National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/21/2022 release of VAERS data:

Found 22,607 cases where Vaccine targets COVID-19 (COVID19) and Patient Died

Government Disclaimer on use of this data



Case Details

This is page 68 out of 227

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167   next


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1921-03-14
   Days after onset: 36506
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levocetirine; Allopurinol; Fluticasone; Probiotic; Albuterol; Amlodipine; Flutic/Salmeter;Olmesartan; Potassium; Eliquis; Furosemide.
Current Illness:
Preexisting Conditions: Benign Essential Hypertension;Allergic Rhinitis; Asthma; Gout;Obesity;Spinal stenosis of lumbar region.
Allergies: No.
Diagnostic Lab Data: 03/04/21 EKG showing afib - many during hospitalization 3/8-3/14/21
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death one day after vaccine.


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypothyroidism, type 2 DM, HTN, afib, CHF, PVD, COPD, respiratory failure, CKD 2, functional quadriplegia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


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

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

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

Write-up: Patient death.


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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipinem bisoprolol, eliquis, furosemide, potassium, atorvasatatin, pravastatin
Current Illness: In hospital for MI "one month ago" for MI then spent two weeks in rehab facility
Preexisting Conditions: extensive cardiac history with recent AMI and CHF. HTN, CHF, ASCVD
Allergies: unknown
Diagnostic Lab Data: autopsy performed
CDC Split Type:

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


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

Administered by: Private       Purchased by: ?
Symptoms: Death, Motor neurone disease, Vaccination complication
SMQs:

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive COVID test; hypoxic; septic shock


VAERS ID: 1683049 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-24
Onset:2021-09-07
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death


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

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

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

Write-up: hypoxic, SOB, positive COVID test


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB; HYPOXIC; PNEUMONIA, POSTIVE COVID TEST


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

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

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

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


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

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

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

Write-up: PNEUMONIA, POSITIVE COVID TEST


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aripiprazole 5 mg daily, azelastine 2 sprays twice daily, aspirin 81 mg daily, buspar 30 mg twice daily cholecalciferol 2000 units daily, desvenlafaxine 100 mg daily, fenofibrate 145 mg daily, hydroxyzine 50 mg every 8 hours as needed for a
Current Illness:
Preexisting Conditions: anemia, anxiety, benign prostatic hyperplasia, depression, diabetes mellitus, hyperlipidemia, insomnia, neuropathy, chronic kidney disease (stage III), hypertension
Allergies: NSAIDs, sulfonamide
Diagnostic Lab Data: COVID Positive on 8/12/2021; chest x-ray: bilateral patchy airspace opacities concerning for multifocal pneumonia on 8/12/2021; serum creatinine 5.71 on 8/29/2021; urine culture positive for pseudomonas aeruginose on 8/26/2021, sputum culture postive for MRSA on 8/28/2021
CDC Split Type:

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 20 mg QD, Calcitriol 0.5 mg TIW, Clonidine 0.1 mg
Current Illness:
Preexisting Conditions: Anemia, Coagulopathy, Dementia, Depression, DM type 1, Dialysis, hearing loss, hyperlipidemia, hypertension,
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

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


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

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

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

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


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

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Dyspnoea, Lung opacity, Mental status changes, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate 70 mg every 7 days, cholecalciferol 5000 units daily, multivitamin daily, mycophenolate 250 mg twice daily, potassium citrate 10 mEq twice daily, prednisone 10 mg daily, sidenafil 20 mg three times daily, bactrim DS three times
Current Illness:
Preexisting Conditions: Interstitial lung disease, pulmonary hypertension, pulmonary fibrosis, thrombocytopenia, cirrhosis, esophageal varices
Allergies: Iodine
Diagnostic Lab Data: COVID Positive on 8/17/2021; CXR showed bilateral patchy peripheral airspace opacities on 8/17/2021
CDC Split Type:

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


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

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

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

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


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

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

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

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


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

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

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

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


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

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Blood culture positive, COVID-19, COVID-19 pneumonia, Candida test positive, Cardio-respiratory arrest, Chest X-ray abnormal, Culture urine, Death, Dyspnoea, Lung opacity, Mechanical ventilation, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

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


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

Administered by: Private       Purchased by: ?
Symptoms: Aspiration, Atelectasis, COVID-19, Cardiac arrest, Chest X-ray abnormal, Death, Dyspnoea, Ileus, Pleural effusion, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Torsemide 20 mg daily, pantoprazole 40 mg daily, flonase, 1 spray each nostril daily, acetazolamide 250 mg every other day, albuterol 90 mcg/actuation 1 puff four times daily as needed, cholecalciferol 5000 units daily, dorzolamide 2% 1 dro
Current Illness:
Preexisting Conditions: Hypertension, congestive heart failure, chronic obstructive pulmonary disease, atrial fibrillation, hyperlipidemia, chronic kidney disease, sleep apnea
Allergies: No known allergies
Diagnostic Lab Data: COVID Positive on 8/5/2021; CXR showed Probable left pleural effusion with atelectasis or possible pneumonia at the left lung base on 8/5/2021
CDC Split Type:

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


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

Administered by: Other       Purchased by: ?
Symptoms: Coma, Death, Headache, Seizure
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210902775

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210910577

Write-up: HOSPITALISATION; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; DEATH; This spontaneous report received from social media via a company representative concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported,1 total for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the 15,739 patients got COVID-19 among people who were fully vaccinated (suspected covid-19 infection, suspected clinical vaccination failure), Of those, 571 had been hospitalised (for unspecified days), and 131 had died. The patients died due to unknown reason on an unspecified date. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. Outcome of suspected covid-19 infection, hospitalisation and suspected clinical vaccination failure was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, and Other Medically Important Condition). This case, from the same reporter is linked to 20210902916, 20210909398 and 20210909281. This case was associated with Product Quality Complaint.; Sender''s Comments: V0; 20210910577-covid-19 vaccine ad26.cov2. s-Death, Hospitalization. These events are considered unassessable. The events have a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the events. V0: - 20210910577- covid-19 vaccine ad26.cov2 - Suspected clinical vaccination failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1683731 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101134188

Write-up: female in her 40s that died after getting the Pfizer covid vaccine; This is a spontaneous report from a contactable consumer. This consumer reported for a female patient in her 40''s which included that. A 5-decade-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Other Products, Patient History and Investigation Assessment was Not Provided. The patient experienced female in her 40s that died after getting the pfizer covid vaccine (death) (death, medically significant) on an unspecified date. Reporter reports that three people got the Pfizer covid 19 vaccine. One is a 63-year-old female, and she had a stroke her verbatim was bleed in the head. Then a female in her 40s that died after getting the Pfizer covid vaccine. Then a male that was 25-30 years old and he died. She does not have further details to provide on female in her 40s that died after the covid vaccine. Later Caller stated during call that she was speaking with another agent, but it was only this Caller on the line when this agent answered. Caller states that she knows a 63-year-old female who received the Pfizer Covid-19 vaccine then had a stroke, "bleed in the head" afterwards. Caller also states that she knew a female in a 40''s (years) and a male between the age of 25-30 years who both died after receiving the Pfizer Covid-19 vaccine. Caller is asking why is Pfizer not reporting the side effects to VAERS? Caller states that the data on VAERS has stopped counting the fatalities from the Pfizer Covid-19 vaccine and the death count exceeds 12,000. Caller stated that the agent before this agent was unable to answer any of her questions (this agent unaware of which Pfizer department due to no warm transfer being performed and the Caller was the only person on the line when this agent answered the Call). Caller provided the following possible feedback: Caller asks why did withheld, approve the Pfizer Covid- 19 vaccine? Caller asks why does she have anything to do with this approval of the Pfizer Covid-19 vaccine? Caller states that the Pfizer Covid-19 vaccine has metals and is asking how is it being passed through the FDA and Pfizer? Normally with other shots, they take years to get approved. FDA only allows, if people die, they don''t put it on the market. Caller states that the data on VAERS has stopped counting the fatalities from the Pfizer Covid-19 vaccine and the death count exceeds 12,000. Caller is asking if "We had COVID, we had the antibodies, why do we have to get the shot?" Confirmed with caller that she is talking about mandates from withheld and employers. Caller asks why did withheld, approve the Pfizer Covid-19 vaccine Caller asks why does she have anything to do with this approval of the Pfizer Covid-19 vaccine Caller states that the Pfizer Covid-19 vaccine has metals and is asking why is it being approved? The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101134213 same reporter/drug/event, different patient.; Reported Cause(s) of Death: unknown cause of death


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.


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=68&PERPAGE=100&VAX=COVID19&VAXTYPES=COVID-19&DIED=Yes


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166