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: 2021-07-16
   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: Irbesartan, lipitor, chlorthalidone, ambien, rybelsus, clindaycin
Current Illness: None
Preexisting Conditions: High blood pressure, high cholesterol
Allergies: N/a
Diagnostic Lab Data: Autopsy says myocarditis from viral infection. I wanted to share our story to help research in case it was linked to his recent vaccine.
CDC Split Type:

Write-up: My dad had received the Johnson and Johnson shot end of April. He was sick for a few days with the normal side effects. In July he died from myocarditis the autopsy came back as. Research has been showing that it is linked to the vaccine and to report it to help research just in case.


VAERS ID: 1667416 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-02-19
Onset:2021-02-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Death, Dysphagia, Noninfective encephalitis, Paralysis, Peripheral swelling, Pharyngeal swelling, Swollen tongue, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 173
Permanent Disability? Yes
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: Swollen limbs, swollen tongue, swollen throat leading to paralysis and inability to speak or swallow. Brain inflammation leading to vegetation. All leading to DEATH!


VAERS ID: 1669555 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-22
Onset:2021-07-25
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Hospice care, Pleural effusion, Pneumonia
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: pneumonia; couldn''t catch her breath; She had fluid around her lungs; passed away; healthcare facility; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away), PNEUMONIA (pneumonia), DYSPNOEA (couldn''t catch her breath) and PLEURAL EFFUSION (She had fluid around her lungs) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 22-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 25-Jul-2021, the patient experienced PNEUMONIA (pneumonia) (seriousness criteria hospitalization and medically significant) and DYSPNOEA (couldn''t catch her breath) (seriousness criterion hospitalization). On 27-Jul-2021, the patient experienced healthcare facility (healthcare facility). On an unknown date, the patient experienced PLEURAL EFFUSION (She had fluid around her lungs) (seriousness criterion medically significant). On 29-Jul-2021, PNEUMONIA (pneumonia), DYSPNOEA (couldn''t catch her breath), PLEURAL EFFUSION (She had fluid around her lungs) and healthcare facility (healthcare facility) outcome was unknown. The patient died on 29-Jul-2021. The reported cause of death was Pneumonia, couldn''t catch her breath, she had fluid around her lungs, she was on the floor and healthcare facility. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. The patient had pneumonia and couldn''t catch her breath. She was on the floor, and then the emergency took her to the hospital on 25 Jul 2021. She had fluid around her lungs. The following day on 27 Jul 2021, the patient was sent to healthcare facility and then she died early morning on 29 Jul 2021. Company comment: This is a case of death in a 82-year-old female patient who died 7 days after receiving first dose of vaccine. The patient experienced pneumonia, pleural effusion and dyspnoea due to which she was hospitalized but discharged to healthcare facility two days later where she passed away. Very limited information has been provided at this time. Further information will be requested.; Sender''s Comments: This is a case of death in a 82-year-old female patient who died 7 days after receiving first dose of vaccine. The patient experienced pneumonia, pleural effusion and dyspnoea due to which she was hospitalized but discharged to healthcare facility two days later where she passed away. Very limited information has been provided at this time. Further information will be requested.; Reported Cause(s) of Death: pneumonia; couldn''t catch her breath; She had fluid around her lungs; She was on the floor; healthcare facility


VAERS ID: 1669558 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210855833

Write-up: DEATH; SEIZURES; This spontaneous report received from a consumer via a company representative via social media (twitter) concerned a male of an unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient developed seizure and then died. As per the reporter, "I know an hour after taking the vaccine this 100 percent healthy kid had seizures. Next thing the patient was dead." It was unknown if an autopsy was performed or not. The cause of death was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died on an unspecified date, and the outcome of seizures was not reported. This report was serious (Death).; Sender''s Comments: V0: 20210855833-covid-19 vaccine ad26.cov2.s -Death, Seizures. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1669567 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
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: Atrial fibrillation; Diabetes (Controlled); Hypertension
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210858457

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer concerned a 94 year old male and unspecified race & ethinicity. Initial information was processed along with the additional information received on 27-AUG-2021 The patient''s height, and weight were not reported. The patient''s concurrent conditions included: diabetes, hypertension, and atrial fibrillation. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) 1 in total dose was administered on APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. The consumer reported that father was in the emergency room on 17-AUG-2021 and was hospitalized. On 18-AUG-2021, the patient was on ventilator and died on 24-AUG-2021 with the delta variant. On an unspecified date, the patient had suspected covid-19 infection, and suspected clinical vaccination failure. On 24-AUG-2021, the patient died from covid-19 infection. The patient was hospitalized for 7 days. It was unspecified if an autopsy was performed The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of suspected covid-19 infection on 24-AUG-2021. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210858457-covid-19 vaccine ad26.cov2.s- suspected clinical vaccination failure. This event is considered not related. The event 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 than the drug. Specifically: SPECIAL SITUATIONS 20210858457-covid-19 vaccine ad26.cov2.s- suspected covid-19 infection. 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: COVID-19 INFECTION


VAERS ID: 1669577 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210860208

Write-up: DEATH; This spontaneous report received from a consumer via company representative concerned 726 patients of unspecified sex, race and ethnic origin. The patients 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 was not reported, batch number: unknown and expiry date: unknown) dose was not reported, 1 total administered, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patients died from unknown cause of death. It was unknown that whether autopsy performed for reported patients. This report was serious (Death).; Sender''s Comments: V0: 20210860208-COVID-19 VACCINE AD26.COV2.S-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1669586 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210900460

Write-up: TWO STROKES; This spontaneous report received from a consumer via a company representative through social media concerned a female of unspecified age, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, 1 total administered 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. It was reported that, on an unspecified date, the vaccine caused blood clotting throughout the patient''s body resulting in two strokes and ultimately her death on 19-AUG-2021. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. On 19-AUG-2021, the patient died from two strokes. This report was serious (Death).; Sender''s Comments: V0: 20210900460 - JANSSEN COVID-19 VACCINE Ad26.COV2.S- Two strokes. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: TWO STROKES


VAERS ID: 1669875 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-06
Onset:2021-08-15
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myeloid leukaemia, Biopsy bone marrow abnormal, Blast cells, Bone marrow failure, Caesarean section, Chemotherapy, Death, Exposure during pregnancy, Full blood count, Haemorrhage intracranial, Myelosuppression, Neutrophil count decreased, Pancytopenia, Platelet count decreased, Platelet transfusion, Premature labour, Transfusion, Twin pregnancy, White blood cell count increased
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Malignant lymphomas (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 18
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRN, aspirin 81 mg daily, docusate 100 mg BID, ferrous sulfate 325 mg daily, fluoxetine 20 mg daily, magnesium 200 mg daily, omeprazole 40 mg daily, prenatal vitamin daily
Current Illness:
Preexisting Conditions: major depression, generalized anxiety, gestational diabetes (diet controlled), gestational hypertension
Allergies: NKA
Diagnostic Lab Data: CBC w/ diff (8/15/21): WBC 11.4, ANC 1.7, Platelets 57, Abs Blasts 8.4, %Blasts 74 Bone Marrow Biopsy (8/17/21): AML in a hypocellular marrow (30%) with decreased trilineage hematopoiesis and 75% blasts Bone Marrow Biopsy (8/31/21): results pending
CDC Split Type:

Write-up: Pregnancy history: G2P1001. Patient had the Pfizer COVID vaccine on 8/6/21 at 33 3/7 weeks gestation (EDD 9/21/21). Presented 8/15/21 at 34 5/7 weeks gestation with preterm labor. CBC with differential found to have significant abnormalities. Twins were delivered via C-section. Twin A birth weight 5lb 2.5oz and twin B birth weight 6lb 1.4oz. Oncology consulted and bone marrow biopsy diagnosed patient with AML. Induction chemotherapy with 7+3 given 8/17-8/23/21 with resulting pancytopenia necessitating daily blood/platelet transfusions. On 9/1/21, had a catastrophic intracranial hemorrhage and patient died on 9/2/21.


VAERS ID: 1670084 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-01
Onset:2021-01-19
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Malnourished due to nursing home neglect as well as constant bacterial infection due to lack of appropriate care and hygiene from staff members.
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died within 36 hours after first inoculation


VAERS ID: 1670089 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-01-28
Onset:2021-08-12
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, COVID-19, Cough, Death, Dehydration, Fatigue, Nausea, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (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, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client''s symptom onset for COVID-19 was on 8/9/21 and included cough, nausea, fatigue, ABD pain, pneumonia, fever, weakness, and dehydration. He tested positive for COVID-19 on 8/11/21. Client was hospitalized on 8/12/21. Client passed away on 8/25/21.


VAERS ID: 1670145 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-09-02
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood gases abnormal, COVID-19, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Exposure to SARS-CoV-2, Hyporesponsive to stimuli, Hypoxia, Pulseless electrical activity, Respiratory failure, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: end stage COPD
Allergies: no known
Diagnostic Lab Data: covid + 9/2/2021
CDC Split Type:

Write-up: Breakthrough COVID. First vaccine 1/22/2021. 70-year-old male A staff member in the nursing home was positive for COVID-19 and passed it on to multiple patient is in the nursing home. The patient was brought in for shortness of breath and hypoxemia. He was poorly responsive an ABG showed acute hypercapnic respiratory failure. He was intubated. he patient underwent PEA arrest. Preliminary cause of death: Cardiac arrest. Due to: COVID-19.


VAERS ID: 1670157 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-27
Onset:2021-08-07
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RL / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, COVID-19 pneumonia, Death, Dehydration, Dyspnoea, Fatigue, Intensive care, Mechanical ventilation
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Respiratory failure (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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:
Current Illness:
Preexisting Conditions: MS
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client''s husband reported client received a flu shot on 7/27/21 when symptoms began. ( does not indicate client received the influenza vaccine and last documented shot was given on 8/23/16.) Symptoms included fatigue, aches mostly in hip, dehydration, and breathing difficulties, which continued to get worse throughout the week. On 8/6/21 husband found client on floor in the bathroom. When paramedics arrived, client refused to go to the hospital. On 8/7/21, husband physically brought client to Hospital where she was admitted with COVID pneumonia. She was in the ICU, ventilated and passed away on 8/30/21.


VAERS ID: 1670340 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-24
Onset:2021-09-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Computerised tomogram abdomen normal, Computerised tomogram head, Computerised tomogram pelvis, Computerised tomogram thorax normal, Drug screen negative, Endotracheal intubation, Life support, Pulse absent, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: nkda
Diagnostic Lab Data: CT scan of chest, abdomen, pelvis, brain all negative. Urine drug screen negative.
CDC Split Type:

Write-up: Patient is a prisoner at the county prison. He had a seizure in his cell and went into cardiac arrest. EMS was called. He got back ROSC en route to the ED. Intubated en route. Lost pulses again and again fot ROSC. Drug screen was negative. All CT scans negative. No medical history. Patient is in critical condition on life support and is not expected to survive the day.


VAERS ID: 1670372 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-07-28
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Benign prostatic hyperplasia, COVID-19, Chronic obstructive pulmonary disease, Diabetes mellitus, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospice patient, COPD, positive COVID test, diabetic, BPH


VAERS ID: 1670444 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-07-29
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Agitation, Bilevel positive airway pressure, COVID-19, Confusional state, Death, Dyspnoea, Endotracheal intubation, Intensive care, Restlessness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 30
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: Date of Admission 08/03/2021. Chief Complaint COVID + on 7/29/21, increased shortness of breath; placed on 4L NC in triage This is a 72-year-old Caucasian gentleman who presented to the hospital on August 3rd with complaints of shortness of breath after being diagnosed with COVID-19 4 days earlier. The patient has a known history of COPD and states that he uses a trilogy machine at home but is not on oxygen on an around the clock basis. The patient did ultimately require intubation but was extubated on August 8th. He had some difficulties yesterday with oxygenation and was on BiPAP at 100% there was some concern that he was going to need re-intubation. However, the patient status has improved somewhat today he is on Precedex to help control some of his agitation and restlessness and he is now been weaned to high-flow nasal cannula. The patient is in the intensive care unit and is awake and alert to self and place but otherwise pleasantly confused. He does not know the year nor the name of the president. Result Title: Patient Death Performed By: RN on August 28, 2021 19:38 EDT Verified By: RN on August 28, 2021 19:38 EDT Encounter info: 3791927, DEL, Inpatient, 08/28/2021 - 08/29/2021 Examined patient. No spontaneous audible heart sounds, no spontaneous audible breath sounds, no corneal reflex, no pupil response. Patient expired at 1705 with family at bedside.


VAERS ID: 1670460 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-14
Onset:2021-08-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: Atenolol 25 mg
Current Illness: High blood pressure. Weakness walking and standing
Preexisting Conditions: Traumatic Brain Injury 1980 due to motorcycle accident - Left sided Paralysis - spleen removed.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: August 29, 2021 patient with NO HISTORY OF SEIZURES had a seizure in the Emergency Room of Hospital. Patient was treated with Keppra for seizure. On August 31, 2021 patient had another seizure and died.


VAERS ID: 1670560 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

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

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? No
Previous Vaccinations:
Other Medications: Lasix 20mg, escitalopram 20mg, alprazolam 0.5mg, naltrexone 50mg, metoprolol tartrate 25mg
Current Illness: Type II diabetes, coronary artery disease, history of cerebral vascular accident, alcohol dependence/abuse, morbid obesity, hypertension, hyperlipidemia.
Preexisting Conditions: Type II diabetes, coronary artery disease, history of cerebral vascular accident, alcohol dependence/abuse, morbid obesity, hypertension, hyperlipidemia.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient deceased 08/25/2021


VAERS ID: 1670621 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-21
Onset:2021-07-27
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E10140 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HF, HTN
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient died


VAERS ID: 1670639 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-12
Onset:2021-08-08
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP 6955 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: admitted 8/08/2021 to hospital and died 08/09/2021


VAERS ID: 1670713 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Death, Dysgeusia, Malaise, Muscular weakness, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, women vitamins apresoline, isordil titration oral, pravastatin,,pro tonic, isosorbife, aspirin, vitamin D, folic acid
Current Illness: none, not sure
Preexisting Conditions: Arthritis, hypertension, heart problems, cholesterol
Allergies: suphur
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: After her first dose she has a metalic taste in her mouth but was ok but after her 2nd dose, the metallic taste was worse and her muscles and limbs were weak and it changed her life. she was in a nursing home and was neglected. She was vomiting. Not sure if she had covid but she could not do anything and became sick . before she died, the back of her month had like nest. she died on 05/14/2021


VAERS ID: 1670758 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-06
Onset:2021-08-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Death, Drain placement, Gait inability, Incisional drainage, Joint effusion, Joint fluid drainage, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Zithromax
Diagnostic Lab Data: Hospital august 15th to August 19th
CDC Split Type:

Write-up: Patient got his modern shot on August 6th, 2021 between the time of 11:00-11:15 at Pharmacy. Less than 22 hours later he was violently ill, and started vomiting. He also had joint pain in his right hip and was unable to walk. For one week he stayed at home and was weak and was unable to walk. On August 15th, Patient was brought to Hospital with c/o right hip pain. At ER, he was diagnosed with fluid collection on right hip. It was a rule out septic joint. The next day he went to IR where he had 150 ml of fluid drained off his hip. At this time they placed a drain and it was draining fluid. The next day he was brought to OR with Orthopedic surgeon and he had more fluid drained off his right thigh. They said the procedure was a incision and drainage. They pulled the old drain and placed a new drain. He stayed in hospital 2 more days with the drain and received Rocephin and Vancomycin via IV catheter. While he was in hospital they were treating him with lovenox SQ injection because patient kept telling everyone he was not sick or had not fallen prior to receiving his vaccination. On Thursday he was discharged to home after the drain was pulled on just Cephalexin, and no lovenox. On Monday August 23rd 17 days after his moderna vaccination patient died at home by what was said by the coroner as "Natural Causes" . patient had not been to the Dr since 2016.


VAERS ID: 1670809 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-07-03
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Chronic kidney disease, Dementia, SARS-CoV-2 test positive, Seizure
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive COVID test, dementia, CVA, CKD3, seizure disorder


VAERS ID: 1670812 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-08-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Cardiac arrest, Central venous catheterisation, Death, Echocardiogram, Influenza A virus test negative, Influenza B virus test positive, Resuscitation, SARS-CoV-2 test negative, Seizure like phenomena, Syncope
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), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE 10MG DAILY, OLMESARTAN 40MG DAILY ROSUVASTATIN 5MG DAILY, PANTOPRAZOLE 40MG DAILY & LEVOCETIRIZINE 5MG DAILY (30 DAY SUPPLIES LAST FILLED IN MAY 2021, COMPLIANCE?) OTC & HERBALS UNKNOWN
Current Illness:
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: 8/22/21 CAPILLARY GLUCOSE = 159 INFLUENZA-A&B = NOT DETECTED SARS-CoV-2 PCR = NOT DETECTED
CDC Split Type:

Write-up: ACCORDING TO DAUGHTER & SISTER: THE DECEASED HAD NO RECENT COMPLAINTS. THEY HAD A HISTORY OF HTN FOR, WHICH THEY WERE TAKING MEDICATION, BUT NO KNOWN CARDIAC ISSUES. THEY WERE AT WORK WHEN THEY HAD "SEIZURE-LIKE" ACTIVITY & COLLAPSED TO THE GROUND. EMS WAS CALLED. SHE WAS NOTED BY EMS TO BE IN ASYSTOLE AND ACLS BEGAN. EMS ADMINISTERED 3MG OF EPINEPHRINE AND CONTINUED COMPRESSIONS UNTIL THEIR ARRIVAL TO ED AT 11:38AM ON 8/22/21. WHILE IN THE ED, SHE RECEIVED MAGNESIUM SULFATE, AMIODARONE, CALCIUM CHLORIDE, SODIUM BICARBONATE, AND ADDITIONAL DOSES OF EPINEPHRINE. BEDSIDE CARDIAC US REVEALED NO CARDIAC WALL MOTION. A CENTRAL VENOUS CATHETER WAS PLACED AND tPA WAS ADMINISTERED. CPR WAS CONTINUED. DESPITE ALL EFFORTS, SHE REMAINED IN ASYSTOLE. REPEAT BEDSIDE CARDIAC US AGAIN REVEALED NO CARDIAC WALL MOTION. SHE WAS PRONOUNCED AT 12:11PM.


VAERS ID: 1670826 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-01
Onset:2021-09-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 035C21A / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death.


VAERS ID: 1670831 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-12
Onset:2021-08-16
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   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: SOB, POSITIVE COVID TEST


VAERS ID: 1672341 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Death
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad)

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

Write-up: passed away; bubbles like blisters in the face/neck /back /arms / legs; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away) and BLISTER (bubbles like blisters in the face/neck /back /arms /legs) in an 80-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and BLISTER (bubbles like blisters in the face/neck /back /arms / legs) (seriousness criterion death). The reported cause of death was bubbles like blisters in the face/neck /back /arms / legs. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Patient was healthy in his 80s. The patient had bubbles like blisters in the face and in the back of the neck, back and arms, and legs. This is a case of death in a 80-year-old male patient after receiving vaccine. The patient also experienced blisters in the face and in the back of the neck, back and arms, and legs. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 80-year-old male patient after receiving vaccine. The patient also experienced blisters in the face and in the back of the neck, back and arms, and legs.Very limited information has been provided at this time.; Reported Cause(s) of Death: passed away; bubbles like blisters in the face/neck /back /arms / legs


VAERS ID: 1672600 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: STATIN [ATORVASTATIN CALCIUM]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Heart attack; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Heart attack) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concomitant products included ATORVASTATIN CALCIUM (STATIN [ATORVASTATIN CALCIUM]) for an unknown indication. On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (Heart attack) (seriousness criteria death and medically significant). The patient died on 14-Mar-2021. The reported cause of death was Heart attack. An autopsy was not performed. Treatment information was not provided. Company comment Very limited information regarding this event/s has been provided at this time. Further information has been requested Most recent FOLLOW-UP information incorporated above includes: On 20-Aug-2021: Follow-up received and contains reporter contact information.; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested; Reported Cause(s) of Death: Heart attack


VAERS ID: 1673094 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiomegaly, Death, Palpitations, Product administered to patient of inappropriate age
SMQs:, Cardiac failure (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Medication errors (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: USMODERNATX, INC.MOD20212

Write-up: death; teenager got palpitation; her heart enlarged; teenager got a covid-19 vaccine.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (death), PALPITATIONS (teenager got palpitation), CARDIOMEGALY (her heart enlarged) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (teenager got a covid-19 vaccine.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (death) (seriousness criteria death and medically significant), PALPITATIONS (teenager got palpitation) (seriousness criterion death), CARDIOMEGALY (her heart enlarged) (seriousness criterion death) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (teenager got a covid-19 vaccine.) (seriousness criterion death). The reported cause of death was teenager got palpitation, her heart enlarged and teenager got a covid-19 vaccine.. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. No treatment information was provided. Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: teenager got palpitation; her heart enlarged; teenager got a covid-19 vaccine.


VAERS ID: 1673117 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-10
Onset:2021-04-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 103
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D [Vitamin D NOS]; Aspirin [Acetylsalicylic Acid]; Cystex [Benzoic Acid; Methenamine; Salicylate Sodium]
Current Illness: Blood pressure high; High cholesterol; Urinary tract infection.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: stroke; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (stroke) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Urinary tract infection, Blood pressure high and High cholesterol. Concomitant products included BENZOIC ACID, METHENAMINE, SALICYLATE SODIUM (CYSTEX [BENZOIC ACID;METHENAMINE;SALICYLATE SODIUM]) for Urinary tract infection, VITAMIN D [VITAMIN D NOS] and ASPIRIN [ACETYLSALICYLIC ACID] for an unknown indication. On 10-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (stroke) (seriousness criteria death and medically significant). The patient died on 14-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication of the patient also included medication to treat her blood pressure and cholesterol. The had been taking her concomitant medications since a long time ago. No treatment information was provided by the reporter. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, patient''s age and med HX of HTN and high cholesterol are possible confounding factors.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, patient''s age and med hx of HTN and high cholesterol are possible confounding factors.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1673406 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Infection
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 INC202101109686

Write-up: breakthrough infection and died; This is a spontaneous report from a 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''s medical history and concomitant medications were not reported. The consumer stated that on the website, it says that it''s not FDA approved, as well as voicemails. She went on to say that it only takes a minute to update those things, and she would think with something this large, they would have been ready. She stated that she was aware that the VAERS website contains side effects and things that have happened. She stated that other vaccines have been halted after 1 to 2 deaths. She is aware of a couple of people dying as a direct result of the Pfizer BioNTech vaccine, as well as as friend that had a breakthrough infection and died on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for BNT162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: breakthrough infections and has died


VAERS ID: 1673422 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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 INC202101113082

Write-up: Died after taking the 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) on an unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were Not Provided. The reporter said his cousin died after taking the Covid vaccine and reported as serious due to death. The caller mentioned about that our website or recorded line doesn''t say FDA approval and she told him that will be updated by the end of the day and they are aware of that. Reporter then started to say is the president lying and the agent ended the call at that time. Investigation Assessment was Not Provided. It was not reported if Autopsy 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.; Reported Cause(s) of Death: died after taking the vaccine


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