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

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



Case Details

This is page 67 out of 150

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VAERS ID: 1673454 (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 - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101123341

Write-up: passed away; This is a spontaneous report from a Pfizer-sponsored program via Regulatory Authority Support received from a non-contactable consumer. The consumer reported same events for two patients (two friends). This is one of the two reports. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE, dose 1 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient took both doses and passed away on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101123407 Same reporter/suspect product/event, different patients; Reported Cause(s) of Death: took both doses and passed away


VAERS ID: 1673460 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-16
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 - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-18
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Temazepam; Centrum Silver [Ascorbic Acid; Calcium; Minerals Nos; Retinol; Tocopheryl Acetate; Vitamin B NOS; Vitamins; Ocuvite [Ascorbic Acid; Beta carotene; Copper; Tocofersolan (TPGS); Zinc]
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: other medical history: none, she was just old.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101127960

Write-up: Renal Failure; This is a spontaneous report from a contactable consumer. A 94-year-old female patient (not pregnant) received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 16Mar2021 15:00 (Batch/Lot number was not reported) (at the age of 94-year-old, not pregnant) as single dose for COVID-19 immunisation. Medical history: none, she was just old. Concomitant medications included temazepam; ascorbic acid, calcium, minerals nos, retinol, tocopheryl acetate, vitamin b nos, vitamins nos, zinc (CENTRUM SILVER); ascorbic acid, betacarotene, copper, tocofersolan, zinc (OCUVITE). The patient previously received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) dose 1 on 23Feb2021 at 12:00 PM in left arm at the age of 94-year-old for COVID-19 immunization and experienced Renal Failure. No covid prior vaccination. No other vaccine in four weeks. No covid tested post vaccination. No known allergies. The patient experienced periodic uncontrollable shaking renal failure. AE resulted in: Doctor or other healthcare professional office/clinic visit. No treatment. The patient died on 18May2021. An autopsy was not performed. The lot number for [BNT162B2], was not provided and will be requested during follow up.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101102004 same reporter, patient, product, event, different doses and potential; Reported Cause(s) of Death: Renal Failure


VAERS ID: 1673464 (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 INC202101129798

Write-up: who got the vaccine and died three days later; This is a spontaneous report from a non-contactable other hcp. The reporter reported for herself and another patient. This was for another patient. A patient of unspecified age and gender received bnt162b2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient got the vaccine and died three days later on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender''s Comments: The causal relationship between bnt162b2 and the event death cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: who got the vaccine and died three days later


VAERS ID: 1673473 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-04
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 INC202101134213

Write-up: died; This is a spontaneous report from a contactable consumer. This consumer reported for an adult male patient. An adult male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection. Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunization. Reason for no lot number of Pfizer COVID-19 Vaccine: complainant hung up abruptly/transfer incomplete. The patient medical and concomitant medication history were reported. Other products, patient history and investigation assessment not provided. The patient experienced died on an unspecified date. It was not reported if an autopsy was performed. Caller was asking why Pfizer not reporting the side effects to VAERS? Caller states that the data on VAERS has stopped counting the fatalities from the Pfizer COVID-19 vaccine and the death count exceeds 12,000. Caller states that the Pfizer COVID-19 vaccine has metals and was asking how was it being passed through the FDA and Pfizer? Normally with other shots, they take years to get approved. FDA only allows, if people die, they did not put it on the market. Caller states that the data on VAERS has stopped counting the fatalities from the Pfizer COVID-19 vaccine and the death count exceeds 12,000. Caller asked if we had COVID, we had the antibodies, why do we have to get the shot. The lot number was not provided. Information on lot number has been requested during follow up.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101134188 same reporter/drug/event, different patient.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1673475 (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 INC202101134490

Write-up: I have lost 3 friends in Spain; This is a spontaneous report from a non-contactable consumer reporting same event under the same suspect product for 12 patients. This is one of 12 reports. A patient of unspecified age and gender received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number not reported) via an unspecified routed of administration on unspecified date at a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter had lost a friend in Spain. The cause of death was unknown. It was unknown whether an autopsy was done. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101100059 same reporter/drug/event, different patient; Reported Cause(s) of Death: I have lost 3 friends in Spain


VAERS ID: 1674474 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-23
Onset:2021-05-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: A small blockage in his artery, not large enough to do a stent.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father received the shot on Sunday May 23rd in the late afternoon, on Tuesday May 25th he had an artery embolism and passed away that morning.


VAERS ID: 1674723 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-18
Onset:2021-08-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication
Current Illness:
Preexisting Conditions: Heart disease, CABGx4 colon cancer in remission
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Went to urgent care 4 days after first vaccination for back pain. Thought to be a kidney stone or pulled muscle and sent home. Died at home two days later on 8/24/21.


VAERS ID: 1674908 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-15
Onset:2021-08-25
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Death, Heparin-induced thrombocytopenia, Lung lobectomy, Pulmonary embolism
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Hypersensitivity (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Glimepiride, Pantoprazole, Tamsulosin, Valtrex, Ellipta, Fluticasone
Current Illness:
Preexisting Conditions:
Allergies: KNDA
Diagnostic Lab Data: PF4 with Optic Density 2.8
CDC Split Type:

Write-up: Patient with no prior heparin exposure. Started on prophylactic heparin (5000U TID SQ) following lobectomy. Developed severe HIT with optic density 2.8. Placed on argatroban after diagnosis, which was prompted by PE. Please note, patient immediately on heparin ppx following surgery and ambulatory. No history of coagulopathy in family or personally. Platelets never rose despite a week of therapeutic argatroban without any pauses in drip or sub therapeutic ranges. At 7 days after initiation of drip, the patient had a second PE and expired. I know it''s a long time out from his vaccine but wondering if prior vaccination and subsequent heparin may be a trigger for HIT.


VAERS ID: 1675012 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-12
Onset:2021-08-18
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Angiogram pulmonary abnormal, Anticoagulant therapy, Anxiety, Bilevel positive airway pressure, Blood gases, Blood pressure decreased, COVID-19, Cardiac arrest, Condition aggravated, Confusional state, Death, Dyspnoea, Echocardiogram, Emphysema, Endotracheal intubation, Gastrointestinal tube insertion, Haemoglobin decreased, Haemoptysis, Infection, Intensive care, Mechanical ventilation, Oxygen saturation decreased, Packed red blood cell transfusion, Patient restraint, Pulmonary embolism, Pulmonary mass, SARS-CoV-2 test positive, Treatment noncompliance
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (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), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   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: PROAIR HFA; VENTOLIN HFA 12/18/15 ELIQUIS 5 MG Information, Historical ZITHROMAX 250 MG 12/21/18 PULMICORT 0.5 MG/2ML 3/10/18 Keflex 500 MG 1/17/20 1/24/20 CeleXA 10 MG 3/5/17 VIBRA-TABS 100 MG 7/29/21 8/8/21 FLONA
Current Illness:
Preexisting Conditions: Chronic anticoagulation Chronic systolic heart failure COPD (chronic obstructive pulmonary disease) History of pulmonary embolism
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 08/18/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received J&J vaccine on 03/12/21. Hospitalized from 08/18/21 - 08/30/21. Below is copied from discharge (death) summary: Hospital Course: HPI: Patient is a 70 year old male with a PMHx of COPD / Emphysema with home O2 dependence recently increased to 3L/NC, HFrEF, recent Dx of PE one month ago on Eliquis and depression who presented to the ED for worsening shortness of breath and hemoptysis. He is Covid positive and did receive the J&J vaccine. He was admitted to the Hospitalist''s Service. He has worsening shortness of breath and increased oxygen demand and work of breathing. He is transferred to the ICU for increased level of care. 8/22: CTA Chest negative for PE but showed severe centrilobular emphysema, left lung apex cavitary lesion (infxn vs. Malignancy). Echo pending. Patient on BiPAP 10/5, 70% FiO2. No other concerns. 8/23: Holding off Baricitinib given concern for CAP. Given Lasix 40 IV x 1 and will resume home Lasix BID in AM for HFrEF. Currently on BiPAP 10/6, 80%. Weaning to HFNC +/- NRB as tolerated. 8/24: Pt with high level of anxiety prn yesterday for which Buspar was effective. He has been anxious overnight. Remains on HFNC. 8/25: Over day time transitioned to bipap with improvement in oxygenation. Reports no change in respiratory status. 8/26: Patient had several episodes of removing HFNC or BiPAP. Placed in restraints w/mittens on HFNC + NRB. Patient with more confusion recently as well. Started on Seroquel. Currently on HFNC + NRB 60L/100%. 8/27: Patient with confusion/agitation yesterday. CT head ordered but patient unable to cooperate even w/Ativan. Patient maxed out on Precedex gtt and still agitated. Added ketamine gtt w/improvement in sedation and patient able to tolerate BiPAP. NG placed. 8/28: Patient with increasing O2 demands last night, patient subsequently intubated and placed on PRVC. Today, patient changed from PRVC to PS with improvements in oxygenation. Patient on 14/10 75% PS satting mid 90''s. 8/29: Overnight patients blood pressure dropping despite being on Levo and Vaso infusions. Neosynephrine infusion added. Bedside ultrasound performed showing ~50% collapse of IVC on inspiration - patient bolused 1L IVF with minimal improvement of blood pressure. Patient with increasing O2 requirements. ABG performed showing Hgb 6.5. Patient type & screened, crossmatched, transfused 1u PRBC''s. Vancomycin added for broad spectrum antibiotic coverage. Spoke with patients significant other who came in to the hospital to see patient - she confirms status of DNR with being ok for intubation. 1957: Maxed on 4 vasopressors. GCS 3T. HR trended down to asystole. No heart tones auscultated. Time of death 1957. Significant other notified. Discharged Condition: deceased


VAERS ID: 1675019 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-14
Onset:2021-07-31
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Atrial fibrillation, Bilevel positive airway pressure, Blood creatine phosphokinase increased, COVID-19, Computerised tomogram abdomen, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Death, Dyspnoea, Endotracheal intubation, Enterococcal bacteraemia, Hypernatraemia, Hypotension, Intensive care, Lethargy, Lung opacity, Mechanical ventilation, Mental status changes, Oxygen saturation decreased, Pseudomonas infection, Respiratory failure, SARS-CoV-2 test positive, Subdural haematoma, Subdural hygroma, Tachypnoea, Urinary tract infection, Use of accessory respiratory muscles, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Supraventricular tachyarrhythmias (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 31 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACCU-CHEK AVIVA PLUS VI STRIP USE ONE STRIP TO CHECK BLOOD SUGAR THREE TIMES DAILY BEFORE MEALS ACCU-CHEK AVIVA PLUS W/DEVICE DOES NOT APPLY KIT 3 times daily. AMLODIPINE (NORVASC) 10 MG ORAL TABLET TAKE ONE TABLET BY MOUTH ON
Current Illness:
Preexisting Conditions: Asthma ? BPH with urinary obstruction ? CAD (coronary artery disease) Echo Dobutamine Stress Test 01/16/20 ? Chronic kidney disease Creatinine NL (0.86) on 04/20/20 ? COPD (chronic obstructive pulmonary disease) severe, PFT 2011 ? Coronary artery calcification seen on CAT scan ? Diabetes mellitus A1C 7.3 01/23/20 ? Dysphonia 2010 chronic ? Elevated PSA per notes ? GERD (gastroesophageal reflux disease) ? Hiatal hernia Small, per 05/22/19 EGD ? History of chronic cough ? Hypercholesterolemia ? Hypertension ? Kidney stones ? Osteoarthritis ? Schatzki''s ring per 05/22/19 EGD ? Snores ? Unspecified gastritis and gastroduodenitis without mention of hemorrhage ? Urinary retention with CIC twice daily
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 07/31/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received the Pfizer vaccine (2nd dose in series) on 04/14/21. Patient was hospitalized from 07/31/21 - 08/31/21. Below is copied from discharge summary: Discharged Condition: deceased Hospital Course: Patient is a 82 y.o. male with a PMH of recurrent UTIs, BPH, COPD, bicytopenia (leukopenia and erythropenia), DDM2, HTN, and HLD who presented to the ED on 7/31 for AMS. He was found down by family and EMS was called. SpO2 was 68% and pt was placed on NRB. He was brought to the ED and was COVID + (despite previous Pfizer vaccination on 3/24 & 4/14). CT C/A/P showed bilateral opacities. He also had a brief episode of afib RVR treated w/ metoprolol w/ subsequent hypotension requiring levophed gtt. He later was intubated d/t hypercapnic respiratory failure and admitted to the MICU. His course was complicated by hypernatremia elevated CK, AKI, PSAR UTI and enterococcus bacteremia. Abx were de-escalated to levoflaxacin and ampicillin.Of note he did not receive Remdesivir or Toclilizumab d/t bacteremia. He completed a 7 day course of solumedrol. He was extubated to HFNC on 8/6 and was transferred to the floor on 8/8 and only requiring 5L NC at the time. While on the floor pt had increased lethargy. On the evening of 8/11 pt was noted to have tachypnea and use of accessory muscles. Pt was placed on a VM and on the morning of 8/12 placed on BIPAP.CTH was obtained and showed new bilateral SDH/hygromas. IM team spoke with team and they recommended MRI brain stroke protocol. Patient continued to have respiratory decline remain on ventilator his symptoms continue to escalate was shortness of breath desaturation to patient was ventrally placed on 100 percent was on flow land saturation still remains low family meeting with palliative Care patient was made DNR with no escalation.


VAERS ID: 1675027 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-15
Onset:2021-08-21
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, Dyspnoea, Dyspnoea exertional, Fatigue, Infection, Life support, Pulse abnormal, Pulse absent, SARS-CoV-2 test positive
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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   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: Lisinopril (unknown) Metformin 500mg BID Pravastatin (unknown) Ammonium Lactate 12% Lotion Apply a moderate amount topically twice daily Fexofenadine 180mg tablets. Take one tablet every day by mouth as needed. Folic acid 1mg tablet. Take
Current Illness:
Preexisting Conditions: HTN, HLD, T2DM
Allergies: Aspirin
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 08/21/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. He received J&J vaccine on 03/15/21. Hospitalized from 08/21/21 - 08/27/21. Below is copied from patients discharge (death) summary: Patient lost pulse soon after family visit. 4 rounds of ACLS performed. Asystole on monitor Time of death pronounced at 1719. Alerted by RN that patient regained a weak pulse at 1722. Pressors restarted. Patient again lost pulse soon after and 1 round of ACLS was performed. No ROSC obtained. Asystole on monitor. No cardiac activity noted. Time of death 1734. 75 y.o. male with a PMH of HTN, HLD, COVId diagnosed 1 week ago presents to the ED c/o worsening SOB. Over the past week he has been noticing exertional SOB, fatigue and dyspnea. He had been able to recover with rest , today he was not able to get back to baseline so he decided to come in. At triage he was satting in the 70s on RA. He was placed on a nonrebreather at that time.


VAERS ID: 1675092 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-08-13
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Atrial fibrillation, Breath sounds absent, Bronchoscopy normal, COVID-19, Chronic kidney disease, Culture negative, Death, Dyspnoea, Endotracheal intubation, Haematemesis, Haemoglobin decreased, Hypoglycaemia, Intensive care, Lethargy, Leukocytosis, Mental status changes, Oxygen saturation decreased, Prone position, Pulse absent, Pupil fixed, SARS-CoV-2 test positive, Sedation, Tremor, Unresponsive to stimuli, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 108 (90 Base) MCG/ACT Inhalation Aerosol Solution Inhale 2 puffs every 6 hours as needed for wheezing. 8/11/21 PA-C amLODIPine (NORVASC) 5 MG PO Tablet Take 5 mg by mouth daily. 12/12/18 Information, Historical atorvastati
Current Illness:
Preexisting Conditions: Allergy to environmental factors ? Anemia ? Arthritis ? Blind left eye 2012 ? CAD (coronary artery disease) 2 stents per patient ? Cancer ( 12) basal cell carcinoma ? Cancer ( 12) skin cancer - excisions on left hand and right arm ? Cerebral artery occlusion with cerebral infarction (100) stroke 2 years ago- blind left eye ? Cerebral artery occlusion with cerebral infarction (100) "stroke in left eye about 5 years ago" per patient ? Chronic kidney disease ? CKD (chronic kidney disease), stage III per patient ? Coronary artery disease ? Diabetes ? Diabetes mellitus ? Dysphagia ? Fall ? GERD (gastroesophageal reflux disease) ? History of chemotherapy ? Hyperlipidemia ? Hypertension ? Malignant neoplasm of breast ? Thyroid disease
Allergies: Penicillin, Sulfa Antibiotics
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 08/13/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. Patient received Pfizer vaccine (2nd dose in series) on 02/19/21. Patient was hospitalized from 08/13/21 - 08/31/21. Below is copied from patients discharge (death) summary: Hospital Course: Patient is a vaccinated 75 y.o. male with a pmhx of HTN, DM, CAD s/p PCI (10 yrs ago), CKD3 and breast cancer s/p lumpectomy and CT who presented to ED on 8/13/21 c/o SOB in setting of known COVID-19 infection. Patient recieved both doses of his vaccine (2nd dose 2/2021). Patient was admitted to hospitalist service for acute hypoxic respiratory failure in setting of COVID-19. Throughout course of stay, had increasing oxygenation requirements (requiring FFCPAP after found to have removed mask from face) with pulse ox O2 sats reportedly in 20''s, lethargy, and new onset tremor. On pulmonology''s evaluation at bedside, patient was A&Ox2 (person/place, thinks year is 2001). Not hypoglycemic on accucheck. Difficult to obtain hx as patient with AMS however shakes head yes when asked if he feels SOB. Admitted to ICU on 18Aug, now intubated and sedated. Bronchoscopy performed at bedside, which was unrevealing. Did not show any mucous plugging. Received solumedrol and lipitor. Toci not given due to depleted supplies. Episodes of hypoglycemia, NPH 35u TID d/c. S/p D5W drip. Continue with SSI. Oligouric AKI on CKD, requiring CRRT. Nephrology on board. New onset A-fib with RVR, now rate controlled. S/p amiodarone drip & metoprolol. Increasing leukocytosis. Continue Vanc/Aztreonam/Flagyl and empiric Caspo, follow cultures. Episodes of coffee ground emesis. Hgb downtrended. Recevied 1 unit of pRBC. Hgb stable. On Levophed. Continue proning protocol. CRRT better when placed in left position. Keep net even. Wean off Levo as tolerated, start midodrine 10mg tid. DC empiric Abx given negative cultures. Palliative care for goals of care. Shock state of unclear etiology at this time. EV1000 hemodynamics to help guide management. Currently on 40 of levophed and vasopressin. Poor oxygenation. Prone ventilation discontinued. DC''d empiric Abx given negative cultures. Spoke to patient''s wife and she wants patient to be DNR with no escalation of care given his overall poor prognosis. Plan to compassionately wean. Confirmed DNR. No further escalation of care. Death Note I was called to the room of patient to pronounce that patient had died. Patient was laying motionless and unresponsive to verbal/tactile stimuli. Pupils where fixed and dilated. There were no spontaneous breath sounds. Peripheral pulses were absent. No heartbeat was heard during auscultation. Family was made aware. Condolences offered. Chaplain and postmortem services offered. Pt was DNR code. Time of death was 1724, confirmed and witnessed by Nurse


VAERS ID: 1675107 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-04
Onset:2021-09-02
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   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: bp and seizure meds
Current Illness: HTN< SEIZURE
Preexisting Conditions: smoker
Allergies: no
Diagnostic Lab Data: dead
CDC Split Type:

Write-up: He died , found dead after 24 hours, Closed casket, no foul play. I am unable to get an autopsy.


VAERS ID: 1675272 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-20
Onset:2021-09-04
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt. was vaccinated on08/20/2021 and was diagnosed with COVID after an exposure on 08/22/2021. COVID was listed as the cause of the death not the vaccine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None-He developed COVID after an exposure two days after the vaccine. He died of COVID 19


VAERS ID: 1675587 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-29
Onset:2021-07-31
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cabergoline .5 mg 2x/week
Current Illness: Chest congestion, cough, cold/flu symptoms.
Preexisting Conditions: Pituitary gland tumor
Allergies: None
Diagnostic Lab Data: Many tests were done at Hospital
CDC Split Type:

Write-up: Immune response, COVID-19 pneumonia. Patient told the pharmacist giving vaccine he was not feeling well. They did not test him for COVID and gave vaccine anyway. It is unknown if he officially had COVID-19, but he became sick almost immediately after getting the vaccine. Taken to hospital by ambulance on 08/06/2021, put on a ventilator on 08/13/2021 and died on 08/31/2021.


VAERS ID: 1675849 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-13
Onset:2021-04-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Fall, Haemorrhage intracranial, Head injury, Intracranial mass, Intraventricular haemorrhage, Magnetic resonance imaging head abnormal, Metastases to meninges
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 38
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, amlodipine, atorvastatin, carvedilol, vitamin D, dexamethasone, furosemide, levothyroxine, losartan, metformin, spironolactone
Current Illness:
Preexisting Conditions: clear cell renal cell carcinoma with metastatic lesions to brain, spine and lung; hypertension, hypothyroidism, type 2 diabetes, GERD,
Allergies: iodinated contrast
Diagnostic Lab Data: 4/14/21 K 2.4 4/14/21 CT head: 1 cm focus of high density also seen in the third ventricle. It could be a small focal acute hemorrhage in view of the patient''s history of trauma. 2. Curvilinear tram track high density seen in the left lateral ventricle. It could be vascular calcification or hemorrhage. 3. Slightly hyperdense structures seen in the right and left lateral ventricles. This could represent mildly acute hemorrhage in the choroid plexus, neoplasm, etc. 4/15/21 MRI brain: 1. Lobulated interventricular masses seen within the bilateral lateral ventricles but demonstrate enhancement and likely represent known intracranial metastasis. This is described on outside MRI report dated 3/17/2021 without images available for direct comparison to determine interval change. 2. Area of abnormal signal without enhancement is seen in the inferior left temporal horn extending to the third ventricle with layered intraventricular nonenhancing fluid. This finding likely represents intraventricular hemorrhage. No associated hydrocephalus. 3. Mild prominence of the leptomeninges with enhancement. This is nonspecific however leptomeningeal metastasis may be present. This was not described on previous imaging.
CDC Split Type:

Write-up: Day after vaccination fell backwards in parking lot trying to get into car. Hit head. Taken to ER. CT/MRI of brain showing evidence of 3rd ventricle and left lateral ventricle intracranial hemorrhage.


VAERS ID: 1676783 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-23
Onset:2021-09-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER UNKNOWN / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Basilar artery occlusion, Brain stem infarction, Brain stem stroke, Computerised tomogram head abnormal, Ischaemic stroke, Magnetic resonance imaging head abnormal, Thalamic infarction
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: DM, HTN
Allergies: NKA
Diagnostic Lab Data: CT head without contrast 9/1/2021 MRI brain without contrast 9/1/2021 CT head without contrast 9/2/2021
CDC Split Type:

Write-up: MRI brain showed large ischemic stroke involving brainstem, bilateral cerebellum, occipital and thalamic region due to basilar artery occlusion.


VAERS ID: 1677072 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210902754

Write-up: DIED; This spontaneous report received from consumer social media via a company representative concerned a 20 year old female of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died from unknown cause of death and it was unknown if an autopsy was performed. The action taken with covid-19 vaccine was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20210902775.; Sender''s Comments: V0:20210902754-covid-19 vaccine Died. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1677074 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USJNJFOC20210903589

Write-up: COVID-19; This spontaneous report received from a company representative concerned multiple patients of unknown race and ethnic origin. No past medical history or concurrent conditions were reported. The patients 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 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 "529 people had died of COVID-19 since 01-APR-2021. According to the ADPH, this included twenty people who were vaccinated, who did their part in the fight against COVID-19". It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210903589- JANSSEN COVID-19 VACCINE Ad26.COV2.S- COVID-19. 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


VAERS ID: 1677280 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / OT

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

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

Write-up: unknown cause of death; got real sick; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (unknown cause of death) and ILLNESS (got real sick) in a patient of an unknown age and gender 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (unknown cause of death) (seriousness criteria death and medically significant) and ILLNESS (got real sick) (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication information not provided. Treatment information not provided. Reporter girl friend is a truck driver and knows a few people who got real sick from getting it and passed away. He said they got the Moderna vaccine. He does not know if it is from the shot. He did not provide any further information. Very limited information regarding the patient, product, events, clinical details and concomitant medications has been provided at this time. Cause of death not provided. Lack of information limits the causality assessment.; Sender''s Comments: Very limited information regarding the patient, product, events, clinical details and concomitant medications has been provided at this time. Cause of death not provided. Lack of information limits the causality assessment.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1677294 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-24
Onset:2021-07-28
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dizziness, Fatigue, Illness, Malaise, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acute kidney failure; Cirrhosis liver; Hospitalization; Hypertension; Immune system disorder (weak immune system)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: arm was sore; felt really sick; dizziness; once he got the shot he just went downhill; nauseous; extremely fatigued; died on 28JUL2021, 4 days after receiving the vaccine, passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (died on 28JUL2021, 4 days after receiving the vaccine, passed away) in a 31-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Cirrhosis liver, Acute kidney failure, Hypertension, Immune system disorder (weak immune system) and Hospitalization from 03-May-2021 to 11-May-2021. On 24-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (arm was sore), ILLNESS (felt really sick), DIZZINESS (dizziness), MALAISE (once he got the shot he just went downhill), NAUSEA (nauseous) and FATIGUE (extremely fatigued). The patient died on 28-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PAIN IN EXTREMITY (arm was sore), ILLNESS (felt really sick), DIZZINESS (dizziness), MALAISE (once he got the shot he just went downhill), NAUSEA (nauseous) and FATIGUE (extremely fatigued) outcome was unknown. He had medications for his chronic illnesses. The patient had recent hospitalization from 03-May-2021 to 11-May-2021. No treatment information was reported. Company Comment: Very limited information regarding this event has been provided at this time. Further information has been requested. Patient?s underlying Cirrhosis , Acute kidney failure, Hypertension and Immune system disorder could be confounding factors for the case.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested. Patient?s underlying Cirrhosis , Acute kidney failure, Hypertension and Immune system disorder could be confounding factors for the case.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1677583 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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 INC202101134355

Write-up: she knew/heard someone past away (die) due to inflammation of the heart; This is a spontaneous report from a contactable consumer via Pfizer Sponsored Program. This consumer reported for two patients. This is the second of two reports. A female patient of an unspecified age received BNT162B2, via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The reporter would like to know if inflammation of the heart was a commonly reported side effect post-vaccination of the COMIRNATY vaccine and if there had been a lot of reports about it. The reporter stated that she knew/heard someone past away (die) due to inflammation of the heart (onset date not reported) as an AE post-vaccination. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Sender''s Comments: Linked Report(s) :PFIZER INC-202101132810 Same reporter/drug, different patient/AE; Reported Cause(s) of Death: she knew/heard someone past away (die) due to inflammation of the heart


VAERS ID: 1677599 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hashimoto''s disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101139821

Write-up: Got a blood clot that went to his brain and died; This is a spontaneous report from a contactable consumer (patient''s friend) based on information received by Pfizer, on behalf of Moderna (Case: MOD21-136450). A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Lot number and expiration date was not reported) as dose 2, single for COVID-19 immunization. Medical history included Hashimoto''s disease. The patient''s concomitant medications were none. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Lot number and expiration date was not reported) as dose 1, single for COVID-19 immunization. On an unspecified date, the patient got a blood clot that went to his brain and had died on an unspecified date after 16-18 days of being fully vaccinated. 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: Got a blood clot that went to his brain and died


VAERS ID: 1678243 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210902860

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer via a company representative from social media (Twitter) concerned multiple (two female) patients. The patient''s weight, height, and medical histories were not reported. The patients 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 was not reported for prophylactic vaccination. Batch numbers were not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On an unspecified date, multiple (two) patients developed blood clots. As per the reporter, "We already know JnJ had to halt Vax distribution temporarily because of 2 reported deaths from blood clots in women". Patients died on unspecified date(s). It was not reported if an autopsy was performed. Action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20210902860- covid-19 vaccine ad26.cov2.s-Blood Clots. 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: BLOOD CLOTS


VAERS ID: 1678295 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

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


VAERS ID: 1678327 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-08-14
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Anticoagulant therapy, Asthenia, Bilevel positive airway pressure, Blood beta-D-glucan, Blood bicarbonate normal, Blood creatinine increased, Blood culture, Blood glucose normal, Blood lactate dehydrogenase, Blood pH normal, Brain natriuretic peptide, C-reactive protein, COVID-19, COVID-19 pneumonia, Chemotherapy, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Clostridium test negative, Colectomy, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Death, Differential white blood cell count, Dyspnoea, Echocardiogram, Ejection fraction, Electrocardiogram normal, Endotracheal intubation, Fatigue, Fibrin D dimer, Full blood count, Fungal test, Haemoglobin decreased, Hepatic mass, Hyperglycaemia, Hypertension, Hypoxia, Ileostomy, Immunodeficiency, Infection, Intensive care, Laboratory test, Legionella test, Leukocytosis, Lung opacity, Neutropenia, Neutrophil count decreased, Obesity, Oxygen saturation decreased, PCO2 normal, PO2 decreased, Pancytopenia, Platelet count normal, Pneumonia bacterial, Polyuria, Positron emission tomogram abnormal, Procalcitonin, Prone position, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Septic shock, Serum ferritin, Shock, Sleep apnoea syndrome, Streptococcus test, Supine position, Troponin, Ultrasound Doppler, Urine analysis, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Agranulocytosis (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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: 2021-09-03
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inhaler, cefdinir, diphenoxylate-atropine, melatonin, promethazine-codeine, silver sulfadiazene cream, triamcinolone cream, trimethoprim-polymyxin b eye drops, aspirin, atorvastatin, vitamin B complex, bisoprolol, bupropion, chol
Current Illness:
Preexisting Conditions: depression, insomnia, GERD, hypothyroidism, COPD, OSA on BiPAP at bedtime, DMII, HTN, HLD, CAD s/p PCI with stents x 6 (last 8/2021), and metastatic colon cancer on chemotherapy
Allergies: empagliflozin (itching, rash, unknown), glipizide (itching, rash, unknown), quetiapine (itching, rash, unknown), Januvia (unknown, other, rash), lithium (other, unknown), olanzapine (other, unknown)
Diagnostic Lab Data: XR Chest 1 View Result Date: 8/13/2021 Narrative: Exam/Procedure: XR CHEST 1 VIEW ordered by GEOFFREY P MCGOWEN, 081065 CLINICAL INDICATION: SOB TECHNIQUE: XR CHEST 1 VIEW COMPARISON: 9 months prior FINDINGS: Left-sided Infuse-a-Port catheter borderline prominence heart. Prominent indistinct bronchovascular markings. Patchy opacities in both lungs predominantly perihilar. Somewhat the patchy opacities or increased densities in both lungs. Minimally blunted costophrenic angles. Underlying mass lesions would be difficult to exclude. Arthritic changes in acromioclavicular joints. Possibly a combination of atypical infection and edema?
CDC Split Type:

Write-up: Patient received second dose of COVID vaccine on 3/31/2021, tested positive for COVID on 8/14/21. 8/14/21: History Of Present Illness Patient is a 61 y.o. male with a PMH of depression, insomnia, GERD, hypothyroidism, COPD, OSA on BiPAP at bedtime, DMII, HTN, HLD, CAD s/p PCI with stents x 6 (last 8/2021), and metastatic colon cancer on chemotherapy presents to ED with dyspnea. Pt reports having a cough and congestion that started last Thursday (8/5). Pt reports feeling more fatigue as well which he thought was related to cycle 2 of FOLFIRI that he just completed. Pt was evaluated by his PCP on 8/5 and started on cough medicine with Cefdinir. Pt was not tested for COVID19 at that time. Pt reports his symptoms became progressively worse with dyspnea even at rest over the last 3 days. Pt reports he has been checking his SpO2 at home with saturations as low as 81% on room air yesterday. Pt reports fever at night as high as 102. Pt denies nausea, vomiting, diarrhea, abdominal pain, dysuria, sore throat, chest pain, heart palpitations, travel, or known sick contacts. Pt received the COVID19 vaccine a few months ago. On presentation to the ED, pt with SpO2 in the low 80''s. Pt was placed on 6L nasal cannula with slight improvement with SpO2 88-90%. Pt then placed on his home BiPAP that he wear at night with improvement of his SpO2. Pt then weaned back down to 4L nasal cannula with SpO2 90% on admission. CXR shows patchy opacities in both lungs that could be edema pneumonia and atypical infection. COVID19 was positive. IM consulted for admission. Assessment and plan: 61 y.o. male with a PMH of depression, insomnia, GERD, hypothyroidism, COPD, OSA on BiPAP at bedtime, DMII, HTN, HLD, CAD s/p PCI with stents x 6 (last 8/2021), and metastatic colon cancer on chemotherapy presents to ED with dyspnea. Pt reports having a cough and congestion that started last Thursday (8/5). Pt reports feeling more fatigue as well which he thought was related to cycle 2 of FOLFIRI that he just completed. Pt was evaluated by his PCP on 8/5 and started on cough medicine with Cefdinir. Pt was not tested for COVID19 at that time. Pt reports his symptoms became progressively worse with dyspnea even at rest over the last 3 days. Pt reports he has been checking his SpO2 at home with saturations as low as 81% on room air yesterday. Pt reports fever at night as high as 102. Pt denies nausea, vomiting, diarrhea, abdominal pain, dysuria, sore throat, chest pain, heart palpitations, travel, or known sick contacts. Pt received the COVID19 vaccine a few months ago. Acute Hypoxic Respiratory Failure likely 2/2 COVID19 in Immunocompromised with Neutropenia Obstructive Sleep Apnea ?COPD -On presentation to the ED, pt with SpO2 in the low 80''s. Pt was placed on 6L nasal cannula with slight improvement with SpO2 88-90%. Pt then placed on his home BiPAP that he wear at night with improvement of his SpO2. Pt then weaned back down to 4L nasal cannula with SpO2 90% on admission. Wife placing pt back on BiPAP with home setting for the night -pH 7.4, PCO2 36, PO2 50, and HCO3 22 -WBC 2118 with ANC 1590 -Troponin 18--- $g19 -EKG without acute ST changes -COVID 19 positive on 8/13/21 -BNP, procal, LDH, CRP, d dimer, and ferritin pending -CBC with diff, ferritin, LDH, d dimer, and CRP daily with AM labs -Pt given Vanc and Cefepime in the ED, will hold further antibiotics for now. Strep pneumo, legionella, and blood cx pending -Pt started on Decadron 6mg daily and Remdesivir per protocol -Titrate O2 to maintain SpO2 $g 95% -MDI with spacer given COVID PRN -Airborne, contact and eye protection precautions Metastatic Colon Cancer on Chemotherapy -Follows with Oncology -s/p colectomy then end ileostomy -s/p 6 cycles FOLFOX -PET in June with liver and poss mediastinal node -Started on FOLFIRI with bevacizumab added Cycle #2 on 8/3/21 (with plans for ECHO Q3 months) -Consult Oncology as needed Pancytopenia -Hgb 11.0, Platelets 153K, and WBC 2118 with ANC 1590 -Etiology likely 2/2 chemotherapy -Continue to trend, transfuse Hgb < 7 and platelets < 10,000 Acute Kidney Injury -sCr 1.37, baseline ~1.0 to 1.1 -UA pending -Avoid NSAID/Nephrotoxin -Renal dose medications -Strict I&O -Repeat BMP in the AM Type II Diabetes with Hyperglycemia -Glucose was 123 on admission -Pt on Metformin and Victoza at home -FSBS AC/HS with correctional insulin -Consistent carb diet CAD -s/p cardiac stents x 6, last 2 placed in 2020 -ECHO 8/2021 with EF 50-60% -Resume home ASA, Plavix, and statin -Will hold home Losartan in setting of AKI, resume as appropriate -Will resume home Bisoprolol for now -Resume home Spironolactone Hypertension -SBP 100''s on admission -Will hold home Losartan in setting of AKI, resume as appropriate -Will resume home Bisoprolol for now Obesity -BMI 36.96 -Complicates all aspects of care 9/3/21: Discharge Summary Hospitalization Admit Date/Time: 8/13/2021 9:57 PM Admitting Attending: Discharge Date: 9/3/21 Discharge Attending Physician: Md 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 61 y.o. male with a PMH of depression, insomnia, GERD, hypothyroidism, COPD, OSA on BiPAP at bedtime, DMII, HTN, HLD, CAD s/p PCI with stents x 6 (last 8/2021) at CB, Familial Hydrocalcicuric Hypercalcemia and metastatic colon cancer on chemotherapy presents to UK ED with dyspnea on 8/13, found to be COVID + 8/14. Per chart review, patient called his medical oncologist with worsening respiratory symptoms and he was advised to come to ER for workup for fever and possible COVID symptoms. Of note, patient did receive Pfizer COVID Vaccine [3/6, 3/31]. Patient thought his increasing fatigue and weakness was related to cycle 2 of FOLFIRI that he just completed. On presentation to the ED on 8/13, pt with SpO2 in the low 80''s. Pt was placed on 6L nasal cannula with slight improvement with SpO2 88-90%. Pt then placed on his home BiPAP that he wear at night with improvement of his SpO2. CT PE remarkable for GGO and consolidations most consistent with multifocal infection. During the afternoon of 8/14, MICU was consulted for increasing oxygenation requirements. On examination patient is on HFNC 40L/60% with a nonrebreather. Sats 88-91%. Increased work of breathing appreciated. Admitted to MICU for further management and evaluation. After admission to ICU, he remained on HFNC. He was diuresed and started on broad spectrum antibiotics with Vanc and Cefepime and dexamethasone 6mg. On 8/17, he had a hypoxic event after coughing, and was placed on 100% BiPAP with improvement in hypoxia. However, later in the afternoon on 8/17, he was intubated for hypoxia. He was started on low dose vasopressors after intubation and increased to dexa/ARDS. He completed 7-day course of empiric Cefepime for secondary bacterial PNA on 8/20. He completed dexa/ARDS on 8/26. He has been intermittently diuresed. He was proned on 8/25 due to severe ARDS and decreased PF ratio. He was supined on 8/27. On 8/28, he spiked a fever and had worsened leukocytosis (from 15k to 40k) along with shock. He was re-cultured and started on empiric broad-spectrum Vanc and Zosyn. He had increased ileostomy output at that time, therefore C. Diff sample was obtained, however was negative. Levophed drip was started for septic shock. He has had persistent fever despite Tylenol and worsening leukocytosis and without source, therefore venous duplex and beta glucan and fungal serologies obtained on 8/29. RESOLVED ISSUES: Pancytopenia (POA) (Resolved) - Etiology likely due to chemotherapy - Continue to trend, transfuse Hgb < 7 and platelets < 10,000 Given severity of patient''s respiratory failure/ARDS secondary to COVID-19 pneumonia he will be unable to receive any chemotherapy for the foreseeable future. Heme Onc was consulted and without chemotherapy his aggressive metastatic colon cancer will likely cause him to pass away. Extensive discussions with his wife and she wishes to make him comfortable and terminally extubate with our inpatient hospice team. Time of Death: 9/3/21 10:52pm


VAERS ID: 1678477 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-25
Onset:2021-08-22
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COVID-19, Hepatitis B, Deep Vein Thrombosis, Arthritis, Depression, Diabetes, Chronic Obstructive Pulmonary Disease, Hyperlipidemia, Hypertension, Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death due to COVID-19


VAERS ID: 1678487 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-08-27
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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: 2021-08-27
   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: COVID-19, Lung Cancer, Atrial Fibrillation, Pulmonary Fibrosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death due to COVID-19


VAERS ID: 1678499 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-08-24
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine breakthrough, symptomatic. Inpatient admit 8/23-9/5. Expired.


VAERS ID: 1678502 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-28
Onset:2021-09-05
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 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: 2021-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPIRED OF COVID-19 ON 9/5/2021; BREAKTHROUGH CASE


VAERS ID: 1678562 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-09-05
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-07
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: 2021-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPIRED FROM COVID-19 ON 9/5/2021; BREAKTHROUGH CASE


VAERS ID: 1678570 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-16
Onset:2021-08-13
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Acute respiratory distress, SOB, positive COVID test


VAERS ID: 1678597 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-26
Onset:2021-08-22
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Arthralgia, COVID-19, Cardiac failure, Computerised tomogram abnormal, Cough, Death, Decreased appetite, Dyspnoea, Electrolyte imbalance, Endotracheal intubation, Exposure to SARS-CoV-2, Pyrexia, Retroperitoneal haemorrhage, SARS-CoV-2 test positive, Transfusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, type 2 diabetes, hypercoagulability with a protein S deficiency
Allergies: Actos, aspirin, bactrim, celebrex, clindamycin, glipizide, pencillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted on 8/22/2021 with fever, cough, dyspnea and decreased appetite. Had contact with COVID + person 6-7 days prior. COVID + on admission.. Received remdesevir 5 day course, steroids, azythromycin, rocephin. Intubated on 8/25. recovering well and extubated on 8/31. on 9/1 complaint of right hip pain and had episode of decompensation requiring intubation nd pressors. CT showed acute retroperitoneal bleed. Received blood products. Bleeding stabilized but continued acute renal failure and electrolyte abnormalities. Family opted for comfort care measures.


VAERS ID: 1678683 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-09-03
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-07
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: 2021-09-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, Hygroton, Synthroid, Coumadin, Klor-Con, Toprol, Claritin, Pepcid, Vit D, Lotrimin, Calmoseptine, Prilosec, Ventolin
Current Illness:
Preexisting Conditions:
Allergies: Lasix
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 09/03/2021.


VAERS ID: 1678809 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-06
Onset:2021-08-19
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Endotracheal intubation, Intensive care
SMQs:, Angioedema (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 15
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: CHF, DM TYPE 2, CKD, DJD, DEPRESSION, GERD, VITAMIN D DEFICIENCY, RLS, PSORIASIS, OBESITY, TOBACCO USE HISTORY
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type: 4429405

Write-up: HOSPITALIZED WITH COVID PNEUMONIA 8/19/2021, ICU AND INTUBATED 8/24/2021, DEATH 9/3/2021


VAERS ID: 1678823 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-06-24
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardioversion, Cerebral infarction, Death, Electroencephalogram abnormal, Encephalopathy, Endotracheal intubation, Feeding intolerance, Gastrointestinal necrosis, Gastrostomy, Ischaemia, Jejunostomy, Loss of consciousness, Magnetic resonance imaging head abnormal, Mechanical ventilation, Palliative care, SARS-CoV-2 test positive, Surgery, Therapeutic hypothermia, Wean from ventilator
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Respiratory failure (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: 2021-06-24
   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: Albuterol, Celexa, Cardizem, Tiazac, Lisinopril, Xarelto
Current Illness:
Preexisting Conditions: A fib, HTN, osteoarthritis, asthma, NSTEMI, normocytic anemia
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated patient who tested positive for COVID with admission testing to hospital. Patient admitted 05/25/21 after an out of hospital cardiac arrest with return of spontaneous circulation after EMS arrival and administration of epinephrine and shock. Patient intubated upon arrival to ED and provided hypothermia protocol. Patient did not have return of consciousness. Encephalopathy and acute to subacute brain infarct per MRI and "severe diffuse encephalopathy" per EEG. Family requesting continuation of "aggressive care." PEG tube placed, feedings were not tolerated so patient was sent back to surgery for removal of PEG and placement of J tube for feedings during which time she was found to have necrotic stomach from ischemia. Family meeting including Palliative Care team and family chose to change to comfort care. Patient was removed from ventilator on 06/24/21 and died shortly after.


VAERS ID: 1678834 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-05
Onset:2021-09-03
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH 9/3/2021


VAERS ID: 1678923 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-08-14
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 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: dyspnea, positive COVID test, HTN, aches, non-small cell CA, taking chemo


VAERS ID: 1678944 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-08-01
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 18
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: hx of renal transplant, hypoxia, positive COVID test


VAERS ID: 1678955 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Laboratory test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   Days after onset: 33
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: allopurinol 100 MG Oral Tablet (Allopurinol) 100 Mg TABLET Active 100 MG PO Daily aspirin 81 MG Delayed Release Oral Tablet (Aspirin Ec) 81 Mg TABLET.DR Active 81 MG PO Daily 30 30 March 25th, 2021 10:08am carvedilol 12.5 MG Oral Tab
Current Illness: diagnosed with covid when brought to hospital
Preexisting Conditions: heart, diabetes, high blood pressure
Allergies: none
Diagnostic Lab Data: Many can be provided if requested. Was in the hospital so they did many tests multiple times daily
CDC Split Type:

Write-up: had a couple of fainting episodes after first vaccine, but collapsed and was hospitalized 2 days after second dose


VAERS ID: 1678961 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-08-07
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   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: hx cardiopulmonary disease, dyspnea, hypoxia, positive COVID test


VAERS ID: 1678982 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-05-13
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Pneumonia viral, SARS-CoV-2 test positive, Sepsis
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive COVID test, viral pneumonia, hypoxic, sepsis


VAERS ID: 1678986 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-01-18
Onset:2021-01-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Hypertension, dementia
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis leading to death


VAERS ID: 1679014 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-22
Onset:2021-09-04
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Asthenia, Bilevel positive airway pressure, Blood beta-D-glucan positive, COVID-19 pneumonia, Hypoxia, Lung infiltration, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol, Norvasc, Vitamin C, Aspirin, Lipitor, Multivitamin, Aricept, Lasix, Lopressor, Procardia XL, fish oil, Prilosec, Miralax, K-Dur, Ultram, Turmeric supplement.
Current Illness:
Preexisting Conditions: Hypercholesterolemia, glaucoma, gout, pituitary tumor, osteoarthritis, transverse colon mass, malignant neoplasm of transverse colon, hyperparathyroidism, chronic kidney injury, anemia, obesity (class 1),
Allergies: Benazapril, seasonal allergies
Diagnostic Lab Data: COVID positive test on 08/08/21. 08/31/21 1,3 Beta D Glucan = 84 pg/mL
CDC Split Type:

Write-up: Fully vaccinated patient admitted for COVID PNA. Treated with Remdesivir and decadron. Discharged to facility on 08/20/21. Returned to ED on 08/22/21 with hypoxia and weakness, discharged back to facility with O2. Returned to ED again on 08/30/21 with hypoxia and started on Bipap. CTA showed extensive infiltrates and was negative for pulmonary emboli. Started on empiric antibiotics with concerns for secondary infection/PNA, diuresis, and steroids. Continued to decline and became comfort care on 09/02/21. Went into cardiac arrest on 09/04/21 and died.


VAERS ID: 1679065 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-08-31
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / IM

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

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

Write-up: Pt. contracted COVID-19.


VAERS ID: 1679098 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-12
Onset:2021-08-20
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Bardycardia, HTN, Myasthenia gravis
Allergies: No known allergies
Diagnostic Lab Data: Covid positive 8/16
CDC Split Type:

Write-up: Pt was hospitalized with Covid and died 8/20-9/3


VAERS ID: 1679133 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-26
Onset:2021-08-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / -

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

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

Write-up: The patient''s husband informed the pharmacy that the patient passed away the day following vaccination. He stated he was unaware of the cause of death at this time.


VAERS ID: 1679141 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-11
Onset:2021-08-29
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 3
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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was taken with the ER, tested positive for COVID-19 upon admission. He passed away on 9/01/21


VAERS ID: 1679166 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-05
Onset:2021-04-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Death, Dyspnoea, Dyspnoea exertional, Fear, Hepatic failure, Incomplete course of vaccination, Lethargy, Pulmonary thrombosis, Renal vascular thrombosis, Slow speech
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Renovascular disorders (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 35
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: Diabetes but was no longer needing medication. Kidney Disease, kidney had not changed in 5 years.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4/5/2021 patient received 1st shot on 4/10/2021 noticed that she was lethargic, we thought that is might be her blood sugar but it was in normal range. we continued to check blood sugar daily thinking that was causing her to be lethargic and voice to be slow. 4/23/2021 my son and I spent the day with her noticing and she was getting worse but had also noticed that she was getting winded easily and would need to sit down. 4/26/2021 canceled 2nd covid shot. 4/30/2021 at about 1:30 pm she called me and said something was wrong something just happened she was scared! She called her Dr. and spoke to the the nurse PA. My sister was with her at the time so they checked for stoke signs none were found. Spoke to my mom through out the day on 5/1 & 5/2/2021 and she sounded out of breath and very lethargic. 5/3/2021 the Nurse PA called mom and said that she needed to go to the hospital where she stayed until she passed away on 5/15/2021. She had passed blood clots to her lungs then kidney and liver failure.


VAERS ID: 1679272 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-08
Onset:2021-03-18
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram abnormal, Atrial fibrillation, Atypical pneumonia, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Death, Hypotension, International normalised ratio decreased, Liver function test increased, Pulmonary congestion
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), 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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 11
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: Buspirone, calcium carbonate with vitamin D, Tums, docusate, duloxetine, ferrous sulfate, fluticasone, levothyroxine, magnesium oxide, meclizine, metoprolol succinate, omeprazole, potassium chloride, pramipexole, pravastatin, simethicone, t
Current Illness: None
Preexisting Conditions: CLL, chronic atrial fibrillation, chronic systolic CHF EF of 20-25%, stage III A chronic kidney disease, nursing home resident, severe protein calorie malnutrition
Allergies: erythromycin, lovastatin, penicillins, prevacid, ropinirole
Diagnostic Lab Data: Chest xray: opacification in left lower lung showing pneumonia
CDC Split Type:

Write-up: Patient was transferred to Hospital from different Hospital with acute hypoxic respiratory failure, COVID pneumonia, afib with RVR, and pulmonary vascular congestion. CTA chest was negative for a PE but again demonstrated concern for an atypical pneumonia along with evidence of pulmonary vascular congestion. She was noted to be in afib with RVR and was placed on a cardizem gtt. She received a dose of lovenox as her INR was subtherapeutic at 1.3. Kidney function appeared stable. Received a dose of dexamethasone at the other hospital. BP is on low side while on the cardizem but HR is now in the 80s. She is on 3-4L O2 NC. She was placed on dexamethasone and remdesivir, but remdesivir was stopped due to elevated liver function tests


VAERS ID: 1679276 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-23
Onset:2021-08-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Computerised tomogram thorax abnormal, Death, Laboratory test abnormal, Lung infiltration, Malaise, Sepsis, White blood cell count increased
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TYLENOL, TRAMADOL, METOPROLOL TARTRATE, BENAZEPRIL, CHOLECALCIFEROL, GABAPENTIN, HCTZ, MAGNESIUM, OMEPRAZOLE, ZINE
Current Illness:
Preexisting Conditions: BENIGN HYPERTENSION, CHRONIC LOW BACK PAIN, DM 2, OSTEOARTHRITIS, GERD, MIGRAINE W/AURA, MIXED HYPERLIPIDEMIA, HRT, SYNCOPE
Allergies: PENICILLIN, SULFA, PRAVASTATIN, CODEINE
Diagnostic Lab Data: CHEST CT 08/16 WITH SEVERE BILATERAL PATCHY INTERSITITIAL AND ALVEOLAR INFILTRATES; LAB SHOWS SEPTICIMIA WBC 12.9 H
CDC Split Type:

Write-up: PHYSICIAN STATES PATIENT RECEIVED JOHNSON AND JOHNSON VACCINE ON 07/23/2021. BECAME ILL 08/06/2021, RESULTING IN COVID PNEUMONIA AND PATIENT''S EXPIRATION ON 09/05/2021


VAERS ID: 1679277 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-23
Onset:2021-05-16
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Chest X-ray, Computerised tomogram head, Computerised tomogram neck, Computerised tomogram thorax, Contusion, Death, Extremity contracture, Laboratory test, Loss of consciousness, Neck surgery, Respiration abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   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: Amlodipine 5mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: All tests were conducted on 5/17/2021. -CT scan head/neck -Radiology/chest -CT/Scan/Head and Neck -CT Scan/Chest -Surgery Neck/Throat There were numbers labs run but I do not have the results
CDC Split Type:

Write-up: 1015 , I found my mother on the floor. She had a contusion on her head from hitting a table edge on the way down. Her right hand was curled up near her face. She was unconscious and breathing with a very loud rasping sound. She was taken to the hospital by ambulance. The Dr told us she had a catastrophic event. One side of her brain was filled with blood. Surgery or comfort care was the only choice. At 1317 they removed everything and began comfort care. Approximately 2000 she was moved to the hospice floor and passed away at approximately 2200..


VAERS ID: 1679301 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-20
Onset:2021-09-06
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None that are mentioned during appointment
Current Illness: Patient marked for diabetic other than that none
Preexisting Conditions: Patient marked for diabetic
Allergies: Patient claims to not have any allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wife claims that patient was coughing up blood after they received the shot and passed away, not much else was described


VAERS ID: 1679351 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-17
Onset:2021-02-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cardiomegaly, Chest X-ray abnormal, Chronic left ventricular failure, Condition aggravated, Cough, Death, Immunodeficiency, Mental status changes, Oxygen saturation decreased, Peripheral swelling, Pleural effusion, Pneumonia, SARS-CoV-2 test positive, Subclavian vein thrombosis, Ultrasound Doppler abnormal, Weight increased
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (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), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 105
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: Acetaminophen, allopurinol, amlodipine, aspirin, atorvastatin, calcitriol, donepezil, famotidine, tamsulosin, hydroxyzine, loperamide, losartan, metoprolol succinate, oxybutynin, prednisolone eye drops, prochlorperazine, montelukast, sodium
Current Illness:
Preexisting Conditions: CAD status post CABG x1 in 2014, ischemic cardiomyopathy, chronic diastolic CHF, paroxysmal atrial fibrillation, on Coumadin, pulmonary hypertension, sick sinus syndrome status post biventricular ICD, severe aortic stenosis status post TAVR, CKD stage 3, multiple myeloma, chronic anemia, hypertension and Alzheimer''s dementia.
Allergies: Amiodarone and tramadole
Diagnostic Lab Data: 3/20/21 Chest xray: Cardiomegaly with changes of CHF and bilateral pleural effusions. Superimposed pneumonia is also consideration. This has progressed since the prior. 3/20/21: Nonocclusive thrombus left subclavian vein. 3/20/21: COVID 19 positive
CDC Split Type:

Write-up: He was noted to have had a change in his mental status as per nursing home staff. Over the night his saturation dropped to 61% on room air because the patient took off his oxygen bed saturation came back to 90s after oxygen was replaced. He does have occasional cough. He has developed worsening swelling in his legs and has gained 20 lb since February 14th. Was placed on dexamethasone, azithromycin, cefepime and vancomycin due to immunocompromised state and chest xray showing pneumonia. Also received remdesivir. Resolved and discharged on 3/26/21. Came back on 4/27/21 for 8 days due to acute hypoxic respiratory failure and found to have CHF exacerbation. Was put on Hospice. Died 6/3/2021


VAERS ID: 1679762 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Finasteride - 5mg (1 per day) - prostate medication Flomax - .4mg (1 per day) - prostate medication Losartan Potassium - 50mg (1 per day) - Blood pressure medication MegaRed - (1 per day) over the counter krill oil for cholesterol Celecoxi
Current Illness: None
Preexisting Conditions: Obesity, enlarged prostate, slightly high blood pressure, bilateral total knee replacements.
Allergies: None
Diagnostic Lab Data: Upon calling emergency services, first responders arrived on the scene and called the Examiners office. They were advised that he had received the covid vaccine earlier in the day; however, they declined sending a ME / coroner and also declined an autopsy even though it was requested by his family and it was an unattended death. His body was then transported to Funeral Home in. The next day, his family requested that the funeral home reach out a second time to the ME office to request an autopsy. The request was denied a second time and the family proceeded with burial. No physician had an opportunity to examine his body. His primary care provider who he hadn''t physically seen since January reluctantly signed the death certificate.
CDC Split Type:

Write-up: Received the vaccine at approx 8:45 am on 8/27. Spent the day at the house with his son and claimed to be feeling totally fine throughout the day. Was last seen alive by his son at 2:30 pm and advised that he felt fine at that time. He was found deceased at 4:00 pm by his son sitting in his workshop with his tools still in his hands and sitting upright.


VAERS ID: 1681562 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dementia, Helplessness, Mobility decreased
SMQs:, Dementia (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: it lead to the death of my mother; her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia; she became totally helpless; unfunctioning after the second shot; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (it lead to the death of my mother), DEMENTIA (her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia), HELPLESSNESS (she became totally helpless) and MOBILITY DECREASED (unfunctioning after the second shot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Memory disturbance (patient had minor memory problems). On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DEATH (it lead to the death of my mother) (seriousness criteria death and medically significant), DEMENTIA (her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia) (seriousness criteria disability and medically significant), HELPLESSNESS (she became totally helpless) (seriousness criterion disability) and MOBILITY DECREASED (unfunctioning after the second shot) (seriousness criterion disability). 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, DEMENTIA (her mind went totally of the rails,She went from some minor memory problems to full blowing dementia/she became with dementia), HELPLESSNESS (she became totally helpless) and MOBILITY DECREASED (unfunctioning after the second shot) outcome was unknown. No concomitant medications or treatment details were reported. The patient was in her 90s and was reportedly a vibrant person in full health and fully functioning. She just got her driving license and was driving, cooking, cleaning and walking. But within a week from the second shot she developed dementia and lead to her death. This a report of dead after receiving the product in a 90-years old female patient with Relevant Medical History of Minor memory problems.It is unknown if an autopsy was performed. Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded. Very limited information regarding the event has been provided. Further information has been requested . This case was linked to MOD-2021-294328 (Patient Link).; Sender''s Comments: This a report of dead after receiving the product in a 90-years old female patient with Relevant Medical History of Minor memory problems.It is unknown if an autopsy was performed. Based on the current available information and temporal association between the use of the product, and the start date of the events, a causal relationship cannot be excluded. Very limited information regarding the event has been provided. Further information has been requested .; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1681700 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Dehydration, Dizziness, Fatigue, Haematochezia, Influenza like illness, Pyrexia, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 91
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Uncertain
Current Illness: Unknown
Preexisting Conditions: COPD, Hypertension
Allergies: None
Diagnostic Lab Data: Uncertain. He did have tests conducted in December 2020 prior to surgery and he was cleared for surgery. He had urine testing preformed at PCP in May 2021. I believe he has been attempting to schedule with a colon/rectal doctor as well to schedule colonoscopy. Not sure if this occurred.
CDC Split Type:

Write-up: After the first dose he complained of bloody stool, severe vomiting, high fever and flu-like symptoms. His symptoms occurred within a few hours of receiving his first dose and lasted approximately 21 days. He said he felt ?run down,? and similar feelings of dehydration and exhaustion. He had the above side effects with second dose but complained that the magnitude of symptoms were much worse and bloody stool increased. He complained of feeling as if he was going to ?pass out,? upon instances of brief aerobic activity. Upon the


VAERS ID: 1682014 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101123407

Write-up: passed away; This is a spontaneous report received from a non-contactable consumer from a Pfizer-sponsored program. The consumer reported same events for two patients (two friends). This is one of the two reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date as dose 2, single; dose 1 via an unspecified route of administration on an unspecified date as dose 1, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient took both doses and passed away on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101123341 Same reporter/drug/event, different patient; Reported Cause(s) of Death: passed away


VAERS ID: 1682027 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-08
Onset:2021-08-25
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (Verbatim: high blood pressure); Cancer (Caller reports his 29 y/o male son (history of brain cancer)); CPAP; Diabetes (Verbatim: Diabetes)
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: Test Result:High
CDC Split Type: USPFIZER INC202101128462

Write-up: Found him dead while he was sleeping; Heart attack; This is a spontaneous report from a contactable consumer. This consumer (patients brother) reported for a 66-year-old male patient (reporters brother). A 66-year-old male had received BNT162B2 (Pfizer-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/lot number and expiration date: not reported) via an unspecified route of administration on 08jun2021 as DOSE 2, SINGLE for covid-19 immunization (At the age of 66 years).The patient medical history had included High blood pressure, Diabetes, and Continuous positive airway pressure. It was reported that, patients brother son had brain cancer. He was on high blood pressure medication and was diabetic but, does not know what medication he was on. He is not sure of the name and can''t say.The patient concomitant medication He was on high blood pressure medication. It was reported that there was no idea that patient took any vaccination within 4 weeks of vaccination. The patient previously took first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot Number: PHURCR8735) on 18May2021 as DOSE 1, SINGLE for COVID-19 Immunization. On 25Aug2021 the patient found while he was sleeping. It was reported that, received Comirnaty second dose and died in his sleep 6 weeks later and was found dead last Wednesday when he was sleeping. He reports he was cremated so an autopsy was unable to be performed so they are unable to determine if there is a connection between the vaccine and his death. He wants to know if deaths after the vaccine have been reported. As cause of death was unknown, Caller figured he just had a heart attack. He still had his CPAP machine on and had copabilities. They figured he would outlast all of them. The patient was on a CPAP machine, had diabetes that wasn''t too bad, and was overweight, probably about 250 pounds, and had been taking blood pressure medications for years. The patient had not visited any emergency room and physician office. The clinical outcome of the event Found him dead while he was sleeping and heart attack was fatal. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: Found him dead while he was sleeping


VAERS ID: 1682056 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101138389

Write-up: Died of cardiac arrest; Inflammation on his heart; This is a spontaneous report from a contactable consumer or other non-HCP (patient friend) via Medical Information Team. A male patient of an unspecified age received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- UNKNOWN) via an unspecified route of administration as dose number unknown single for COVID-19 immunization. Patient medical history and concomitant medications were not reported. Patient died recently and he was a bigger man. He experienced inflammation on his heart and died of cardiac arrest. It was unknown if an autopsy was done. The outcome of the event inflammation on his heart was unknown. The lot number for [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: Died of cardiac arrest


VAERS ID: 1682092 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Drug ineffective
SMQs:, Lack of efficacy/effect (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 INC202101139471

Write-up: My dad has been on Pfizer vaccine and he passed away from the complications because of it; He passed away, because of your vaccine; your vaccine, that doesn''t work; This is a spontaneous report from a contactable consumer or other non hcp. A male patient of an unspecified age received bnt162b2 (BNT162B2, Formulation: Solution for injection, Lot number was not reported, Expiry date: Unknown) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. It was reported that on an unspecified date, my dad has been on Pfizer vaccine and he passed away from the complications because of it, he passed away, because of your vaccine. Reporter stated, he passed away, because of your vaccine. He never went to other house. Nobody came to his house. Last time he left the house when he got the vaccine and he died from it. Reporter want all to hold up to your vaccine because your vaccine, that doesn''t work. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of the event was fatal. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: My dad has been on Pfizer vaccine and he passed away from the complications because of it; He passed away, because of your vaccine


VAERS ID: 1682094 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-31
Submitted: 0000-00-00
Entered: 2021-09-08
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? 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 INC202101141749

Write-up: My best friend just dies after taking the Pfizer Covid shot; This is a spontaneous report from a contactable consumer or other non hcp. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection Batch/Lot number was not reported) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. The patient medical history was not reported and concomitant medications were not reported. On 31Aug2021, It was reported his best friend just dies after taking the pfizer covid shot. The outcome of event was fatal.; Reported Cause(s) of Death: My best friend just dies after taking the Pfizer Covid shot


VAERS ID: 1682095 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
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 INC202101141821

Write-up: my friend''s grandmother died; This is a spontaneous report from a contactable consumer reported for friend''s grandmother via a female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (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 stated that her friend''s grandmother died with the Pfizer COVID 19 vaccine on an unspecified date. It was not reported if an autopsy was performed. The lot number for BNT162B2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: my friend''s grandmother died


VAERS ID: 1682403 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-11
Onset:2021-08-01
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 28
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: unknown
Current Illness: unknown
Preexisting Conditions: None
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 and is now deceased


VAERS ID: 1682432 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-29
Onset:2021-08-28
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Blood lactate dehydrogenase increased, Bordetella test negative, C-reactive protein increased, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Chlamydia test negative, Condition aggravated, Confusional state, Coronavirus test negative, Death, Enterovirus test negative, General physical health deterioration, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Liver function test normal, Lung opacity, Mycoplasma test negative, Platelet transfusion, Procalcitonin increased, Productive cough, Pyrexia, Respiratory syncytial virus test negative, Respiratory viral panel, Rhonchi, SARS-CoV-2 test positive, Serum ferritin normal, Sputum discoloured, Tachypnoea, Thrombocytopenia, Troponin increased, Viral test negative, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: TYLENOL 325 mg tablet VENTOLIN HFA 90 mcg/actuation inhaler ZYLOPRIM 300 mg tablet aspirin 81 mg tablet LIPITOR 40 mg tablet (Expired) SYMBICORT 160-4.5 mcg/actuation inhaler VITAMIN D2 1,250 mcg (50,000 unit) capsule PEPCID 40 mg ta
Current Illness:
Preexisting Conditions: Nervous Common migraine without aura Nicotine dependence Transient ischemic attack, posterior circulation, acute Right arm weakness Cervicalgia Left lumbar radiculopathy Left leg paresthesias Acute back pain less than 4 weeks duration Chronic back pain greater than 3 months duration Respiratory COPD, moderate Pulmonary nodule Pneumonia due to COVID-19 virus Allergic rhinitis Asthma without status asthmaticus Circulatory Benign essential hypertension Bradycardia Myocardial infarction Peripheral vascular disease Ascending aortic aneurysm Arteriosclerosis of artery of extremity Sinus pause Mobitz type II atrioventricular block Dilated aortic root Moderate concentric left ventricular hypertrophy Digestive Gastroesophageal reflux disease without esophagitis Diverticulitis of intestine Intestinal obstruction Malignant neoplasm of large intestine Colon distention Acute upper gastrointestinal hemorrhage Vitamin D deficiency Small bowel obstruction Calculus of gallbladder without cholecystitis without obstruction SBO (small bowel obstruction) Colon cancer Genitourinary Benign localized hyperplasia of prostate Calculus of kidney Acute renal failure (ARF) Musculoskeletal Degenerative joint disease of shoulder region Malignant neoplasm of skin Osteoarthritis Fracture of humerus following insertion of orthopedic implant, joint prosthesis, or bone plate, left arm Closed nondisplaced fracture of acromial end of left clavicle, initial encounter Partial tear of rotator cuff Closed fracture of neck of radius Closed supracondylar fracture of humerus Effusion of joint of hand Localized, primary osteoarthritis Onychomycosis Radial styloid tenosynovitis Interphalangeal osteoarthritis DDD (degenerative disc disease), lumbar Endocrine/Metabolic Gout Hypercholesterolemia Impaired fasting glucose Mixed hyperlipidemia Neoplasm of uncertain behavior of adrenal gland Hematologic Thrombocytopenia MDS (myelodysplastic syndrome), low grade Other Obesity (BMI 30.0-34.9) Incisional hernia Lumbosacral spinal stenosis Malignant neoplasm of rectum and anus Melanoma in situ Fall Acute alcohol intoxication History of cholecystectomy History of right shoulder replacement Tobacco user Ambulatory dysfunction Degenerative cervical spinal stenosis S/P lumbar spinal fusion Anxiety state
Allergies: DigoxinDizziness / Lightheaded DoxazosinOther (document details in comments) GabapentinDizziness / Lightheaded
Diagnostic Lab Data: 08/31/21 1456 Respiratory virus detection panel Collected: 08/31/21 1356 | 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 Procedure Component Value Ref Range Date/Time X-ray chest 1 view, portable - STAT Resulted: 09/01/21 1529 Order Status: Completed Updated: 09/01/21 1529 Narrative: XR CHEST 1 VW PORT IMPRESSION: Stable-to-slightly worsened mild-to-mild/moderate multifocal bilateral COVID-19 pneumonia. END OF IMPRESSION: INDICATION: Pneumonia, unresolved Pneumonia, unresolved. TECHNIQUE: Upright AP portable chest. COMPARISON: 8/31/2021 FINDINGS: Multifocal bilateral airspace disease consistent with COVID-19 pneumonia -minimally more conspicuous compared to 8/31/2021. No pleural effusion, pulmonary edema or pneumothorax; heart, mediastinum, bones and left subclavian approach CCD are grossly stable. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view, Portable Resulted: 08/31/21 1419 Order Status: Completed Updated: 08/31/21 1420 Narrative: XR CHEST 1 VW PORT IMPRESSION: Multifocal opacities within the lungs concerning for pneumonia. END OF IMPRESSION: INDICATION: wheezing, productive cough, rhonchi. TECHNIQUE: AP portable chest. COMPARISON: 4/26/2021 FINDINGS: Multifocal airspace opacities are identified notably in the right perihilar region and left lung base concerning for pneumonia. No pleural effusion or pneumothorax. Heart size appears top normal. Stable dual-lead pacemaker. No pneumothorax is identified. No acute bony abnormalities. Left shoulder arthroplasty is identified.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 8/31/2021 - 9/2/2021 (2 days) - DECEASED 09/02/2021 Presenting Problem/History of Present Illness/Reason for Admission Thrombocytopenia [D69.6] History of myelodysplastic syndrome [Z86.2] Pneumonia due to COVID-19 virus [U07.1, J12.82] Hospital Course Patient is an 86 yo gentleman with past medical history of MDS, on IV chemotherapy with Vidaza. Most recent chemo was given 8/9/2021 through 8/17/2021. He also has past medical history of GERD, HTN, BPH, asthma, thrombocytopenia, COPD, HLD, CAD, PVD, AAA, TIA, Mobitz type II AV block, LVH. He presented to ED from infusion center on 08/31/2021. He was there for a platelet transfusion. He was found to have a temperature and shaking chills. For approximately 3 days prior to admission he had been having increasing cough productive of yellow sputum. Pt lives at nursing facility where he was possible exposed to COVID. In the ED he was found positive for COVID 19 pneumonia. Initially on admission pt had fever and no hypoxia. He was not initially started on dexamethasone. Overnight he developed fevers which steadily climbed during the day. Blood work in the morning showed a normal ferritin, elevated crp/LDH/trop and procalcitonin, normal LFT''s Mid afternoon pt became tachypnic and per nursing pt was more confused. He was oriented to person, place and time when I examined him. His temp increased and did not respond to tylenol. Antibiotics were initiated due to concerns of possible bacterial pneumonia. Repeat lab work was ordered. I was contacted again around 6 pm that pt''s temp was 106. The call provider was contacted to see the pt at bedside. She was already aware of the situation. ICU was called and made aware of the pt. They indicated that pt''s condition was dire and family was updated on the pt''s current status. PT''s sister who is POA was contacted and pt was made DNR/DNI. Pt continued to decline overnight. Pt''s sister, who is also his POA was contacted that and updated that he was actively dying. Due to COVID she declined to come into the hospital. Patient expired at 0758 09/02/2021


VAERS ID: 1682464 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-20
Onset:2021-08-29
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cough, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, General physical health deterioration, Multiple organ dysfunction syndrome, Myocardial injury, Renal failure, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), 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), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 9
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: chronic lymphocytic leukemia
Allergies: Amoxicillin, hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with COVID on 8/27 at outside hospital after cough, shortness of breath and diarrhea x 2 weeks. Treated with steroids and remdesivir. Transferred to Medical Center on 9/2 with COVID pneumonia and intubated. continued to decline with increased respiratory support, septic shock, dual pressors and worsening renal failure. Developed new Afib and EKG showed evidence of acute MI/mycardial injury. Multi organ system failure. 9/7 family chose comfort care.


VAERS ID: 1682490 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-19
Onset:2021-08-10
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: + PCR test 8/10/21
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 61-year-old female patient. The patient received two doses of the Pfizer vaccine on 1/29/21 and 2/19/21. The patient tested positive for COVID-19 on 8/10/21 via PCR. The patient died 9/1/21 and the cause of death is listed as ?ARDS Covid-19?. I do not have further information regarding immunodeficiency status or underlying health conditions.


VAERS ID: 1682500 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-08-23
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B221A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: + PCR 8/26
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 84-year-old female patient. The patient received two doses of the Moderna vaccine on 3/11/21 and 4/8/21. The patient tested positive for COVID-19 on 8/23/21 via PCR. On 8/26/21, nurse at facility where patient resided reported the patient?s only symptom as ?a bit of weakness.? The patient died 8/30/21 and the cause of death is listed as ?Acute Respiratory Failure; Pneumonia; Covid-19?. I do not have further information regarding immunodeficiency status or underlying health conditions.


VAERS ID: 1682712 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac failure congestive, Condition aggravated, Death, Dyspnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD; CHF; RA; NIDDM
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC202147

Write-up: Approx 14 hours post-vaccination, patient''s wife awoke to her husband struggling to breath. EMT was called, and he was transported to the hospital ED and passed away. ED physician believed death was related to CHF and not directly related to the Moderna vaccine.


VAERS ID: 1682806 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-10
Onset:2021-02-23
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL9261 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac failure congestive, Cardiogenic shock, Dyspnoea, Electrocardiogram abnormal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1921-03-14
   Days after onset: 36506
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: Levocetirine; Allopurinol; Fluticasone; Probiotic; Albuterol; Amlodipine; Flutic/Salmeter;Olmesartan; Potassium; Eliquis; Furosemide.
Current Illness:
Preexisting Conditions: Benign Essential Hypertension;Allergic Rhinitis; Asthma; Gout;Obesity;Spinal stenosis of lumbar region.
Allergies: No.
Diagnostic Lab Data: 03/04/21 EKG showing afib - many during hospitalization 3/8-3/14/21
CDC Split Type:

Write-up: SOB - Afib - CHF leading to cardio genie shock.


VAERS ID: 1682874 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death one day after vaccine.


VAERS ID: 1682937 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-07
Onset:2021-08-27
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 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: hypothyroidism, type 2 DM, HTN, afib, CHF, PVD, COPD, respiratory failure, CKD 2, functional quadriplegia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident was end of life care, tested positive for COVID-19 8/26/21 and expired


VAERS ID: 1682967 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death.


VAERS ID: 1683006 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-21
Onset:2021-08-23
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Cough, Death, Endotracheal intubation, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital 8/24/2021, had fever, cough abdominal cramps, was intubated and pt. expired on 8/27/2021


VAERS ID: 1683013 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-14
Onset:2021-08-10
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DECREASE APPETITE, SOB, WEAKNESS, POSITIVE COVID TEST


VAERS ID: 1683035 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT DOCUMENTED / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Autopsy, Death, Fatigue
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   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: amlodipinem bisoprolol, eliquis, furosemide, potassium, atorvasatatin, pravastatin
Current Illness: In hospital for MI "one month ago" for MI then spent two weeks in rehab facility
Preexisting Conditions: extensive cardiac history with recent AMI and CHF. HTN, CHF, ASCVD
Allergies: unknown
Diagnostic Lab Data: autopsy performed
CDC Split Type:

Write-up: Patient reported to family that she began feeling tired and weak after the second dose on 9/3. Passed away in her home on the couch sometime during the night of 9/5


VAERS ID: 1683041 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-06
Onset:2021-08-30
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Motor neurone disease, Vaccination complication
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: Upon the regulatory authority reviewing their weekly notifiable conditions death report, they came across a report of decedent where the death certificate COD literal text is indicated to be: ACUTE MOTOR NEURON DISEASE SERUM REACTION TO VIRAL VACCINE Here is some additional decedent details: DOD: 08/30/2021 We speculate that the COD literal text is in reference to COVID-19 vaccinations since those were the most recent two vaccinations that this person had received based on data. Here are the COVID-19 vaccine dose dates: 3/16/2021 (Pfizer) 4/06/2021 (Pfizer)


VAERS ID: 1683045 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-08-18
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, SARS-CoV-2 test positive, Septic shock
SMQs:, Asthma/bronchospasm (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   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: positive COVID test; hypoxic; septic shock


VAERS ID: 1683049 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-24
Onset:2021-09-07
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-08
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: 2021-09-07
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death


VAERS ID: 1683101 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-07
Onset:2021-08-27
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO LOT # AVAILA / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hypoxic, SOB, positive COVID test


VAERS ID: 1683127 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-12
Onset:2021-08-09
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted in the hospital on 08/09/2021. Date of death 09/02/2021


VAERS ID: 1683133 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-08-04
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   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: SOB; HYPOXIC; PNEUMONIA, POSTIVE COVID TEST


VAERS ID: 1683142 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0880021A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Congestive cardiomyopathy, Sudden death, Toxicologic test, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None; Supposed to be taking amlodipine, clonidine, labetalol and losartan-HCTZ but non-compliant.
Current Illness: None
Preexisting Conditions: Hypertension, Obesity
Allergies: None
Diagnostic Lab Data: None. Pending toxicology testing for routine prescription medications and common drugs of abuse.
CDC Split Type:

Write-up: Patient died within 12 hours after vaccination. Sudden death without prodrome. Only complaints after administration were soreness at the vaccine site. Autopsy performed and no obvious evidence vaccine played a role. Dilated cardiomyopathy at examination. No evidence of anaphylaxis, or pulmonary emboli.


VAERS ID: 1683150 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-07-16
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Pneumonia, SARS-CoV-2 test positive
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PNEUMONIA, POSITIVE COVID TEST


VAERS ID: 1683226 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-27
Onset:2021-09-03
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   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: N/A
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 6 months later died of suddenly when heart stopped


VAERS ID: 1683287 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-26
Onset:2021-09-01
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Death, Dyspnoea, Lung opacity, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone 200 mg QD, Amlodipine 5 mg QD, Cetirizine 10 mg QD,
Current Illness:
Preexisting Conditions: Essential hypertension, dyslipidemia, atrial fibrillation, abdominal aortic aneurysm, CVA
Allergies: NKDA
Diagnostic Lab Data: COVID Positive on 9/1/2021 @ 0310 utilizing Roche LIAT SARS assay platform using PCR. Hazy ground-glass opacities seen throughout both lungs on CT
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/26/2021 and 3/26/2021. Presented to ED on 9/1/2021 from Medical Lodge with complaints of shortness of breath requiring oxygen. Patient was placed on high flow oxygen and started on Dexamethasone, ceftriaxone, doxycycline, remdesivir, piperacillin + tazobactam, vancomycin, ascorbic acid, zinc, and Vitamin D. Per patient''s wishes he was transitioned to comfort care at 08:40 and expired at 09:00 on 9/5/2021.


VAERS ID: 1683324 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-29
Onset:2021-09-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time shortened, Antibody test positive, Anticoagulant therapy, Blood fibrinogen decreased, Blood lactate dehydrogenase normal, Brain death, Cerebral haemorrhage, Computerised tomogram head abnormal, Craniotomy, Death, Fibrin D dimer increased, Haemoglobin normal, Haemostasis, Haptoglobin normal, Headache, Heparin-induced thrombocytopenia test positive, Immunoglobulin therapy, Infarction, International normalised ratio increased, Intracranial pressure increased, Neurological decompensation, Ovarian vein thrombosis, Platelet count decreased, Prothrombin time prolonged, Renal vein thrombosis, Thrombocytopenia, Transfusion, Ventricular drainage, White blood cell count increased, Withdrawal of life support
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vasculitis (broad), Renovascular disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of pre-eclampsia (2015)
Allergies: None
Diagnostic Lab Data: WBC 11.77, Hgb 13.2, Plt 31 (nadir). INR 1.4, PT 16.7, PTT 34. D-Dimer $g 40.00. Fibrinogen 74. Haptoglobin 192. LDH 158. HIT panel with strong positive, HIT optical density 2.552 (this was after she had already received IVIG and some transfusions).
CDC Split Type:

Write-up: Patient presented to the ED around 10pm on 4/21, ~one week after her J&J COVID vaccine (exact date of initial vaccination not confirmed but was reportedly 1 week prior) with abdominal pain and headache. She was found to have thrombocytopenia (Plt 38) on presentation as well as renal and ovarian vein thrombosis. CT head showed a large right frontal intraparenchymal hemorrhage. She was taken for urgent craniotomy on 9/5 with EVD placement. Brain tissue was noted to have bleeding spots unresponsive to cautery and requiring local hemostatic agents. Repeat imaging showed worsening infarction. She had continued elevated intracranial pressures, so was taken back to the OR on the morning of 9/6 for bilateral EVD placement to help relieve pressure. Given her thrombocytopenia, thrombosis, significantly elevated D-dimer, low fibrinogen, and +HIT Ab test, she was diagnosed with vaccine-induced thrombocytopenia and thrombosis (VITT). She was started on IVIG 1g/kg daily x 2 days, bivalirudin with supportive transfusions to maintain goal plts $g50K, fibrinogen $g 150. Despite this, her neurologic status deteriorated due to elevated pressures, clotting off of her EVDs, and ultimately was declared brain dead in the afternoon on 9/7. Family withdrew supportive care and patient passed at 3:57PM on 9/7/21.


VAERS ID: 1683350 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-08-17
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, Anticoagulant therapy, COVID-19, Catheter site haemorrhage, Chills, Culture, Death, Device related infection, Diarrhoea, Dyspnoea, Fatigue, Illness, Multiple organ dysfunction syndrome, Nausea, Pain, SARS-CoV-2 test positive, Sepsis, Staphylococcal bacteraemia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Taste and smell disorders (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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 40 mg QD, Calcitriol 0.25 mcg QD, Calcium acetate 668 mg QD, Ferrous sulfate 1 tab Weekly, Glipizide 10 mg QD, Metoprolol 50 mg QD, Sodium bicarbonate 325 mg TID, Tamsulosin 0.4 mg QD,
Current Illness: Rhabdomyolysis (non-traumatic)
Preexisting Conditions: ESRD on Dialysis, History of renal cell carcinoma (right), Diabetes mellitus Type 2, Hyperlipidemia, Hypertension, Anemia
Allergies: Lisinopril (Swelling of lips)
Diagnostic Lab Data: COVID Positive test 0n 8/11/2021 @ 2120 using PCR or equivalent.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/25/2021 and 3/23/2021. Presented to the ED on 8/11/2021 for asymptomatic testing so he may resume dialysis. On 8/14/2021 patient returns to ED with a two day history of fatigue, nausea, vomiting, diarrhea, chills, body aches, and loss of taste and smell. Denies shortness of breath, headache or chest pain, Has O2 sats of 100%. Patient was discharged from ED with instructions to return if dyspnea occurs. On 8/17/2021 patient returns to ED with shortness of breath and sepsis secondary to infected dialysis catheter (MSSA bacteremia). Treated with dexamethasone, heparin prophylaxis dosing, zosyn, and vancomycin. Antibiotics were later changed to cefazolin once culture and sensitivity resulted. Patient also developed bleeding from catheter site. he eventually succumbed to multiple acute illnesses with multiorgan failure.


VAERS ID: 1683354 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-29
Onset:2021-08-11
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Asthenia, Blood antidiuretic hormone, Blood gases abnormal, Bradycardia, COVID-19, Cardiac arrest, Chest tube insertion, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Endotracheal intubation, Fatigue, General physical health deterioration, Hypotension, Inappropriate schedule of product administration, Mechanical ventilation, Nausea, Pain, Pneumonia staphylococcal, Pneumothorax, Pulseless electrical activity, Resuscitation, SARS-CoV-2 test positive, Sinus tachycardia, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Clonazepam 0.5 mg BID prn, Insulin Aspart; 0-20 units TID, Insulin glargine 13 units QD, Magnesium Oxide 800 mg BID, Mirtazepine 15 mg QHS, Mycophenolate 720 mg BID, Ondansetron 4 mg Q8H prn, Prednisone 2.5 mg QD, Pantopro
Current Illness:
Preexisting Conditions: Dyslipidemia, Essential Hypertension, H/O Kidney Transplant (2 years prior), Anxiety, Type 2 DM, Immunosupression; cataracts, Parathyroid disease, ESRD on Dialysis
Allergies: Tide Detergent (Rash)
Diagnostic Lab Data: Positive COVID-19 on 8/11/2021 using the Roche LIAT SARS Assay platform using PCR or equivalent nucleic acid amplification technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/1/2021 and 5/29/2021. Presented to ED on 8/11/2021 with complaints of worsening symptoms over the past 10-11 days including generalized fatigue, body aches, weakness, decreased appetite, nausea, vomiting, diarrhea, dyspnea, and cough. Intubated 8/19. His course was complicated by L pneumothorax requiring Left chest tube placement X 2. He was given Decadron 10 d through 8/21. Completed course of Remdesevir 5 days. Course complicated by MSSA pneumonia and concern for fungal pneumonia. Was being treated with Ancef and Micafungin. However he rapidly declined on 9/2. The patient was with significant. hypotension and bradycardia, despite vasopressin and levophed gtts. Atropine x 1 given. Patient with full cardiac arrest at 1255 and CPR was initiated. Epinephrine 1mg given. 1257 pulse check revealed a pulse that progressed into vtach at 1259, shock x 1 at 200J with PEA and subsequent sinus tachycardia. 1303 patient again went into vtach and another shock x 1 at 200J given and amiodarone bolus of 150mg administered. Return of sinus tachycardia. ABG revealed acidosis and 3 amps of bicarb were administered. At that time the patient''s family was called and the wife and daughter arrived at bedside. The family decided at that time to make the patient comfort care. He was taken off the ventilator and passed at 1350.


VAERS ID: 1683357 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-29
Onset:2021-08-12
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C12A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, COVID-19, Chest X-ray abnormal, Culture urine positive, Death, Dyspnoea, General physical health deterioration, Lung opacity, Mechanical ventilation, Pseudomonas infection, Pseudomonas test positive, SARS-CoV-2 test positive, Septic shock, Sputum culture positive, Staphylococcal infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 17
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: aripiprazole 5 mg daily, azelastine 2 sprays twice daily, aspirin 81 mg daily, buspar 30 mg twice daily cholecalciferol 2000 units daily, desvenlafaxine 100 mg daily, fenofibrate 145 mg daily, hydroxyzine 50 mg every 8 hours as needed for a
Current Illness:
Preexisting Conditions: anemia, anxiety, benign prostatic hyperplasia, depression, diabetes mellitus, hyperlipidemia, insomnia, neuropathy, chronic kidney disease (stage III), hypertension
Allergies: NSAIDs, sulfonamide
Diagnostic Lab Data: COVID Positive on 8/12/2021; chest x-ray: bilateral patchy airspace opacities concerning for multifocal pneumonia on 8/12/2021; serum creatinine 5.71 on 8/29/2021; urine culture positive for pseudomonas aeruginose on 8/26/2021, sputum culture postive for MRSA on 8/28/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/25/2021 and 4/29/2021. Presented to ED on 8/12/2021 with complaints of dyspnea for 1 week requiring oxygen. Patient was placed on oxygen and eventually required mechanical ventilation. Patient had septic shock and acute kidney injury. Medications administered: dexamethasone, ascorbic acid, ceftriaxone, azithromycin, micafungin, remdesivir, piperacillin/tazobactam, tocilizumab, prednisone, and vancomycin. Patient continued to decompensate and expired at 14:44 on 8/29/2021.


VAERS ID: 1683449 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-08-28
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, Cardiac arrest, Cough, Death, Dyskinesia, Endotracheal intubation, Haemodialysis, Hyponatraemia, Mechanical ventilation, Neutropenia, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dyskinesia (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 7
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: Atorvastatin 20 mg QD, Calcitriol 0.5 mg TIW, Clonidine 0.1 mg
Current Illness:
Preexisting Conditions: Anemia, Coagulopathy, Dementia, Depression, DM type 1, Dialysis, hearing loss, hyperlipidemia, hypertension,
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Jannsen Vaccine on 4/01/2021 and 3/23/2021. Presented to facility of 8/28/2021 with a chief complaint of cough without SOB, with room sats of 85%, fever, and COVID positive. Patient required intubation on 8/30/2021 during a cardiac arrest. On 8/31/2021 patient transferred to facility. On arrival with air transport, patient is hemodynamically stable, sedated on propofol. Patient is connected to MV with settings CMV 20/450/.70 +10. On 9/2/2021, spontaneous movement but not following commands. Remains in prone position. HD yesterday.


VAERS ID: 1683451 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-17
Onset:2021-08-08
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Asthenia, Asymptomatic COVID-19, Atelectasis, Atrial fibrillation, Bladder catheterisation, Candida infection, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Death, Haematuria, Hypernatraemia, Lung consolidation, Lung infiltration, Mental status changes, Pleural effusion, Pneumonia, Pulmonary embolism, SARS-CoV-2 test positive, Sepsis, Upper limb fracture, Urinary tract infection
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 28
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: Ascorbic acid, Aspirin, Azithromycin, Ceftriaxone, Robitussin DM, Duloxetine, finasteride, Norco, Albuterol, Ipratropium, Linaclotide, Meloxicam, Mirtazaepine, pantoprazole, Miralax, Potassium chloride, rosuvastatin, Fluticasone nasal, lis
Current Illness: Fracture of right shoulder on 7/14/2021
Preexisting Conditions: allergic rhinitis, atrial fibrillation, BPH, coronary artery disease, dehydration, GERD, history of pneumoconiosis, IBS, Hyperlipidemia, hypertension, ischemic cardiomyopathy, depression, neuralgia, neuritis, urinary retention, vitamin deficiency.
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive on 8/26/2021 using Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/25/2021 and 3/17/2021. Presented to another organizations ED on 8/7/2021 with complaints of hematuria in Foley bag, and pain in lower part of abdomen. Patient was subsequently found to have COVID infection that was asymptomatic (on room air throughout admission) and discharged on 8/12/2021. Patient subsequently presented to ED on 8/26/2021 with generalized weakness and altered mental status. Patient''s mentation briefly improved with supplemental oxygen. Chest X-ray Atelectasis/infiltrate especially left mid and lower lung zones, clinical correlation recommended for developing acute pneumonia/pneumonitis. CT Chest shows occlusive and non occlusive PE LUL, small bilat eff, bilat lower lobe consolidation. In ER patient was noted to be in atrial fibrillation with RVR and was initiated on cardizem. Patient was diagnosed with severe sepsis, bilateral pneumonia, and UTI from indwelling foley (Candida albicans), Pulmonary embolism, hypernatremia, as well as continued COVID positive originally diagnosed 8/7/2021 and confirmed with repeat testing on 8/26/2021. Patient was transitioned to inpatient hospice on 8/30/2021, and expired on 9/5/2021.


VAERS ID: 1683454 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-21
Onset:2021-08-17
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL6203 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Dyspnoea, Lung opacity, Mental status changes, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), 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), 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: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate 70 mg every 7 days, cholecalciferol 5000 units daily, multivitamin daily, mycophenolate 250 mg twice daily, potassium citrate 10 mEq twice daily, prednisone 10 mg daily, sidenafil 20 mg three times daily, bactrim DS three times
Current Illness:
Preexisting Conditions: Interstitial lung disease, pulmonary hypertension, pulmonary fibrosis, thrombocytopenia, cirrhosis, esophageal varices
Allergies: Iodine
Diagnostic Lab Data: COVID Positive on 8/17/2021; CXR showed bilateral patchy peripheral airspace opacities on 8/17/2021
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/29/2021 and 2/21/2021. Presented to ED on 8/17/2021 with complaints of fever and shortness of breath for 2 days with increased oxygen requirements. Medications administered: dexamethasone, methylprednisolone, ceftriaxone, cefepime, azithromycin, remdesivir, epoprostenol, and vancomycin. Patient continued to decompensate requiring more oxygen. On 8/29/2021 patient''s mental status declined while on BiPAP. Patient expired at 13:44 on 8/29/2021.


VAERS ID: 1683459 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-08-16
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, COVID-19, Chest X-ray abnormal, Condition aggravated, Death, Dyspnoea, Platelet count decreased, Pneumonia, Productive cough, Refusal of treatment by patient, Renal impairment, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 500 mg every 6 hours as needed for pain, azelastine 1 spray by nasal route twice daily, flunisolide 2 sprays twice daily, miralax 17 grams daily as needed for constipation, senna-docusate 1 tablet daily, sodium bicarbonate 65
Current Illness:
Preexisting Conditions: Hypertension, asthma, chronic kidney failure stage 4, sexual dysfunction, urinary incontinence, GERD, gout, arthritis
Allergies: Iodine
Diagnostic Lab Data: COVID Positive on 8/16/2021; CXR showed right basal pneumonia on 8/16/2021; troponin 257 on 8/16/2021; serum creatinine 9.1 and platelets 91 on 8/16/2021
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/2/2021 and 2/23/2021. Presented to ED on 8/16/2021 with complaints of shortness of breath and productive cough for two weeks. Supplemental oxygen initiated in ED. Medications administered: dexamethasone, ceftriaxone, azithromycin, vancomycin. Patient''s chronic renal dysfunction continued to worsen while hospitalized. Patient refused dialysis. After discussion with family discharged home with hospice on 8/25/2021. Per patient''s son, patient expired on 8/30/2021 at home.


VAERS ID: 1683491 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-04
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Chest tube insertion, Death, Hypoxia, Ileus, Ischaemic stroke, Mechanical ventilation, Pneumonia, Respiratory distress, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine-benazepril 5-20 mg daily, aspirin 81 mg daily, atorvastatin 80 mg daily,fluticasone 1 spray as needed for rhinitis, hydrocortisone cream as needed, tamsulosin 0.4 mg daily, fexofenadine-pseudoephedrine 180-240 mg as needed
Current Illness:
Preexisting Conditions: actinic keratosis, erectile dysfunction, heart murmur, hyperlipidemia, seborrheic eczema, basal cell skin cancer
Allergies: Neomycin
Diagnostic Lab Data: Reported COVID Positive on 7/30/2021; chest x-ray: Moderate multifocal pneumonia on 8/4/2021; CRP 158.5, LDH 341, and WBC 24 on 8/4/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/15/2021 and 2/12/2021. Presented to ED after referral from primary care provider on 8/4/2021 for hypoxia. Patient was hospitalized, placed on oxygen supplementation and received dexamethasone, remdesivir, and tocilizumab. Oxygen demand continued to increase so patient was transferred to hospital on 8/8/2021 after chest tube placement. On 8/14/2021, patient required mechanical ventilation for respiratory distress. Patient received multiple rounds of antibiotics. Head CT confirmed an ischemic stroke. Patient continued to decompensate requiring vasopressor support and developed an ileus. After discussion with family, comfort care measures were pursued and patient expired at 1420 on 9/6/2021.


VAERS ID: 1683492 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-08-17
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute sinusitis, COVID-19, Cough, Death, Dyspnoea, General physical health deterioration, Hypoxia, Oxygen saturation decreased, Plasmapheresis, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol nebs PRN, Apixaban 5 mg QD, atorvastatin 20 mg QD,azathioprine 100 mg BID, benzonatate 200 mg TID prn, Pulmicort flexhaler BID, carvedilol 6.25 mg BID, Dexamethasone 4 mg QD, ferrous sulfate 325 mg QD, finasteride 5 mg QD, Ibrut
Current Illness:
Preexisting Conditions: Anemia, Chronic Lymphocytic Leukemia, Diabetes, Hyperlipidemia, Hypertension, Myasthenia gravis, skin cancer
Allergies: Sulfa Antibiotics
Diagnostic Lab Data: COVID-19 Positive on 8/11/2021 using PCR or equivalent
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/28/2021 and 2/23/2021. Presented to physician office on 8/9/2021 for evaluation of dry non-productive cough, clear runny nose x3 days. Was prescribed levofloxacin for acute sinusitis, benzonatate, albuterol nebs, and prednisone taper. Patient called provider back on 8/11/2021 stating symptoms are still persistent and a COVID test was ordered w positive result. on 8/12 the prednisone taper was discontinued and patient was prescribed dexamethasone 4 mg QD. on 8/17/2021 patient presented to ED with shortness of breath and hypoxia. Pulse ox on presentation was 70% on room air. Patient was treated with dexamethasone, Remdesivir, ascorbic acid, zinc sulfate, and convalescent plasma. Patient status deteriorated and was switched to comfort care on 9/4/2021, expired at 1335.


VAERS ID: 1683498 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-08-11
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Blood culture positive, COVID-19, COVID-19 pneumonia, Candida test positive, Cardio-respiratory arrest, Chest X-ray abnormal, Culture urine, Death, Dyspnoea, Lung opacity, Mechanical ventilation, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Interstitial lung disease (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 1-2 puffs every 4 hours as needed for wheezing, aspirin 81 mg daily, coreg 12.5 g twice daily, famotidine 20 mg twice daily as needed, fluoxetine 40 mg daily, levothyroxine 175 mcg daily, mycophenolate 540 mg twice daily, predniso
Current Illness:
Preexisting Conditions: Deceased donor kidney transplant, post-transplant erythrocytosis, thrombocytopenia, asthma, hypertension, depression, hypothyroid, coronary artery disease, degenerative joint disease, hyperlipidemia, sleep apnea, anxiety, kidney transplant failure due to chronic rejection, chronic kidney disease
Allergies: Cefdinir, penicillins, valganciclovir, cranberry, grapefruit, pomagranate
Diagnostic Lab Data: COVID Positive on 8/11/2021; CXR showed Pulmonary opacities concerning for multifocal pneumonia on 8/11/2021; Blood culture positive for candida albicans 8/25/2021; urine culture; positive for candida albicans 8/26/2021
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/11/2021 and 4/8/2021. Presented to ED on 8/11/2021 with complaints of shortness of breath for last 7 days. Supplemental oxygen was initiated in the ED. Admitted with COVID 19 pneumonia with ARDS and ongoing respiratory failure. On 8/22/2021 patient had cardiorespiratory arrest and required mechanical ventilation. Medications administered during hospitalization include: dexamethasone, cefepime, levofloxacin, micafungin, and remdesivir. Support withdrawn after discussion with family about poor prognosis. Patient expired at on 9/1/2021.


VAERS ID: 1683500 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-24
Onset:2021-08-05
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspiration, Atelectasis, COVID-19, Cardiac arrest, Chest X-ray abnormal, Death, Dyspnoea, Ileus, Pleural effusion, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 2021-09-01
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Torsemide 20 mg daily, pantoprazole 40 mg daily, flonase, 1 spray each nostril daily, acetazolamide 250 mg every other day, albuterol 90 mcg/actuation 1 puff four times daily as needed, cholecalciferol 5000 units daily, dorzolamide 2% 1 dro
Current Illness:
Preexisting Conditions: Hypertension, congestive heart failure, chronic obstructive pulmonary disease, atrial fibrillation, hyperlipidemia, chronic kidney disease, sleep apnea
Allergies: No known allergies
Diagnostic Lab Data: COVID Positive on 8/5/2021; CXR showed Probable left pleural effusion with atelectasis or possible pneumonia at the left lung base on 8/5/2021
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/3/2021 and 2/24/2021. Presented to ED on 8/5/2021 with shortness of breath. Medications administered: acetylcysteine, baricitinib, dexamethasone, methylprednisolone, prednisone, ceftriaxone, azithromycin, remdesivir, piperacillin/tazobactan, zinc, and vancomycin. During hospitalization, patient aspirated and had small bowel ileus subsequently requiring vasopressor support. Patient eventually went to cardiac arrest and expired on 9/01/2021.


VAERS ID: 1683559 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-27
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Coma, Death, Headache, Seizure
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), 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: 2021-08-31
   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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210902775

Write-up: COMA; FITTING; SEVERE HEADACHES (WORSEN NEXT DAY); DIED; This spontaneous report received from a patient social media via a company representative concerned a male of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: Unknown) dose was not reported, frequency time 1 total administered on 27-AUG-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 27-AUG-2021, after vaccination the patient instantly got severe headaches, even worst next day (28-AUG-2021). On 29-AUG-2021, patient started fitting in hospital and on 30-AUG-2021, she was in coma and was hospitalized (days unspecified). On 31-AUG-2021, the patient died from unknown cause of death. It was unknown, if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died of died on 31-AUG-2021, and had not recovered from severe headaches (worsen next day), coma, and fitting. This report was serious (Death, Hospitalization Caused / Prolonged, and Other Medically Important Condition). This case, from the same reporter is linked to 20210902754.; Sender''s Comments: V0: 20210902775-covid-19 vaccine ad26.cov2.s-died, coma, fitting. 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). 20210902775-Covid-19 vaccine ad26.cov2.s-severe headache. This event(s) is labeled per RSI and is therefore considered potentially related.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1683561 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Hospitalisation, 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210910577

Write-up: HOSPITALISATION; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; DEATH; This spontaneous report received from social media via a company representative concerned multiple patients. 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, start therapy date were not reported,1 total 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 15,739 patients got COVID-19 among people who were fully vaccinated (suspected covid-19 infection, suspected clinical vaccination failure), Of those, 571 had been hospitalised (for unspecified days), and 131 had died. The patients died due to unknown reason on an unspecified date. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. Outcome of suspected covid-19 infection, hospitalisation and suspected clinical vaccination failure was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, and Other Medically Important Condition). This case, from the same reporter is linked to 20210902916, 20210909398 and 20210909281. This case was associated with Product Quality Complaint.; Sender''s Comments: V0; 20210910577-covid-19 vaccine ad26.cov2. s-Death, Hospitalization. These events are considered unassessable. The events have a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events. V0: - 20210910577- covid-19 vaccine ad26.cov2 - 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.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


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