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From the 9/17/2021 release of VAERS data:

Found 15,386 cases where Vaccine is COVID19 and Patient Died



Case Details

This is page 68 out of 154

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VAERS ID: 1683905 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-01
Onset:2021-09-05
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   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: client fully vaccinated, patient died 09/05/2021-Cause: Complications of COVID-19


VAERS ID: 1684121 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-20
Onset:2021-04-20
   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: 2021-08-19
   Days after onset: 121
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness:
Preexisting Conditions: HIV
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1684500 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-08-29
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive on 8/29/21
CDC Split Type:

Write-up: Patient received Pfizer on 2/8/2021 and 3/1/2021. Patient was admitted to the hospital on 8/29/2021 for COVID pneumonia, and acute on chronic respiratory failure. Patient died on 9/8/2021.


VAERS ID: 1684691 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-08-19
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypoxia, Intensive care, Multiple organ dysfunction syndrome, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 100 MG tablet amLODIPine-benazepril (LOTREL) 10-20 MG capsule ascorbic acid (VITAMIN C) 250 MG tablet aspirin (HALFPRIN) 81 MG tablet Calcium Carbonate-Vitamin D (CALTRATE 600+D PO) clopidogrel (PLAVIX) 75 MG tablet o
Current Illness: None known
Preexisting Conditions: Hyperlipidemia Mitral regurgitation HTN (hypertension) Gout Depression Rotator cuff arthropathy Obesity (BMI 30-39.9) Gastroesophageal reflux disease without esophagitis IFG (impaired fasting glucose) Bilateral wrist pain Thrombocytopenia CAD S/P percutaneous coronary angioplasty S/P cardiac cath 08/21/20 Osteoarthritis of right knee, unspecified osteoarthritis type S/P TKR (total knee replacement), right Memory loss Tremor
Allergies: Latex (contact dermatitis), Celebrex (rash), lipitor (dizziness), penicillins
Diagnostic Lab Data: COVID-19 test positive on 8/19/2021
CDC Split Type:

Write-up: Patient presented to emergency department on 8/19/2021 with shortness of breath. He was found to be COVID-19 positive and admitted for further management. He was transferred to the ICU on 8/23/2021 due to worsening hypoxia. He was intubated on 8/28/2021. Patient''s condition further deteriorated into multisystem organ failure. He was placed on comfort measures on and expired on 9/8/2021.


VAERS ID: 1684695 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-02-13
Onset:2021-02-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Confusional state, Death, Disorientation, Feeling abnormal, Impaired driving ability, Loss of personal independence in daily activities, Social avoidant behaviour
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-21
   Days after onset: 96
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fentanyl Patch; Fluconazole; Clonidine; Albuterol; Atorvastatin; Baclofen; Fluoxetine; Spironolactone; Losartan; Furosemide; Allopurinol; Hydralazine; Estradiol; Verapamil; Lansoprazole; Isosorbide; Clopidogrel; Metoprolol; Nitroglycerine;
Current Illness: Phenomena - UTI
Preexisting Conditions: COPD - Lung Fungus - Asthma - Congestive heart failure - Back and leg
Allergies: Codeine - Morphine
Diagnostic Lab Data: None - We did not put the two together until she was in the hospital in May.
CDC Split Type:

Write-up: Became unable to take care of her daily activities, unable to remember anything and when she passed away we found that none of her bills had been paid since before she took her 2nd shot. She was disoriented, confused, didn''t know where she was or remember speaking with anyone on the phone and just felt overall worse. Since she had the chronic health issues she/we were not aware she had gotten worse as she pulled away from everyone and kept telling us "this episode was just lasting longer". When she passed and I started going through her things I realized it all started after the shot. Nothing had been taken care of after that date. She also had been driving up until March, she herself stopped driving stating she didn''t feel comfortable in driving any longer.


VAERS ID: 1684789 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-04-15
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 143
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sinemet
Current Illness: Parkinson''s disease
Preexisting Conditions: Parkinson''s disease - diagnosed in 1995
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient brought to the ED on 4/15/2021 at 0330 with increased weakness. Patient takes Sinemet every 3 hours and last Sinemet dose was sometime late on 4/14/2021. Patient stated the medication wore off sooner than it should have. Patient was discharged to home on 4/15 at 0551. Patient was seen again in the ED on 7/17/2021 at 2100 for weakness. Again, brought in by EMS. No medications were given in the ED. Patient discharged to home on 4/17/2021 at 2345.


VAERS ID: 1684790 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: E11.2, D51.9,E55.9,E87.0,F03.91,F32.9,G31.1,K86.89,M15.0,N18.30,G63.8,E86.9,H91.90,I10,K21.00,Z68.1,Z87.430
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT IS RESIDENT OF HEALTH AND REHAB FACILITY. PT WAS FOUND UNRESPONSIVE ON 9/5/21 BY NURSE.


VAERS ID: 1684819 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-14
Onset:2021-08-10
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Death, Diarrhoea, Dyspnoea, General physical health deterioration, Hypoxia, Inappropriate schedule of product administration, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Medication errors (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 15
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: Citalopram, fluticasone-salmeterol Diskus, simvastatin, gabapentin, quetiapine, meloxicam, acetaminophen, preservision ared 2, ferrous sulfate, colchicine, xanax, nystatin topical powder, ketoconazole topical, mucinex, omeprazole
Current Illness:
Preexisting Conditions: HTN, COPD, HLD, CHF, anxiety, depression
Allergies: Flagyl, Polysporin ointment, shellfish
Diagnostic Lab Data: patient reported positive COVID test on 8/10/21. PCR COVID-19 test positive in hospital on 8/15/2021
CDC Split Type:

Write-up: 8/14/2021 Admit Hospital. Patient presented to emergency room with shortness of breath for the last 4 days with weakness and decline in status and diarrhea. Her oxygen saturation was low in the low 90s. home oxygen dependent. Tested positive for COVID-19 from PCR on 8/15/21. Diagnosed with: COVID-19 pneumonia, acute on chronic hypoxic respiratory failure. Transferred to Hospice 8/20/21. patient died on 8/25/21. Note: COVID-19 Moderna vaccine previously given: First dose: 03/08/21 Lot Number 025A21A; Second dose: 04/14/21 Lot Number 030B21A


VAERS ID: 1684866 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-02-04
Onset:2021-07-22
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 24
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: It was noted that he had weakness in his legs and some weakness in his arms and a diagnosis of Guillain-Barre.


VAERS ID: 1684882 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-08-12
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, 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: 2021-08-29
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST IN JULY 2021, SOB WORSENED, SENT BACK TO HOSPITAL DUE TO HYPOXIA,, THEN DISCHARGED TO HOSPICE WHERE HE PASSED AWAY.


VAERS ID: 1684903 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-08-07
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-09-09
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, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COUGH, SOB, HX OF MOTHER BEING POSITIVE FOR COVID, PT TESTED POSITIVE FOR COVID


VAERS ID: 1684960 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-08-17
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Lung infiltration, Pulmonary oedema, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   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: CONFUSION, POSITIVE COVID TEST, BILATERAL PULMONARY INFILTRATE, PULMONARY EDEMA


VAERS ID: 1684977 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-09-05
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death, Pneumonia bacterial, Pyrexia, SARS-CoV-2 test positive, Superinfection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), 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: 2021-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: type 2 diabetes, hypertension, & obesity
Allergies: unknown
Diagnostic Lab Data: COVID-19 PCR positive on 8/16/2021.
CDC Split Type:

Write-up: 1st vaccine given on 1/20/21, 2nd dose given on 2/9/21; tested positive for COVID-19 via PCR on 8/16/2021; admitted to hospital on 8/31/21 with acute respiratory failure secondary to COVID, also had superimposed bacterial pneumonia, severe fever, and died on 9/5/21.


VAERS ID: 1684982 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-08-24
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood culture positive, COVID-19, Myalgia, Pyrexia, SARS-CoV-2 test positive, Staphylococcal infection
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST, MYALGIAS, FEVER, BLOOD CULTURE POSITIVE FOR MSSA


VAERS ID: 1685005 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-23
Onset:2021-08-01
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH E110140 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aceaminophen-ibuprofen, amlodipine, atorvastatin, doxycycline, ergocalciferol, hydralazine, ivermectin, metformin, multivitamin, Visine, valsartan, zinc sulfate
Current Illness:
Preexisting Conditions: diabetes, hypertension, right BKA, CAD
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8/1/2021: patient admitted. Apparently, he has been ill for a few days. He was given antibiotic as outpatient basis - including oral ivermectin. He was diagnosed with COVID at outside facility. He failed outpatient treatment. His oxygen has been going down. He presented to the emergency department with shortness of breath as well as chest pain. Diagnosed with Covid pneumonitis, hypoxic resp failure Note: patient previously vaccinated with Covid-19 vaccine: First dose: 01/02/21 Lot Number E110140;Second dose: 01/23/21 Lot Number EL3248 8/7/2021: patent Died


VAERS ID: 1685011 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-08-26
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac arrest, Dyspnoea, Pyrexia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, FEVER, WEAKNESS, POSITIVE COVID TEST, RESPIRATORY FAILURE, CARDIAC ARREST


VAERS ID: 1685045 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-08-20
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-09-09
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, Diarrhoea, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DIARRHEA, POSITIVE COVID TEST, HX OF DIABETES AND HTN; SEIZURE DISORDER


VAERS ID: 1685068 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-12
Onset:2021-08-16
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Mental status changes, Pneumonia, Respiratory syncytial virus infection, Respiratory syncytial virus test positive, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PNEUMONIA, POSITIVE COVID TEST, RSV POSITIVE, ALTERED MENTAL STATE


VAERS ID: 1685087 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-17
Onset:2021-09-02
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of myeloma, thyroid cancer, breast cancer, RA, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed, hospitalized and expired with COVID 19 while fully vaccinated


VAERS ID: 1685092 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-07
Onset:2021-08-10
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Cardiovascular disorder, Chronic kidney disease, Condition aggravated, Death, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease, Chronic Renal disease, High blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is fully vaccinated and died in hospice care. Case was previously living in a Long term care facility and recently relocated to hospice as in-patient in hospital. Case tested Covid positive at hospital and didn''t show any signs and symptoms. Case was told his heart and kidney medical conditions were declining. Case had chronic conditions listed previously. Case died about a week later after being admitted to hospice.


VAERS ID: 1685095 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-27
Onset:2021-08-10
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Decreased appetite, Dyspnoea, Fatigue, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus COPD Cardiovascular disease Hypertension Immunosuppressive condition
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient started with symptoms on Friday 8/6/21. They decided to test him on Tues 8/10/21 and he came back positive on Wed 8/11/21. Patient has a history of COPD, CHF, Diabetes, Prostate Cancer, CVA. He started with SOB, cough, loss of taste and smell and now is very fatigued, has a loss of appetite and has low O2 saturation. DON of PHH denied that he has any stomach concerns (no vomiting or diarrhea). His O2 sat has been in the high 70''s and they are concerned about him. They may look into if he has pneumonia, as he has not had a chest xray, however they have already prescribed antibiotics, steroids, ivermectin, and vitamins C, D, and Zinc


VAERS ID: 1685099 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-08-17
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-09
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, COVID-19 pneumonia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (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: 2021-08-18
   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: PRESENTED IN RESPIRATORY DISTRESS, COVID POSITIVE, PNEUMONIA DUE TO COVID


VAERS ID: 1685126 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-09-02
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nursing notes have been submitted into system, death summary is not available yet.


VAERS ID: 1685155 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-16
Onset:2021-08-19
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   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: O2 dependent COPD.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID 19. Patient expired.


VAERS ID: 1685163 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-08-11
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-09
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, Cerebrovascular accident, Death, Pneumonia, SARS-CoV-2 test positive
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RECENT CVA; HX OF COPD, HTN, ASTHMA; PNEUMONIA DUE TO POSITIVE FOR COVID


VAERS ID: 1685183 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-08-20
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Dyspnoea, Heart rate decreased, Oxygen saturation decreased, Procalcitonin increased, Tachypnoea, X-ray abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trelegy Ellipta 100-62.5-25mcg 1 puff daily, lisinopril 10mg daily, prednisone 10mg daily, albuterol 2 puffs q4hours prn, atorvastatin 20mg daily, cetirizine 10mg daily, fluticasone 2 sprays each nostril daily, Floranex 100 million cell gra
Current Illness:
Preexisting Conditions: morbid obesity, HTN, moderate persistent asthma, OSA, HLD, allergic rhinitis, long term systemic steroid user
Allergies: Aleve, Fentanyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccine on 03/11/2021 and 04/08/2021. On 8/20/2021, pt presented to ED with increasing shortness of breath. Pt was admitted to a hospital on 8/17/2021 and diagnosed with COVID-19 pneumonia. She was discharged on 8/20/2021 with 4 L NC oxygen. Once discharged patient began to desaturate to 80% and called EMS. Patient was transported to ED and placed on HFNC 50/40 then titrated up to 60/60 and then later 70/60. Her lab work demonstrated elevated procalcitonin and her x-ray demonstrated a multifocal pneumonia. She was given dexamethasone, Rocephin and remdesivir. On morning of 8/25/21 she was noted to be significantly tachypneic with RR to 40s and slightly altered. Despite ongoing treatment, she declined. Patient expired on 8/25/21.


VAERS ID: 1685188 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-08-12
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Death, Decreased appetite, Dyspnoea, Endotracheal intubation, Fatigue, Hypophagia, Infarction, Nausea, Pain, Pneumocystis jirovecii pneumonia, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg 2 puffs q4h prn, amlodipine 5mg daily, Eliquis 5mg BID, benzonatate 200mg TID PRN, Tylenol PM 25-500mg nightly prn, Lomotil 2.5-0.025mg 2 tabs QID prn, famotidine 20mg BID, ibuprofen 200mg 2 tabs QID prn
Current Illness:
Preexisting Conditions: HTN, ED, HLD
Allergies: Ciprofloxacin, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccine on 03/11/2021 and 04/02/2021. On 7/12 he began developing symptoms of fatigue, chills, low-grade fevers, body aches, intermittent nausea, poor p.o. intake, poor appetite, some dry cough. He tested COVID positive on 7/16 and continued symptomatic treatment at home. Patient was then admitted 7/24 and discharged on 7/30 with oxygen. Received decadron during this stay. Returned to ER on 8/12 due to worsening shortness of breath. Received vancomycin and cefepime. Started on BiPAP then eventually intubated on 8/17. Patient''s respiratory status continued to worsen. Multifocular infarcts noticed on 8/22. Patient treated for PJP on 8/23. Family planned withdrawal of care on 8/24 after discussion of patient''s poor prognosis. Patient expired on 8/25/21.


VAERS ID: 1685194 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-23
Onset:2021-08-15
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-09
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, Cough, Fatigue, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: fever, fatigue, cough, positive for COVID


VAERS ID: 1685242 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-08-31
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cerebrovascular accident, Death, Endotracheal intubation, Extubation, Hypoaesthesia, Paraesthesia
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 54-year-old female who was diagnosed with Covid several weeks prior presented to outside hospital due to facial numbness/tingling. She was found to have evidence of MCA stroke and was given TPA, she was transferred here for further management. Upon arrival here she was found to have evidence of bilateral MCA strokes, given that the patient was intubated and there is no likelihood of meaningful recovery goals of care discussions were had with neurology and the recommendation was to proceed with comfort care measures. The patient was extubated and transitioned to comfort care measures. Patient expired on 8/31/2021, cause of death was bilateral MCA strokes.


VAERS ID: 1685297 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2020-12-30
Onset:2021-08-22
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Donepezil 10 mg bid, Amlodipine 5mg daily, Benazepril 10mg daily, Escitalopram 20mg daily, Furosemide 40 mg daily, Memantine HCL 10 mg bid, Multivitamin daily,
Current Illness: None
Preexisting Conditions: HIstory of Tuberculosis. Hypertension, Late onset Alzheimers with behavioral disturbances, History of a colon resection.
Allergies: NKDA
Diagnostic Lab Data: Covid positive 8-16-2021
CDC Split Type:

Write-up: Fever, cough, recent pneumonia diagnosed by chest xray.


VAERS ID: 1685315 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-18
Onset:2021-09-08
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cardio-respiratory arrest, Cardioversion, Death, Dyspnoea, Endotracheal intubation, Gastrointestinal tube insertion, Hypoxia, Intensive care, Mechanical ventilation, Oxygen saturation decreased, Pulseless electrical activity, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   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 admitted to COVID floor on 8/25/21 for acute hypoxic respiratory failure secondary to bilateral pneumonia COVID-19. She was initiated on dexamethasone and remdesivir. Pulmonology consulted 8/31 for worsening hypoxemia, on heated high-flow nasal cannula and alternating with noninvasive positive pressure ventilation. On 09/02 patient was transferred to the COVID19 ICU for worsening respiratory status. Patient requested multiple times to delay intubation and maintain on AVAPS. She did have a feeding tube placed and was receiving tube feeds. She essentially became dependent on noninvasive ventilation unable to wean. She did attempt self proning with some improvement in her oxygenation. This morning, patient''s oxygen saturations dropped to 60s with increased work of breathing despite noninvasive ventilation and self proning. Discussed with patient again and she was agreeable to being intubated and family agreed. Patient sedated and intubated, unfortunately shortly after intubation patient had a PEA arrest and Code Blue called. See previous note for details. Ultimately, after multiple rounds of CPR, epinephrine, defibrillations without persistent return of spontaneous circulation and approx 35 minutes resuscitation efforts, all resuscitation efforts stopped and time of death called at 08:07am.


VAERS ID: 1685326 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 1 LA / IM

Administered by: Public       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: MS Contin 15mg, Lasix 20mg, Clonazepam 0.5mg, Trazadone, Haldol, Morphine, Vicks Vaporub, Albuterol Neb, Hydroxyzine, Prednisone, Compazine, Phenergan, Coreg, Zestril, Anti-fungal powder, Miralax, Zofran, Prilosec, Acetaminophen, Imodium,
Current Illness:
Preexisting Conditions: Chronic Systolic Congestive Heart Failure, Aneurysm of iliac artery, COPD, Cardiomyopathy, hypertension, Obesity, Atrial Fibrillation, Rheumatoid Arthritis
Allergies: Ciprofloxacin, metronidazole
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient of Hospice who requested to have Covid Vaccine. Our Community Paramedic, took the vaccine to the Hospice on 9/2/2021. He administered the vaccine and waited 15 minutes to observe for reactions. No adverse reactions were noted. The following morning we received a call from the nurse at the Hospice House that pt was pronounced deceased on 9/3/2021 in early am.


VAERS ID: 1685347 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-08-17
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Apnoea, Cough, Death, Delirium, Diarrhoea, Dysphagia, Dyspnoea, Hypoxia, Nausea, Pneumonia, Respiratory failure, Sneezing, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol 6.25mg BID, Isosorbide dinitrate 10mg daily Tylenol 500mg 1 tablet q6h prn, aspirin 81mg daily, atorvastatin 40mg ? tab daily, vitamin D3 5000unit daily, folic acid 1mg daily, furosemide 40mg 1 tab daily, Levemir 12 units daily i
Current Illness:
Preexisting Conditions: T2DM with nephropathy, Stage IV renal insufficiency, HTN, HLD, CAD, CHF, Complete Heart Block, Cardiomyopathy
Allergies: Influenza Virus Vaccines, Penicillins, Promethazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/6/2021 and 3/27/2021. Patient started having cough and sneezing around 8/11 after going out of town. She then developed nausea, vomiting, and diarrhea on 8/12. Patient presented to ED on 8/17, o2 sat was 75% on room air. She was placed on a non-rebreather but was saturating at 100%. Imaging showed multifocal pneumonia. Patient was treated with dexamethasone, remdesivir, and baricitinib . Patient continued to experience respiratory failure. Patient developed AKI and acute delirium and was unable to safely swallow. Dobhoff tube was placed, and she received enteral nutrition. She developed worsening hypoxia on 8/25/21. Patient continued to have acute worsening of breathing, became apneic, and expired on 8/25/21.


VAERS ID: 1685352 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-27
Onset:2021-05-31
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bacteraemia, Blood culture positive, Cardiac failure congestive, Computerised tomogram thorax, Cough, Death, Dyspnoea, Enterococcal infection, Pneumonia, Pneumonia aspiration, Pneumonia bacterial, Productive cough, Sepsis, White blood cell count increased
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 42 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, albuterol, amlodipine, benzonatate, calcium carbonate, breo ellipta, duoneb, macular vitamin, magnesium hydroxide, melatonin, metoclopramide, Montelukast, omeprazole, ondansetron, refresh tears, spironolactone, apixaban, levo
Current Illness:
Preexisting Conditions: Asthma, Coronary artery disease, DJD (degenerative joint disease), DVT (deep venous thrombosis) (HCC), Hypercoagulable state (HCC), Hypertension, Hypothyroidism, Iron deficiency anemia, Osteopenia, and Seasonal allergies.
Allergies: fexofenadine, meloxicam, sulfa
Diagnostic Lab Data: 5/3/21 CTA chest: neg for embolism 5/3/21 Chest: Marked interval improvement in previously seen extensive consolidation within the left lung. Minimal residual is seen. 5/3/21 blood culture x 2: enterococcus faecium VRE
CDC Split Type:

Write-up: Had COVID 19 in November 2020 and again in May 2021. Came to hospital with complaint of worsening shortness of breath associated with cough and sputum expectoration. Recently discharged for recurrent pneumonia. WBC 20. Started on ceftriaxone, azithromycin and dexamethasone. Placed on 2L NC. Diagnosed with community acquired bacterial pneumonia. Had VRE bacteremia. Switched to daptomycin and discharged on linezolid x 10 days. Readmitted on 5/29/21 with SOB, cough, and new left-sided pneumonia. Discharged 6/9/21. Admitted again on 6/10/21 for aspiration pneumonia and CHF exacerbation. Placed on unasyn and discharged on augmentin. Admitted again on 6/28/21 for sepsis secondary to pneumonia. Went comfort measures at this time and discharged with hospice. Died 7/15/21


VAERS ID: 1685364 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-08-16
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: All Day Pain Relief 220mg bid. Ipratropium 0.03%, 1 puff in each nostril bid. Levothyroxine 88mcg daily. Polyeth Glycol 1 capful in water daily.
Current Illness: none
Preexisting Conditions: Hydrocephaly, Benign Prostatic Hypertrophy, Coronary Artery Disease, Tremors, Hypothyroidism, Anemia
Allergies: NKDA
Diagnostic Lab Data: Covid positive 08/16/2021
CDC Split Type:

Write-up: Fever, cough


VAERS ID: 1685422 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-08-16
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dofetilide 250mcg daily, Polyethyl Glycol powder 1 capful with water daily. ASA 81 mg daily. Donepezil 5 mg daily. Latanoprost sol .005% 1 drop to each eye at night. Senna 0.8 mg daily. Levothyroxine 25 mcg daily. Lorazepam 0.5 mg twi
Current Illness: none known
Preexisting Conditions: Hypothyroidism. Senile Hyperkeratosis. Scoliosis deformity of the spine. Dementia with behavioral disturbances. Alzheimers Disease. Atrial Fibrillation.
Allergies: Iodine contrast
Diagnostic Lab Data: Covid positive 08/16/2021
CDC Split Type:

Write-up: Fever, cough, runny nose


VAERS ID: 1685430 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-05
Onset:2021-09-05
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown


VAERS ID: 1685448 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death, Dyspnoea, Fatigue, Gait inability, Laboratory test, Mobility decreased, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Alzheimer''s
Allergies: None
Diagnostic Lab Data: Various Test Ran
CDC Split Type:

Write-up: Tiredness unable to get out of bed and walk Acute Respiratory Failure COVID 19 Positive Septic Shock Shortness of Breath Expired on 08/27/2021 *She lived with a caregiver. Her son called to report but had limited information. He says that the caregiver has more information.


VAERS ID: 1685498 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-08-16
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: 2021-09-04
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carb/Levo 25-100 mg tid. Amantadine 100 mg bid. Clonazepam 0.5 mg every hs. Bisacodyl 5mg daily. Olanzapine 2.5 mg every hs. Citalopram 20 mg daily. Simethicone 180 mg bid. Oxycodone 5 mg bid. Senna s 8-6-50 3 tablets bid. Lisinop
Current Illness: none known
Preexisting Conditions: Dementia, Debility, Hypertension, Parkinson Disease, Spondylosis, Allergic Rhinitis, Osteoarthritis, Anxiety, Depression, Schizophrenia.
Allergies: NKDA
Diagnostic Lab Data: Covid positive 08/18/2021
CDC Split Type:

Write-up: Fever, sore thoat, cough.


VAERS ID: 1685546 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-07
Onset:2021-08-14
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Coma scale abnormal, Computerised tomogram head normal, Death, Endotracheal intubation, Hypotension, Pulmonary mass, Respiratory failure, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, amlodipine, amoxicillin-clavulanate, aspirin, baclofen, gabapentin, metoprolol tartrate, pantoprazole, sulfamethoxazole-trimethoprim
Current Illness:
Preexisting Conditions: neurogenic bladder with recurrent UTI, hypertension
Allergies: morphine
Diagnostic Lab Data: Tested positive for covid 8/14/21.
CDC Split Type:

Write-up: 8/14/21: patient brought to ED as she was found unresponsive by family last time was seen was 8:00 p.m. on arrival to ED patient has to be intubated for low GCS round 3 stroke alert team was activated head CT is negative chest x-ray significant for right upper lobe mass patient required norepinephrine as she was hypotensive. COVID test PCR came back positive. admitted to COVID unit Note: patient previously vaccinated with Pfizer Covid-19 vaccine on 4/26/21 & 5/17/21. Diagnosed with hypoxic respiratory failure secondary to covid pneumonia. 8/22/21: patient died.


VAERS ID: 1685561 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-11
Onset:2021-08-12
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, Cardiac arrest, Chills, Death, Disease risk factor, Hypotension, Intensive care, Myalgia, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive, Therapeutic response decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 25
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: Lisinopril, Amiodipine,quin
Current Illness: UTI
Preexisting Conditions: Bladder Cancer 2004, Hypertension, Renal Cancer (Nephrectomy 2004)
Allergies: Penicillin
Diagnostic Lab Data: COVID Anti-Spike IgG Positive, COVID Anti-Spike Nucleocapsid IgG Negative, COVID Rapid Molecular Positive,
CDC Split Type:

Write-up: Presented to the ED with chief complain of fever, myalgia and noted low oxygen saturation. He was possibly exposed to the coronavirus at his bar during a hosted festival from 8/6-8/8 where one attendant called to inform him he tested positive to the coronavirus. His symptoms started with fever, myalgia, chills about 1-2 weeks prior to his admit on 8/24/21, In the ED, he was desaturating to the 50s and placed on a HFNC. His code status is DNR/DNI. He has received remdesivir, decadron, 2 doses of barticinib and therapeutic anticoagulation for being at high thrombotic risk from the coronavirus infection. Patient was managed in the ICU from the time of admission. On the night of 9/5/21 patient became hypotensive and not responding adequately to IV fluids. Patient was found to have asystole at 3:06 AM on 9/6/21. Pronounced dead at 3:06 AM.


VAERS ID: 1685563 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-23
Onset:2021-09-04
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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: albuterol, vitamin C, aspirin, zebeta, fibercon, calcium, vitamin D, plavix, tricor, proscar, lasix, gabapentin, glucosamine, guafenesin, novolog, ketoconazole, lisinopril, loratadine, magnesium oxide, metformin, multivitamin, nitro, ropini
Current Illness:
Preexisting Conditions: acute respiratory failure, chronic kidney disease, obesity, nocturnal hypoxemia, hypersomnia, vitamin D deficiency, hyponatremia, PTSD, diabetes mellitus, diabetic neuropathy, coronary artery disease, hypertension, dyslipidemia, COPD
Allergies: iodine, tamsulosin, atorvastatin, doxycycline monohydrate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Decedent on hospice for acute respiratory failure due to chronic obstructive pulmonary disease.


VAERS ID: 1685567 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-12
Onset:2021-08-29
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin,lipitor, vitamin B, iron, midodrine, potassium, gluconate, brilinta, vitamin D, nitro
Current Illness:
Preexisting Conditions: hyperlipidemia, hypertension, coronary artery disease, chronic kidney disease, cerebral infarction
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 8/29/2021, decedent presented to the ER with a three day duration of worsening shortness of breath. He was admitted to the hospital and discharged home on 9/1/2021 with COVID pneumonia.


VAERS ID: 1685584 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-08
Onset:2021-08-15
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 - / -

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

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

Write-up: SOB, positive COVID test, productive cough, current lung CA


VAERS ID: 1685607 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 UN / -

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Death, Dyspnoea, Dyspnoea exertional, Electrocardiogram normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: predaxa, crestor, matopolol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ekg - normal
CDC Split Type:

Write-up: chest tightness, shortness of breath after walking short distances, on 23rd collapsed at work and died


VAERS ID: 1685619 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-08-18
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Ageusia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea exertional, Fatigue, Gastroenteritis viral, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), 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 (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 22
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: Diltiazem, furosemide, glimepiride, levothyroxine, memantine, metoprolol, miralax, KCL, entresto, sertraline, simvastatin, timolol Malaete eye, travoprost eye, warfarin
Current Illness:
Preexisting Conditions: Afib, CHF, glaucoma, hyperlipidemia, hypothyroid, diabetes, ocular shingles, mild dementia
Allergies: hydrocodone, oxycodone
Diagnostic Lab Data: COVID-19 PCR positive on 8/18/21
CDC Split Type:

Write-up: 8/18/2021: admitted with COVID breakthrough Pt reports fully vaccinated in April 2021. Reports since Sunday having fatigue, diarrhea, mild cough, loss of taste/appetite, and exertional dyspnea. reported testing positive for COVID-19 on 8/16/21. 1st vaccine 3/8/2021 second 4/15/2021. Diagnosed with: COVID-19 pneumonia, acute hypoxic respiratory failure, viral enteritis 9/9/21: patient died.


VAERS ID: 1685644 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-13
Onset:2021-02-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024MZOA / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Decreased appetite, Feeling abnormal, Gait inability
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   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: Seroquel
Current Illness: Lewy Bodie dementia Lyden factor five
Preexisting Conditions: Lyden factor five -Lewy bodies dementia
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: He received the vaccine on 2/13/21 by 2/15/21 he was not feeling himself didn?t really eat by 2/17/21 he couldn?t walk by 2/19/21 he was admitted to hospice and by 2/22/21 he passed away


VAERS ID: 1685648 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-21
Onset:2021-08-23
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Blood culture positive, COVID-19, Death, Dialysis, Disseminated intravascular coagulation, Dyspnoea, Enterobacter bacteraemia, Enterobacter test positive, Gastrointestinal haemorrhage, Inappropriate schedule of product administration, International normalised ratio decreased, Mechanical ventilation, Oxygen saturation decreased, Platelet count decreased, Positive airway pressure therapy, SARS-CoV-2 test positive, Seizure, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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: 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: albuterol 1-2 puffs 4 times daily as needed, atorvastatin, 40 mg daily, azelastine 1 drop both eyes twice daily as needed, bupropion 300 mg daily, cetirizine 10 mg daily, cinacalcet 30 mg daily, citalopram 40 mg daily, ergocalciferol 1250 m
Current Illness:
Preexisting Conditions: congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, sleep apnea, cirrhosis, chronic obstructive, pulmonary disease, history of hepatitis C, esophageal varicies, anemia, vitamin D deficiency, pulmonary hypertension, chronic pain syndrome, chronic kidney disease
Allergies: Ibuprofen, tramadol, methocarbamol
Diagnostic Lab Data: COVID Positive on 8/23/2021; INR 4.4 on 9/1/2021; platelets 14 on 8/29/2021; blood culture positive for enterobacter cloacae
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/24/2021 and 7/1/2021. Patient previously hospitalized for COVID-19 8/11/2021 to 8/15/2021 where he received remdesivir an. Presented to ED on 8/23/2021 with complaints of difficulty breathing. BiPAP was initiated in ED. Patient oxygenation continued to decompensate and eventually required mechanical ventilation. Patient developed seizures, shock, GI bleeding, DIC, and acute kidney failure requiring dialysis. Patient had enterobacter bacteremia. Patient received dexamethasone, ceftriaxone, cefepime, methylprednisolone, azithromycin, and vancomycin. After discussion with family, care was withdrawn on 9/1/2021 and patient expired at 1442.


VAERS ID: 1685668 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-02
Onset:2021-08-14
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Brain hypoxia, COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, Endotracheal intubation, Gastrooesophageal reflux disease, General physical health deterioration, Headache, Intensive care, Pneumonia bacterial, Pyrexia, Respiratory distress, Respiratory tract congestion, SARS-CoV-2 test positive, Use of accessory respiratory muscles, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol MDI PRN, Aspirin 81 mg QD, Atorvastatin 40 mg QD, Calcium Carbonate+Vitamin D BID, Cholecalciferol 5000 units QD, Citalopram 20 mg QD, Fluticasone nasal QD, folic acid 1 mg QD, Gabapentin 300 mg BID, Hydroxychloroquine 200 mg QD
Current Illness:
Preexisting Conditions: Anxiety, Arthritis, Asthma, CKD, Thoracic compression fracture, COPD, Depression, Diabetes mellitus, Dysphagia, GERD, Esophageal ring, hyperlipidemia, hypertension, migraine, nephrolithiasis, premtaure ventricular contractions, restless legs syndrome.
Allergies: NKDA
Diagnostic Lab Data: Positive COVID test on 8/10/2021 using the Roche LIAT SARS assay platform using PCR or equivalent nucleic acid amplification technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/14/2021 and 2/2/2021. Patient contacted physician office on 8/9/2021 stating had a positive COVID HOME test on 8/8/2021 with a three day history of sore throat, headache, congestion, coughing also noted to have oxygen level of 81 and fever of 101.9. Patient was retested on 8/10/2021 and was positive. Patient presented to ED on 8/10/2021 with complaints of shortness of breath. On presentation SpO2 100% on room air without significant tachypnea, but with mild bilateral wheezes. Patient received Imdevimab+casirivimab and was discharged home @ 1645. Patient presented back to ED at 2011 in respiratory distress with increased work of breathing, accessory muscle use, and transient hypoxia. Noted O2 sats of 74% on room air, and placed on high-flow nasal cannula. Patient improved rapidly overnight coming down to just 2 L NC by the following morning. Patient stated she felt better as well denying SOB, fevers or chills but reporting some cough. Patient O2 needs had decreased to 4 L on ambulation by 8/13. She was discharged on home with home O2 on 8/13. She was prescribed dexamethasone to complete a total of 10 days of therapy for COVID and cefdinir to complete 5 days of therapy for suspected overlying bacterial PNA. Patient presented to ED on 8/14/2021 due to shortness of breath. She was transferred to ICU 8/15 due to acute hypoxic respiratory failure due to COVID-19 pneumonia and found to have secondary bacterial pna. Patient returned to the floor in hosptial but subsequently bounced back to the ICU 8/25 and intubated 8/26. Patient continued to deteriorate and palliative care was consulted. 8/31 decision was made by family to pursue DNR/AND. Patient passed away peacefully at 8:54PM on 8/31/2021.


VAERS ID: 1685685 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-16
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, General physical health deterioration, Hypoxia, Pulmonary fibrosis, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: 2021-09-03
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tivicay 50 mg QD, Descovy 200mg/25 mg QD, Prezcobix 800mg/150 mg QD, Bactrim 800mg/160 mg QD, Pravastatin 10 mg QD, Dulera 200mcg/50 mcg BID, Cyanocobalamin 100 mg QD, Albuterol PRN.
Current Illness:
Preexisting Conditions: HIV Infection, Pulmonary fibrosis
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/14/2021 and 2/12/2021. Presented to ED on 8/16/2021 with complaints of worsening hypoxia after a positive COVID test the previous week from an outside facility. Symptom onset was 8/11/2021. Patient has been on 5L NC at baseline for pulmonary fibrosis. Patient treated with dexamethasone, remdesivir, and highflow oxygen. Patient initially improved after 5 days of remdesivir and 10 days of dexamethasone, but hypoxia worsened starting on 8/30/2021. On 9/3/2021 patient rapidly deteriorated, and expired at 1545 on 9/3/2021.


VAERS ID: 1685687 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-08-17
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure abnormal, COVID-19, Cough, Death, Decreased appetite, Diabetic ketoacidosis, Dialysis, Diarrhoea, Endotracheal intubation, General physical health deterioration, Hypoxia, Nausea, Prone position, Pyrexia, Renal impairment, Respiratory acidosis, Resuscitation, SARS-CoV-2 test positive, Septic shock, Tachycardia, Urine output decreased, Vascular catheterisation, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Toxic-septic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Eosinophilic pneumonia (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 (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Atorvastatin 40 mg QD, Cholecalciferol 1000 units BID, Cyanocobalamin 100 mcg QD, Fish Oil BID, Glimepiride 4 mg BID, Hydralazine 50 mg TID, Insulin aspart 20 units TID, Insulin glargine 30 units QD, Isosorbide dinitrate 2
Current Illness:
Preexisting Conditions: Anemia of Chronic Disease, BPH, Chronic diastolic CHF, CHronic gout without tophus, Chronic ulcer of toe (left foot), Chronic venous insufficiency, CKD stage 3, CAD involving native artery of transplanted heart without angina pectoris, diabetic peripheral neuropathy associated with type 2 DM, Essential hypertension, H/O depression, H/O heart transplant, H/O nephrolithiasis, H/O shingles, hyperlipidemia, long-term immunosuppression, metabolic bone disease, obesity, Obstructive sleep apnea on CPAP, primary urethral papillary carcinoma.
Allergies: Gabapentin (altered mental status)
Diagnostic Lab Data: Positive COVID Tests on 8/17 and 8/18 .
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/7/2021 and 4/30/2021. Presented to ED on 8/17/2021 with cough, nausea, vomiting, diarrhea fever of 102, loss of appetite, and decreased UOP. Treated initially for DKA, and placed on HFNC. DKA resolved, and transitioned off insulin gtt 8/21. Due to increasing oxygen requirements, patient intubated on 8/23, and subsequently required proning. Developed septic shock, requiring norepinephrine and vasopressin gtt. Worsening renal function prompted Vascath placement and initiation of dialysis 8/29. Patient continued to deteriorate clinically, requiring the addition of epinephrine for blood pressure support, and worsening respiratory acidosis and hypoxemia. He developed wide complex tachycardia requiring 1 shock, after which family was called for goals of care discussion. Transitioned patient to comfort care, and he expired shortly thereafter.


VAERS ID: 1685693 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-15
Onset:2021-08-16
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood urine present, COVID-19, Chills, Cough, Culture urine positive, Death, Escherichia test positive, Feeling cold, Nephrolithiasis, Nephrostomy, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (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: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg Q6H PRN, Allopurinol 100 mg QD, Amlodipine 10 mg QD, Cholecalciferol 1000 units QD, Lomotil QID PRN, Ferrous sulfate 325 mg QD, Loperamide 2 mg TID PRN, Metoprolol 50 mg BID, Sevelamer 800 mg TID, Sodium bicarbonate 5 g
Current Illness:
Preexisting Conditions: Benign prostate hyperplasia, , bilateral macular degeneration, bilateral sensorineural hearing loss, chronic gout with tophus, chronic respiratory failure with hypoxia due to obstructive sleep apnea, chronic kidney disease stage 3, depression with anxiety, essential hypertension, generalized osteoarthritis of multiple sites, H/O calcium pyrophosphate deposition disease, H/O prostate cancer, H/O Clostridium difficile colitis (3/2020), H/O of left nephrectomy for large nonfunctioning kidney, H/O of nonmelanoma skin cancer, Iron deficiency anemia, Left lower lobe pulmonary nodules, obesity, Primary insomnia, H/O renal cell cancer (right kidney).
Allergies: NKDA
Diagnostic Lab Data: COVID Positive Test 8/18/2021 using the Hologic Panther System Platform using PCR or equivalent nucleic acid amplification technology. Urine culture = E. coli ESBL.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/18/2021 and 4/15/2021. Presented to ED on 8/16/2021 with complaints of weakness and fever over the past day. Patient''s nephrostomy tube was changed two weeks prior for an infected kidney stone and patient just started noticing blood in his foley bag the morning of presenting to the ED. Admitted for UTI. On 8/17/2021 patient expressed concern for COVID status since family at home is COVID positive. Patient has mild cough but feels it is chronic at baseline. Patient tested positive for COVID on 8/18/2021 and spiked a fever that afternoon. On 8/19/2021 patient reported feeling cold and having chills overnight as well as dry cough, but denies shortness of breath. On 8/20/2021 patients SPO2 dropped (86-88%) on 6L O2. Patient was placed on NRB with 96% sats. On 8/21 patient on HFNC with escalating oxygen requirements, patient started on dexamethasone. On 8/25 patient experienced destauration to 87% while on 6L NC. On 8/30/2021 patient wished to discuss comfort care. On 8/31/2021 patient was transitioned to inpatient hospice, and patient expired on 9/1/2021.


VAERS ID: 1685705 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-11
Onset:2021-08-25
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bacteraemia, Bacterial test, COVID-19, Chills, Cough, Death, Diarrhoea, Endotracheal intubation, Fatigue, Haemodialysis, Hypoxia, Mechanical ventilation, Myalgia, Pyrexia, Renal impairment, SARS-CoV-2 test positive, Sepsis, Septic shock, Staphylococcus test positive, Ultrasound kidney normal, Vascular catheterisation
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Toxic-septic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 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: Amlodipine 5 mg QD, Aspirin 81 mg QD, Atorvastatin 40 mg QD, Calcium Acetate QD, Carvedilol 25 mg BID, Cetririzine 10 mg QD PRN, Clopidogrel 75 mg QD, Ergocalciferol 50,000 units QWeek, Fluticasone nasal BID, Insulin aspart 28 units TID, La
Current Illness:
Preexisting Conditions: Type 2 DM, HTN, hyperlipidemia, Obesity, PVD, CKD, GERD, OSA on CPAP, Hypothyroidism.
Allergies: Lisinopril (Cough), Potassium (Nausea)
Diagnostic Lab Data: Covid Positive Test on 8/25/2021 using Roche LIAT SARS Assay platform using PCR or equivalent nucleic acid amplification technology.
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 3/11/2021. Presented to ED on 8/25/2021 with a 9-10 day history of coughing, fevers, diarrhea, fatigue, hypoxia, myalgiam and chills. She was started on Dexamethasone on 8/26 and continued this through her hospital course. Eventually her oxygen requirements escalated and she required intubation on 8/27/21 due to persistent significant hypoxia despite maximum non-invasive interventions. A trialysis catheter was also placed for her and nephrology was consulted due to urgent need for dialysis as her kidney function continued to deteriorate since admission. Renal ultrasound did not show any hydronephrosis or obstructive processes. On 8/27 she had 3L removed via HD. She required paralytics, sedation, and pain control while on the ventilator. On 8/27/21, her code status was changed to DNAR/COT. Eventually, she developed septic shock and was found later to be bacteremic (GPC in clusters) with a positive MRSA PCR nares. The culture did not have a final result by the time of her passing. She was started on broad spectrum antibiotics on 8/30 at the time of her becoming more septic. On 8/31, the patient''s MAPs and oxygen saturations continued to decrease despite maximal therapy (including four vasopressors). The patient passed away at 0630 on 8/31/21.


VAERS ID: 1686251 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-31
Onset:2021-09-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Injection site pruritus
SMQs:

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patients daughter reported to us that the patient died on 9/4 or 9/5. the patient was otherwise healthy. the patient told her daughter that her arm itched some at the injection site. the family is not doing an autopsy


VAERS ID: 1688944 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-08-14
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, General physical health deterioration, Lung infiltration, Nausea, Nephropathy, Nucleic acid test, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol 12.5mg BID, Norco 5-325mg take 1 tab cont. q6h prn, Mag Ox 400mg BID, Cellcept 250mg 3 tabs in the morning and nightly, Nifedipine 60mg daily, omeprazole 40mg BID, prednisone 10mg daily, remipril 5mg nightly, Bactrim 400-80mg dai
Current Illness: Umbilical Hernia
Preexisting Conditions: CHF, HTN, Kidney Transplant s/p 15 years
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive 8/14/21: This sample was analyzed using the Biofire Torch system using PCR or equivalent Nucleic Acid Amplification
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 05/20/2021 and 06/17/2021. Presented to ED on 8/14 with complaints of shortness of breath and coughing. Noticed symptoms of chills, nausea, and abdominal pain on 8/11. In ED pt was febrile, tachycardic, and tachypneic. CXR showed bilateral infiltrates. Patient required HFNC at 75-90% and Non-rebreather. Patient was proned. During stay, patient received zosyn, vacomycin,prednisone, ceftriaxone, and decadron. Renal disease precluded use of remdesivir. Patient continued to decline and expired on 8/28/21.


VAERS ID: 1688947 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-31
Onset:2021-04-14
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, SARS-CoV-2 test, Sinus operation, Upper respiratory tract infection
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, stent
Allergies: Clonidine
Diagnostic Lab Data: Covid test, CXR.
CDC Split Type:

Write-up: Pt came to ER c/o URI and nasal drainage onset 3 weeks prior.


VAERS ID: 1688950 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-20
Onset:2021-08-18
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, General physical health deterioration, Pyrexia, Renal failure, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (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: 2021-08-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 500mg 1tab Q6h prn, amlodipine 2.5mg daily, cont. Combigan 0.2-0.5mg place 1 drop into both eyes q12h; Trulicity 0.75mg weekly, furosemide daily, Garlic daily, glucosamine sulfate 1,000mg daily, Humalog 100u/ml 5-10 units with lunc
Current Illness:
Preexisting Conditions: paroxysmal A Fib, Combined CHF/NICM (LHC with no CAD 2015, LVEF 20% off meds), DM II, HTN, HLD hypothyroidism, cont CKD, H/O osteomyelitis requiring amputation
Allergies: NKDA
Diagnostic Lab Data: COVID-19 positive 8/18/2021 This sample was analyzed using the Cepheid GeneXpert 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 Vaccine on 01/28/2021 and 02/20/2021. Presented to ED on 8/18 with complaints of fever and vomiting. On 8/22, Patient was placed on high flow oxygen and required vasopressors. Patient was intubated on 8/23. Patient continued to decline and also developed renal failure. Patient was transitioned to comfort care on 8/26. During stay patient received cefepime, vacomycin, doxycycline, remdesivir, baricitinib, and decadron. Patient expired on 8/26/21.


VAERS ID: 1688955 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-08-06
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest pain, Chills, Death, Dyspnoea, Hypoxia, Intensive care, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: 2021-08-26
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium carbonate 600mg/Vitamin D3 daily, Vitamin D2 1250mcg weekly, famotidine 20mg BID, Myfortic 360mg 1 tab BID, Nifedipine 60mg daily, prednisone 5mg 2 tab daily, sirolimus 1mg 3 tab daily, Bactrim 400-80mg daily, aspirin 81mg daily, s
Current Illness:
Preexisting Conditions: Kidney Transplant 11/11/2020, HTN, T2DM with diabetic foot ulcer, ESRD, elevated EBV antibody titer positivie CMV antibody
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive 8/6/2021: This assay was performed on the RP2.1 platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccine on 05/06/2021 and 06/03/2021. Patient presents to ER on 8/6/2021 referred directly from outpatient clinic with chief complaint of fever, chills, chest pain and dyspnea times 3 days. He was admitted to medical floor 08/06/2021 for acute hypoxemic respiratory failure secondary to COVID pneumonia requiring 2 L supplemental oxygen via nasal cannula. Patient received remdesivir, ceftriaxone, Bactrim and Baricitinib. On 08/10, oxygen demand increased from 7 L nasal cannula to high-flow nasal cannula 40 L 40% FiO2. Oxygen demand slowly increased requiring 60 L 100% FiO2. Patient was transferred to ICU for worsening hypoxia. 8/14-8/15 patient remained on HFNC and desaturated in the 50s. 8/15 patient left the hospital against medical advice. Patient expired on 8/26/21.


VAERS ID: 1689025 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-20
Onset:2021-08-02
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: FOUND UNRESPONSIVE ON 8/2/2021, TAKEN TO ED IN CARDIC ARREST, FOUND COVID POSITIVE, NEVER RESPONDED TO TREATMENT, DIED ON 8/2/2021


VAERS ID: 1689045 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-09
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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: Chronic Lung Disease (asthma/emphysema/COPD), Diabetes Mellitus, Cardiovascular disease, Chronic Renal disease
Allergies:
Diagnostic Lab Data: 08/13/2021 PCR+ COVID-19 test at Medical Center
CDC Split Type:

Write-up: Hospitalization (8/9/2021-8/18/2021) and death (8/18/2021) due to COVID-19


VAERS ID: 1689053 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-18
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031K20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 19
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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: AFIB, COPD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID DIAGNOSIS 8/18/2021; HOSPITALIZED 8/24/2021 WITH COVID PNEUMONIA; ACUTE RESPIRATORY FAILURE.


VAERS ID: 1689072 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-08-27
Onset:2021-09-06
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions:
Allergies: Denied
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Suffered a major heart attack on 09/06/2021 and expired on 09/07/2021 on hospice.


VAERS ID: 1689102 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-04
Onset:2021-08-27
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cardiopulmonary failure, Death, Dementia, Failure to thrive, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (narrow), Dementia (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Neonatal disorders (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: 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: On hospice at time of death
Allergies:
Diagnostic Lab Data: 08/27/2021 Antigen+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case, death. Vital records cause of death: CARDIOPULMONARY FAILURE, FAILURE TO THRIVE, END STAGE DEMENTIA. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: COVID-19


VAERS ID: 1689182 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-18
Onset:2021-05-29
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Loss of consciousness, Posturing, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10 MG
Current Illness: none
Preexisting Conditions: blood pressure - sometimes acid reflux
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was sleeping, rolled over siezed up body postured with arms drawn. Called 911.Patient was unconscious and appeared to take his last breath as medics arrived. Medics and sheriffs arrived. I verified patient did not hit his head, fall or have any injury. They worked on the patient and transferred him to the hospital. Patient was pronounced Dead at the hospital.


VAERS ID: 1689193 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-08-03
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, Influenza B virus test positive, Lethargy, SARS-CoV-2 test positive
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: lethargy; decrease appetite, positive for COVID and flu B; hx of HTN, pacemaker, A Fib


VAERS ID: 1689211 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-14
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Decreased appetite, Lethargy, Poor quality sleep, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (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: 15
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: LETHARGY; DECREASE APPETITE, POOR SLEEP X WKS, POSITIVE COVID TEST; ACUTE HYPOXEMIC RESPIRATORY FAILURE


VAERS ID: 1689212 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-17
Onset:2021-07-20
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 51 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CETIRIZINE, ERGOCALCIFEROL,
Current Illness: STAGE IV TESTICULAR EMBRYONAL RHABDOMYOSARCOMA W/ LUNG & BONE METASTASES
Preexisting Conditions: SEE ABOVE
Allergies: VANCOMYCIN, TEMSIROLIMUS
Diagnostic Lab Data:
CDC Split Type:

Write-up: SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021


VAERS ID: 1689261 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-20
Onset:2021-08-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Arterial occlusive disease, Computerised tomogram abdomen abnormal, Death, Duodenitis, Gastritis bacterial, Hepatic enzyme increased, Intensive care, Intestinal perforation, Mental status changes, Nausea, Pancreatitis, Pneumoperitoneum, Respiratory failure, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (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), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Estrogen for male to female transition.
Current Illness: none
Preexisting Conditions: None. Patient was male to female transition and was taking hormone therapy to assist in transition.
Allergies: none
Diagnostic Lab Data: patient had a CT scan of the abdomen and pelvis showing emphysematous gastritis and duodenitis. She also had pancreatitis. Patient had marked elevation in liver enzymes that continued to worsen throughout her hospital stay. She had no previous liver problems. She also had acute kidney failure. There is suspicion that the patient developed an arterial occlusion in the abdominal vasculature that could have precipitated this event. Unfortunately this is not proven and only clinical suspicion. An autopsy was not done.
CDC Split Type:

Write-up: Patient had her 1st dose of the vaccine on Friday 8/20. Over the next day the patient developed nausea, vomiting and abdominal pain. The pain continued until the patient presented to the emergency department on 08/22. Patient was found to have emphysematous gastritis. She was started on antibiotics and admitted to the intensive care unit. The patient also had significant elevation in liver enzymes. She developed altered mental status and eventually respiratory failure and was unable to protect her airway. Further radiologic examinations showed perforated viscus and diffuse pneumoperitoneum. Patient died on 08/24.


VAERS ID: 1689284 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-05
Onset:2021-07-01
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NO LOT # AVAILA / 1 - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-17
   Days after onset: 16
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: weakness; pneumonia due to COVID-19


VAERS ID: 1689315 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-08-13
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive for COVID-19, fever, confusion


VAERS ID: 1689318 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-17
Onset:2021-09-09
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

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

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

Write-up: 8/17/2021 Client received Pfizer #1 in a homebound mission. 9/7/2021 Homebound team contacted husband for Pfizer #2 and he informed the team that she was in the hospital after a stroke. 9/92021 Team notified that client had died.


VAERS ID: 1689320 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-13
Onset:2021-08-16
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Arthralgia, Atrial fibrillation, COVID-19, Cough, Death, Endotracheal intubation, Fatigue, Hypotension, Hypoxia, Intensive care, Mechanical ventilation, Nausea, Positive airway pressure therapy, Respiratory distress, Syncope, Ventricular dyssynchrony
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   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: atorvastatin 40mg 1/2 tab daily, escitalopram 10mg 1/2 tab daily, metoprolol XL 100mg daily, rybelsus 7mg 1 tab daily before meal
Current Illness:
Preexisting Conditions: CAD, T2DM with stage 3 CKD, Non- Hodgkin''s Lymphoma, HLD, HTN
Allergies: Cefuroxime Axetil
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer BioNTech Vaccine on 1/23/2021 and 2/13/2021. Presented to ED on 8/16 with complaints of syncope and right shoulder pain. Patient had been diagnosed with COVID on 8/13, with his main symptoms being fatigue/tiredness, cough, nausea. On 8/27, patient was agonal breathing (after he removed his bipap); patient was intubated and placed on mechanical ventilation and moved to ICU. On 8/29, patient became more hypoxic in respiratory distress with dyssynchronous hypotensive Afib with RVR. Patient received decadron x 6 days, baricitnib x 8 days, doxycycline x 7 days, Micafungin started on 8/26, started vancomycin and meropenem on 8/28. Patient expired on 8/29/21.


VAERS ID: 1689321 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-03
Onset:2021-08-16
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249-ELBERT / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Encephalopathy, Hyperglycaemia, Influenza, Influenza B virus test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospital states pt was admitted 8/16 -8/24 for treatment of Covid and Flu B+, patient was discharged to Nursing Home. Pt was readmitted 8/30 ? 9/4 for encephalopathy and hyperglycemia. Patient expired 9/4/21. No ventilators either hospitalization. Patient was fully vaccinated.


VAERS ID: 1689323 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-06
Onset:2021-08-20
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Atrial fibrillation, COVID-19, Cardiogenic shock, Catheterisation cardiac abnormal, Cough, Death, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Endotracheal intubation, Feeding disorder, Intensive care, Intra-aortic balloon placement, Myocarditis, Positive airway pressure therapy, Right ventricular dysfunction, SARS-CoV-2 test positive, Tachypnoea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Myocardial infarction (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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (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), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Probiotic & Acidophilus 300-250 million cell-mg daily, Tylenol 325mg 2 tab q4h prn, temazepam 15mg 2 cap at bedtime, Symbicort 160-4.5mcg 2 puff BID, cetirizine 10mg daily. Flonase 50mcg 2 sprays in both nostrils daily, metoprolol 50mg BID
Current Illness:
Preexisting Conditions: COPD on continuous 2 L of oxygen at home, HTN, remote hx of CVA caused by meningitis causing right hemiparesis, pulmonary embolism not on AC
Allergies: Codeine Phosphate, Colistimethate Sodium, Diltiazem, Metoprolol Tartrate, Penicillin V Potassium, Pentazocine
Diagnostic Lab Data: COVID19 Positive 8/21/21 The sample was analyzed using one or a combination of Real-Time PCR based methods and multiplex reagents
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer BioNTech Vaccine on 1/18/2021 and 2/06/2021. Presented to ED on 8/20/21 with worsening shortness of breath. Patient was diagnosed with COVID-19 on 8/18/2021. Patient was tachypneic upon arrival and did not improve with BiPAP and was subsequently intubated and transferred to ICU. Before admission patient developed poor appetite and mild cough and PCP ordered monoclonal antibody for patient. Bedside echo showed an underfilled, hyperdynamic RV. Patient developed ST elevations in inf leads. She underwent LHC on 8/22 which showed myocarditis and lvef of 10%. She had an IABP placed and started on multiple pressors for cardiogenic shock. Patient also developed AKI, afib (started on amiodarone). Received vancomycin, cefepime, and azithromycin. Patient was transitioned to inpatient hospice on 8/28/21. Patient expired on 8/29/21.


VAERS ID: 1689325 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-08-18
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatine increased, Blood urine present, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Confusional state, Crystal urine present, Death, Incontinence, Lung opacity, Nucleic acid test, Oxygen saturation decreased, Pollakiuria, Protein urine present, Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Tachypnoea, Urine abnormality, White blood cell count increased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg BID, Ocuvite Extra daily, apixaban 5mg BID, azithromycin 250mg 2 tab on day 1 and 1 tab daily after, Lumigan 0.01% 1 drop both eyes nightly, Alphagan 0.1% 1 drop in right eye BID, calcium-vitamin D 500mg-200unit BID, clopi
Current Illness: TAVR July 2021
Preexisting Conditions: CAD s/p CABG, CHF, severe aortic stenosis, Afib, HTN, CKD, hypothyroid, arthritis, Hx of chronic lymphocytic leukemia, DM, dyslipidemia, gout
Allergies: Ciprofloxacin
Diagnostic Lab Data: COVID-19 Positive 8/18/21 This sample was analyzed using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 1/14/2021 and 2/12/2021. Presented to ED on 8/18/21. Family was concerned about patient''s increasing confusion and generalized weakness, urinary frequency, incontinence, and fever. In the ED, the patient was found to have WBC count 16.9, Cr 1.38, urine is hazy with amorphous crystals, blood pos 1+, trace protein, CRP 11.3, Cr 1.38 which was up from 0.8 from July 2021, CT chest shows ground glass opacities in bilateral lungs. Patient was experiencing respiratory failure and was placed on Airvo at 80%. He experienced low saturations in low 80s and was tachypneic in 40s. Patient voiced he did not want to be intubated. Patient received Solumedrol, Ceftriaxone, Doxycycline, Remdesivir. Pt removed his oxygen and restated he did not want it. The patient expired on 8/28/21.


VAERS ID: 1689346 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-29
Onset:2021-09-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Death, Dyspnoea, 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: 2021-09-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 illness 9/2/21
Preexisting Conditions: CHF, HTN, Rheumatoid arthritis, Kidney Cyst
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to our ED on 9/2/21 complaining of progressive shortness of breath. She tested positive for COVID-19 PCR on admission. She expired 9/9/21 following cardiopulmonary arrest.


VAERS ID: 1689354 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-11
Onset:2021-08-06
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-10
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, 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: 2021-08-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated with Pfizer vaccine x doses. Tested positive for COVID 19 on 8/6/2021 and died at home on 8/20/2021.


VAERS ID: 1689360 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-03
Onset:2021-08-23
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac disorder, Cough, Death, Fatigue, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, cholecalciferol, clopidogrel, escitalopram, famotidine, furosemide, gabapentin, Pepto-Bismol, ipratropium-albuterol, isosorbide mononitrate, acidophilus, levothyroxine, magnesium oxide, omega 3, pantoprazole, potassium chloride, p
Current Illness:
Preexisting Conditions: Coronary artery disease, left bundle branch block, congestive heart failure, chronic kidney disease, obstructive sleep apnea, pulmonary fibrosis, cerebrovascular accident, thromboembolism
Allergies: Sulfa antibiotics (rash)
Diagnostic Lab Data: COVID-19 Positive (8/23/2021)
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 8/23/2021 and was hospitalized. The patient had been having a cough for over a week. He states that he feels tired and fatigue and is worse when he ambulates. The patient was hospitalized for about 8 days until he expired on 9/1/2021 due to cardiac disturbances.


VAERS ID: 1689372 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-04-21
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Ankle fracture, Anticoagulant therapy, Bedridden, Biopsy, Biopsy bone marrow, Biopsy lymph gland, Blood calcium increased, Blood creatinine increased, Blood immunoglobulin A decreased, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Blood lactate dehydrogenase increased, Blood uric acid increased, C-reactive protein increased, Contusion, Death, Epistaxis, Follicular lymphoma, Full blood count, Gait inability, Haematocrit decreased, Haemoglobin decreased, Hepatic mass, Hepatomegaly, Hypercalcaemia, Hypersplenism, Hyperuricaemia, Hypophagia, Inflammation, Lymphadenopathy, Lymphocyte count, Positron emission tomogram, Pyrexia, Red blood cell count decreased, Serum ferritin increased, Splenic calcification, Splenomegaly, Thrombocytopenia, Ultrasound abdomen abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Malignant lymphomas (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 113
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood counts prior to that date: always perfect March 31, 2021 1st dose Pfizer COMIRNATY vaccine 01 April 2021 I start vomiting: over 3 mouthfuls of food everything is vomited April 21, 2021 2nd dose Pfizer COMIRNATY vaccine April 21-23, 2021 fever 39.5 ? C-40 ? C and uninterrupted epistaxis April 29, 2021 personal malleolus fracture May 02, 2021 hospital for foot plaster and start of heparin May 05, 2021 CBC: thrombocytopenia, Hb 11.4 g / dL, CRP 3 mg / dL May 11, 2021 orthopedic discontinue heparin and start fondaparinux 2.5 mg 1 fl. He said "surely it''s all due to the vaccine." May 12, 2021 CBC: thrombocytopenia, Hb 11.1 g / dL, RBC 3.89x106 mcL. request for "heparin dependent PF4 antibodies" test May 14, 2021 CBC: thrombocytopenia May 17, 2021 CBC: thrombocytopenia, Hb 10.9 g / dL, RBC 3.77x106 mcL, HCT 32.7%. "heparin-dependent PF4 antibodies" test has been suspended throughout: perhaps because it is the only test that would have admitted the correlation between the covid19 vaccine and thrombocytopenia and splenomegaly? May 26, 2021 CBC: thrombocytopenia, Hb 10.9 g / dL, reactive lymphocytes present May 28, 2021 haematologist "it is possible (but not demonstrable) that the induction of thrombocytopenia is linked to the 2nd dose of the anti SarsCoV2 (Pfizer) vaccine ... Important epistaxis and bruising on the whole body are reported from the 2nd / 3rd day post vaccination, which suggests thrombocytopenia prior to trauma and LMWH therapy. " May 31, 2021 CBC: thrombocytopenia, Hb 10.9 g / dL, HCT 33.5%, RBC 3.85x106 mcL, ferritinaemia 197 ng / mL, calcium 12.9 mg / dL, uricaemia 12.2 mg / dL, creatinine 1.51 mg / dL, VFG according to CKD-EPI 32 ml / min / 1.73 m2, LDH 934 U / L, IgG 627 mg / dL, IgA 44 mg / dL, IgM 281 mg / dL, beta2microglobulin 7 mg / L, CRP 4.8 mg / dL 01 June 2021 orthopedic check: tredimin 50,000 I.U. every 15 days for 6 months 01 June 2021 echo abdomen: "Liver slightly larger than normal (DL lobe DX 17cm). In the right lobe 1 hyperechoic nodule 22mm and 1 hypoechoic nodule 30mm of doubtful attribution ... Very large spleen (DL 21cm) with widespread structural alteration due to the presence of hypoechoic areas up to 4cm. Without color signal ... " 01 June 2021 hematologist: "clinical picture with anemia and thrombocytopenia due to hypersplenism in recent fractures, IR, hypercalcemia, hyperuricemia, high LDH values, inflammation and reduction of peripheral IgG and IgA ..." 07 June 2021 CT scan of the abdomen without MDC: "Slightly enlarged liver. ? Marked splenomegaly (160% x 105 mm), presence of small middle III parenchymal calcification. ? Some lymphosdenopathies appear to be in the lumbo-aortic area. Lymphadenopathy 30 mm right iliac-femoral region. Oval lymph node short diameter 13 mm ipsilateral inguinal region. ... " 08 June 2021 hospitalization for further investigations. Enter with the help of a walker. June 10, 2021 hematology: posterior iliac crest marrow biopsy June 16, 2021 hematology: inguinal lymph node biopsy: they spoke of "disease neither good nor evil that is treated with chemotherapy" June 22, 2021 hematology: checkup after bone marrow biopsy: they talked about "a rare disease that is treated with chemotherapy" June 25, 2021 hospital discharge: until now no doctor has ever clearly stated what the patient is suffering from: they said to read the discharge letter at home. "? Diagnosis of discharge:" Non-Hodgkin B-lymphoid malignant lymphoma, follicular, grade 3 ? sec WHO ". ... Hematology ... 847% of B lymphocytes have large lesions (FSC +++) ... Conclusions: flow cytometric pattern compatible with localization of large cell B lymphoma. ? Medullary biopsy: cytological picture free from infiltration, compatible, with medullary hypoplasia with prevalent aspects affecting the erythroid series? Lymph node biopsy: morpho-phenotype picture compatible with localization of non-Hodgkin B-lymphoid, follicular malignant lymphoma, grade 3 ? sec. WHO (immunophenotypic profile: CD3-, CD20 +, CD10 +, CD21-, CD23-, Bcl2-, Bcl6-, cMyc - / + (15%), MUM1-, CD5-, EBV-; Ki67 proliferation antigen 80%). ? Microscopic description. Iliac crest bone marrow: biopsy needle frustule of hypercellulated osteomedullary tissue with the presence of interstitial infiltration and, predominantly. Diffuse (70%) of small and medium-sized B-lymphoid elements? with medullary localization of the lymphoproliferative neoplasm known in the anamnesis (follicular NHL grade 3, leukemized). June 26, 2021 begins to walk safer, always with the help of the walker 05 July 2021 PET 07 July 2021 she can no longer walk, even with the help of a walker: bedridden July 14, 2021 hematology: check after lymph node biopsy: they insist on chemotherapy without saying what the patient has. In the letter to the attending physician: "Conclusions: Non-Hodgkin B-lymphoid, follicular malignant lymphoma, grade 3 ?, st IV (marrow), IPI High." July 15, 2021 PET outcome 19-22 July 2021 discussions on chemotherapy July 21, 2021 should have entered the PICC to do chemotherapy. July 30, 2021 request for home palliative care: never had: the doctor is on vacation and no one replaces him. 03 August 2021 CBC: thrombocytopenia 07 August 2021 last full meal: from now on only a few bites in free fall 11 August 2021 at 11:00 (after heated discussions with the doctor for not being admitted to the Hospice) they give her morphine 40 mg / 24h 12 August 2021 at 15:00 dead


VAERS ID: 1689377 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-08-11
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6023 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Pfizer. Last dose on 3/4/21. Tested positive for COVID on 8/11/2021. Admitted to Community Hospital East on 8/16/2021. Expired on 8/27/2021 while still hospitalized.


VAERS ID: 1689378 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-28
Onset:2021-08-10
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 20
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: Ocrelizumab
Current Illness:
Preexisting Conditions: Multiple sclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted on 8/10/2021 with acute respiratory failure secondary to COVID pneumonia. She was COVID positive on 7/22/2021 following a family gathering. She had been hospitalized for 3 days previously (8/4 - 8/7/2021) and seen in the ED on 8/8/2021. This current admission, she was intubated and required high dose dexamethasone. After 20 days, she was converted to comfort care and compassionate extubation was performed. She passed away comfortably soon after this.


VAERS ID: 1689405 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-24
Onset:2021-08-31
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Pfizer. Last dose on 2/24/2021. Tested positive for COVID 19 on 08/31/2021. Admitted to Hospital on 8/31/2021. Expired on 9/7/2021 while still hospitalized.


VAERS ID: 1689428 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-30
Onset:2021-08-28
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Asthenia, COVID-19, Cough, Death, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, vitamin C, aspirin, cimetidine, diclofenac gel, fish oil, gabapentin, Humalog KwikPen, Lantus Solostar, latanoprost, Miralax, pravastatin, Tradjenta, zinc
Current Illness:
Preexisting Conditions: Dementia, diabetes, blindness, GERD, chronic kidney disease, hyperlipidemia, peripheral vascular disease
Allergies: Tramadol (confusion, duloxetine (confusion)
Diagnostic Lab Data: COVID-19 Positive (8/28/2021)
CDC Split Type:

Write-up: This patient presented to the emergency department with shortness of breath, cough, fevers, and generalized weakness. Patient tested positive for COVID-19 on 8/28/2021 and was hospitalized for 4 days until she ultimately expired after experiencing a NSTEMI during admission.


VAERS ID: 1689447 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-16
Onset:2021-08-02
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Pt came to ER c/o cough, difficulty breathing.


VAERS ID: 1689485 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-08
Onset:2021-07-24
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Myalgia, Pain, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease, Hypertension/High Blood Pressure, Psychological/Psychiatric condition, Other chronic diseases
Allergies:
Diagnostic Lab Data: 07/24/2021 Antigen+ COVID-19 test, 07/30/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with Muscle or body aches, and Cough (new onset or worsening of chronic cough). Hospitalization 7/30/2021. Death due to COVID-19 8/3/2021


VAERS ID: 1689508 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-25
Onset:2021-08-25
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   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: Diabetes, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized and died due to COVID-19. Patient was fully vaccinated. Primary cause of death: Acute hypoxic respiratory failure from COVID-19 pneumonia.


VAERS ID: 1689524 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-13
Onset:2021-09-06
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. contracted COVID 19 and passed away.


VAERS ID: 1689538 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-11
Onset:2021-08-09
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Intensive care, Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 15
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: Patient is a 75yo man with PMH of dementia, seizure d/o, CKD III, ETOH use disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: developed symptoms on 08/04/2021 and was admitted to the ICU on 08/09/2021 Patient expired on 8/24/2021


VAERS ID: 1689555 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-31
Onset:2021-09-09
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Condition aggravated, Dialysis, Pneumonia
SMQs:, Acute renal failure (narrow), 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), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD on hemodialysis, type 2 diabetes, COPD, chronic respiratory failure
Allergies: Bactrim, doxycycline, zofran
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to MC on 8/12 with progressive SOB, weakness and fatigue. Previously diagnosed with COVID. Evidence of sepsis and pneumonia with increased O2 support. Given remdesivir, dexamethasone and broad spectrum antibiotics. Due to long stay her isolation was discontinued and got first vaccination for COVID on 8/31. On 9/2 experience recurrent respiratory decompensation. Again treated with steroids and antibiotics for pneumonia as well as dialysis. Respiratory status continued to decline and patient requested DNR/DNI with family agreeing to comfort care.


VAERS ID: 1689572 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-13
Onset:2021-08-04
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Intensive care, Mental status changes
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Lung Disease, Chronic Renal Disease, Hypertension, Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted from ED due to 1 day history of shortness of breath and altered mental status. Pt was intubated upon arrival to ED and later admitted to ICU. Pt had a hx of COPD, CKD3, hypertension, obesity, and was a former smoker. Pt was admitted to Hospital on 08/06/2021 and expired on 08/19/2021. Patient was fully vaccinated.


VAERS ID: 1689574 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-03
Onset:2021-08-02
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is fully vaccinated for Covid and later was hospitalized and died. Case son suspects case may have gotten it during a hospital visit July 30th after collapsing and hitting his head. Only close contact was case''s son and wife, but he did not want to be contacted by contact tracers, almost through with quarantine.


VAERS ID: 1689598 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-24
Onset:2021-09-03
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

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? No
Previous Vaccinations:
Other Medications: Depakote Sprinkles, tylenol, aspirin, namenda, neurontin, risperdal, lipitor, trandate, eliquis, albuterol, milk of mag.
Current Illness:
Preexisting Conditions:
Allergies: lisinopril
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1689608 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-26
Onset:2021-08-20
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chills, Death, Diarrhoea, Dyspnoea, General physical health deterioration, Malaise, Productive cough, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sepsis, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, apixaban, atorvastatin, azithromycin, cholecalciferol, cyanocobalamin, diltiazem, folic acid, levothyroxine, lisinopril, memantine, metoprolol succinate, artificial tears, prednisone
Current Illness:
Preexisting Conditions: atrial fibrillation (on Eliquis), diabetes mellitus, COPD, CKD (stage III), hypothyroidism and right eye blindness
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 Breakthrough case. 8/20/21: Patient states he has had COVID like symptoms for almost 2 weeks now and had an outpatient positive COVID test 9 days ago on 8/11/2021. He states he has had symptoms of a productive cough, worsening shortness of breath, chest congestion, some diarrhea, subjective fevers and chills that have now resolved. He states at baseline he has some shortness of breath but since testing positive for COVID, SOB has been worse than his baseline. He states he had a Regeneron treatment 2 days ago but does not believe his symptoms are any better. Admitted 8/20/21. Note: previously received Moderna COVID-19 vaccines on 12/29/21 & 1/26/21. Diagnosed with ARDS, acute hypoxic respiratory failure, Covid-19 viral pneumonia and sepsis. Condition deteriorated and patient died on 8/29/21.


VAERS ID: 1689610 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-22
Onset:2021-08-26
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Death, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Roxanol, Robinul, Senokot, Tylenol, Klor-Con, Florinef, Requip, Sinemet, Miralax, Proventil, Duo-Neb
Current Illness:
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: COVID-19 test 08/26/2021
CDC Split Type:

Write-up: Patient received 2nd dose of Pfizer vaccine on 07/22/2021. Patient participated in weekly testing at hospital and tested positive for COVID-19 on 08/26/2021. Symptom onset of a low grade fever also started on 08/26/2021. Patient received Regeneron treatment and then passed away on 09/08/2021.


VAERS ID: 1689714 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:1935-07-08
Onset:2021-07-27
   Days after vaccination:31431
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Pyrexia, Respiratory symptom
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic liver disease, unspecified autoimmune condition, other unspecified chronic diseases.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case is fully vaccinated and died from COVID related issues. Case''s wife reported her husband''s onset date was 7/25/21, mostly felt low-grade temp and respiratory symptoms. Was hospitalized on 7/27/21, only received oxygen. Passed away still in the hospital on 08/07/21. Hasn''t traveled and pre-existing medical conditions are p anca vasculitis, lungs and kidneys were effected, chronic autoimmune disease for 9 years. Fully vaccinated, Pfizer 1/15/21 and 2/05/21.


VAERS ID: 1689728 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Cough, Death, End stage renal disease, Intensive care, Pyrexia, SARS-CoV-2 test positive, Septic cerebral embolism, Shock, Staphylococcal bacteraemia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), 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: 03/07/21 SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected; 03/25/21 SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected; 05/08/21 SARS-CoV-2 (COVID-19) by NAA, Micro DETECTED
CDC Split Type:

Write-up: Pt. w/ "multiple medical problems including failed renal transplant x 2 with ESRD on HD, SAH, HTN, OSA 2018, afib and acute DVT in Dec 20 on eliquis, orthostatic hypotension, adrenal insuff (secondary), recent pseudomonas sepsis who presented to facility on 3/25/2021 with infection of L leg wound. Was sent from surgeon''s office when noted to have increased pain, increased drainage from wound. Left lower extremity wound with exposed muscle and tendons."... "initially transferred to a different department on 4/23/21 but transferred off on 5/8/21 due to cough and fevers to 104.4 attributed to new diagnosis of COVID-19." Pt. died on 08/24/21 in hospice, after D/C from ICU due to MRSA bacteremia, ESRD, Arrest, Shock, Septic Emboli to the brain.


VAERS ID: 1689846 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-08-31
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Dizziness, Dyspnoea, Endotracheal intubation, Intensive care, Malaise, Positive airway pressure therapy, Pulseless electrical activity, Pyrexia, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (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: 2021-09-09
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRn, Aspirin 81 mg QD, Atorvastatin 40 mg QD, Azelastine/Fluticasone nasal QD, benzonatate 100 mg TID PRN, Clonidine 0.3 mg BID, Epoetin alfa 20,000 units Q2Weeks, Ergocalciferol 50,000 units QWeek, Erythromycin 200 mg QID, Es
Current Illness:
Preexisting Conditions: Allergic rhinitis, Atrial flutter, Vertigo, Chronic kidney disease, Chronic sinusitis, CAD, hypertension, Focal, segmental glomerulosclerosis, Gout, hyperlipidemia, H/O kidney transplant, osteoarthritis of knee, sensorineural hearing loss, H/O stroke, Type 2 DM.
Allergies: Ciprofloxacin (muscle rigidity), Levofloxacin (muscle rigidty)
Diagnostic Lab Data: Positive COVID Test on 9/1/2021 utilizing the Cepheid GeneXpert Platform using PCR or Equivalent Nucleic Acid Amplification technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/27/2021, 2/21/2021, and 8/25/2021. Presented to ED on 8/31/2021 with malaise, low-grade fever, and feeling lightheaded. His daughter was recently diagnosed with COVID and had been quarantining. Patient admitted for acute hypoxic respiratory failure secondary to COVID PNA. Initially required BiPAP, but able to be weaned off. Patient transferred to ICU 9/4 due to increased work of breathing and increased oxygen requirements. Hospital course complicated by worsening hypoxic respiratory failure requiring emergent intubation 9/8 overnight. Pt with a total of 2 cardiac arrests overnight. PEA Arrest on 9/9/2021 @ 0658. Patient converted to DNAR/COT per family wishes and patient expired at 0750 on 9/9/2021. Patient treated with dexamethasone, remdesivir,


VAERS ID: 1689932 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-28
Onset:2021-07-14
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Angiogram pulmonary abnormal, Atrial fibrillation, Bacteraemia, COVID-19, COVID-19 pneumonia, Dyspnoea, Electrocardiogram, Fibrin D dimer increased, Hypotension, Hypoxia, Mechanical ventilation, Pneumonia, Respiratory distress, Rhabdomyolysis, SARS-CoV-2 test positive, Septic shock, Troponin, Ultrasound Doppler normal
SMQs:, Rhabdomyolysis/myopathy (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), 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), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine and hydrochlorothiazide
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Penicillins
Diagnostic Lab Data: 7/14/21 COVID19: Positive 7/23/21 US: Neg for DVT 7/25/21 Chest xray: Fairly extensive bilateral airspace disease most consistent with COVID-19 pneumonia. Developing ARDS not excluded. 8/1/21 CTA: PE and COVID19 pneumonia with ARDS
CDC Split Type:

Write-up: Transferred from another hospital. Presented there on 7/14/2021 with shortness of breath. While at outside hospital (OSH), pt with BP of 103/54, HR of 65, RR 20. Upon presentation there, pt with oxygen saturation of 77%. He was started on Optiflow with 25 L at 85%; pt now with spO2 of 91%. Pt had elevated D-dimer, so CT angio chest done. It showed multifocal pneumonia; no PE. He had nl trop and EKG. Pt was given Azithromycin and Decadron while there. Request for transfer made given pt''s need for Optiflow. When received at our hospital, patient was resumed on dexamethasone, started remdesivir, ceftriaxone and doxycycline. He continued to have acute hypoxemic respiratory distress requiring mechanical ventilation. Developed septic shock was requiring pressors had low blood pressure and was found to have septic shock from COVID pneumonia, with superimposed likely Gram-negative bacterial infection. received Steroids, Rocephin, doxycycline, remdesivir. Received 1 dose of Actemra. Course complicated by rhabdomyolysis, new onset atrial fibrillation. Passed away on 8/16/2021


VAERS ID: 1690161 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-20
Onset:2021-05-06
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Gene mutation identification test negative, Pericardial haemorrhage, Toxicologic test normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: IBS,
Allergies:
Diagnostic Lab Data: 1) Genomic Sequencing and Deletion/Duplication Analysis of Genes Associated with Arterial Aneuryms and Dissections: No abnormailty identified in genes tested Toxicology Report: Examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the Analysis Summary.
CDC Split Type:

Write-up: Patient passed away on 05/06/2021, 16 days after the first Pfizer injection. He was a healthy 34 year old. Autopsy report showed no organ or other physical abnormalities. The autopsy report stated his cause of death was an hemopericardium (acute dissection of proximal thoracic aorta / fatal cardiac tamponade / rupture into pericardial sac).


VAERS ID: 1690543 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-21
Onset:2021-08-03
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Drooling, Endotracheal intubation, Fall, Hyperhidrosis, Myocardial infarction, Thrombosis, Withdrawal of life support
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   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: Tart cherry extract tablet
Current Illness: None
Preexisting Conditions: Past history of hypertension, no current medications Seasonal allergies
Allergies: None
Diagnostic Lab Data: CT scan of head revealed total rt sided stroke and went into afib per ER physician
CDC Split Type:

Write-up: Female was well, alert, on no medications, active with family. Then just fell to the floor , was sweaty and drooling, taken to the ER. Tests revealed massive stroke and heart attack. Due to clot. No chance of recovery, no ability to gain speech or function was incubated and on a sedative. She was taken off life support 2 days later and passed away on 8/5/21


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