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From the 10/15/2021 release of VAERS data:

Found 17,128 cases where Vaccine is COVID19 and Patient Died



Case Details

This is page 69 out of 172

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

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

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

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


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

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

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

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


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

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tart cherry extract tablet
Current Illness: None
Preexisting Conditions: Past history of hypertension, no current medications Seasonal allergies
Allergies: None
Diagnostic Lab Data: CT scan of head revealed total rt sided stroke and went into afib per ER physician
CDC Split Type:

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


VAERS ID: 1691329 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Covid-19
CDC Split Type: USJNJFOC20210913396

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a media via a company representative concerned an elderly patient (over 80 years) of an unspecified sex. 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: not reported) dose was not reported, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced suspected covid-19 infection and suspected clinical vaccination failure. On an unspecified date (over the past week of 03-SEP-2021) in AUG-2021, the patient died from suspected covid-19 infection. It was unknown if an autopsy was performed or not. Laboratory data (dates unspecified) included: COVID-19 virus test (NR: not provided) Covid-19. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of suspected covid-19 infection on an unspecified date, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This report was associated with product quality complaint: 90000192684.; Sender''s Comments: V0: 20210913396- Covid-19 vaccine ad26.cov2.s-Suspected covid-19 infection. 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). 20210913396- Covid-19 vaccine ad26.cov2.s-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: SUSPECTED COVID-19 INFECTION


VAERS ID: 1691338 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210914084

Write-up: DEATH DUE TO THE VACCINE; This spontaneous report received from a consumer concerned a 32 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died due to the Johnson and Johnson vaccine. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210914084-Covid-19 vaccine ad26.cov2.s-Death due to the vaccine. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1691345 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Diabetic; Kidney disorder
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210915595

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a health care professional. Initial information was processed along with the additional information received on 09-SEP-2021. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: diabetic, and issues with kidney. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown expiry: Unknown) 1 total, administered, dose and start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, months after vaccination, the patient experienced suspected covid-19 infection and coronavirus related illness (suspected clinical vaccination failure). On an unspecified date, the patient died from coronavirus related illness. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This report was associated with product quality complaint: 90000192723.; Sender''s Comments: V0: -20210915595 - 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. 20210915595 -covid-19 vaccine ad26.cov2. s-suspected covid-19 infection. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: SUSPECTED COVID-19 INFECTION


VAERS ID: 1691358 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210915824

Write-up: DEATH AFTER VACCINATION; This spontaneous report received from a consumer via a company representative through media concerned a patient of unspecified age, sex, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown expiry: unknown) dose, start therapy date were not reported,1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient died 4 days after the vaccination. The patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event was fatal. This report was serious (Death).; Sender''s Comments: V0: 20210915824-COVID-19 VACCINE AD26.COV2.S-death after vaccination. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1691360 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-06-06
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Internal haemorrhage, Myocardial infarction, Pulmonary thrombosis, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210916075

Write-up: BLOOD CLOTS IN LUNGS; BLOOD CLOTS IN LIVER; INTERNAL BLEEDING; HEART ATTACK; DEATH; This spontaneous report received from a consumer via a company representative concerned a 52 year old male of unknown race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, and expiry: Unknown) dose was not reported, 1 total, administered on 03-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 06-JUN-2021, 3 days after vaccination the patient had heart attack on the golf course. On an unspecified date, the patient had internal bleeding and blood clots in his liver and lungs. The patient was in intensive care for 13 weeks and was put on liver transplant list but they could not stop the internal bleeding. The patient hospitalized for unspecified date and days. The patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of heart attack, internal bleeding, blood clots in lungs and blood clots in liver was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210916075-COVID-19 VACCINE AD26.COV2.S-Death, Heart attack, Blood clots in lungs, Blood clots in liver, Internal bleeding. These events are considered unassessable. The events have a compatible/suggestive temporal relationship, are unlabeled, and have unknown scientific plausibility. There is no information on any other factors potentially associated with the events.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1691361 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210916087

Write-up: BLOOD CLOT; This spontaneous report received from a consumer. 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 and Expiry: Unknown) dose, frequency one total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested No concomitant medications were reported. On an unspecified date, the patient experienced blood clot and died (due to blood clot). It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20210428051.; Sender''s Comments: V0: 20210916087-covid-19 vaccine ad26.cov2.s ? Blood Clot. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOT


VAERS ID: 1691984 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Poor quality product administered, Product contamination physical
SMQs:, Medication errors (broad)

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

Write-up: Two people died after taking the vaccine because of metal in the vials; Product contamination metal; Poor quality product administered; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Two people died after taking the vaccine because of metal in the vials) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Two people died after taking the vaccine because of metal in the vials) (seriousness criteria death and medically significant), PRODUCT CONTAMINATION PHYSICAL (Product contamination metal) and POOR QUALITY PRODUCT ADMINISTERED (Poor quality product administered). The patient died on an unknown date. The reported cause of death was two people died after taking the vaccine because of metal in the vials. It is unknown if an autopsy was performed. At the time of death, PRODUCT CONTAMINATION PHYSICAL (Product contamination metal) outcome was unknown and POOR QUALITY PRODUCT ADMINISTERED (Poor quality product administered) had resolved. Concomitant product use was not provided by the reporter. The patient was clearly venting his frustration. The patient also states that two people died after taking the vaccine because of metal in the vials. No treatment information was provided. Company Comment: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested. This case was linked to MOD-2021-307513 (Patient Link).; Sender''s Comments: Very limited information regarding this events has been provided at this time. However, based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested.; Reported Cause(s) of Death: Two people died after taking the vaccine because of metal in the vials


VAERS ID: 1691995 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CYCLOSPORIN; MYCOPHENOLATE MOFETIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Kidney transplant
Allergies:
Diagnostic Lab Data: Test Name: SARS-COV-2 test; Test Result: Positive ; Result Unstructured Data: 63 days from second dose
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: COVID-19; Lack of efficacy; Unknown cause of death; This literature-non-study case was reported in a literature article and describes the occurrence of DEATH (Unknown cause of death) and COVID-19 (COVID-19) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Kidney transplant. Concomitant products included CICLOSPORIN (CYCLOSPORIN) and MYCOPHENOLATE MOFETIL for Immunosuppression. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced DEATH (Unknown cause of death) (seriousness criteria death and medically significant), COVID-19 (COVID-19) (seriousness criterion hospitalization) and DRUG INEFFECTIVE (Lack of efficacy). The patient was treated with CASIRIVIMAB;IMDEVIMAB for COVID-19, at an unspecified dose and frequency. The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, COVID-19 (COVID-19) had resolved and DRUG INEFFECTIVE (Lack of efficacy) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) 63 days from second dose. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered COVID-19 (COVID-19) and DRUG INEFFECTIVE (Lack of efficacy) to be possibly related and DEATH (Unknown cause of death) to be not related. The patient received the first dose of the vaccine after 28 months from the time of transplant. After 62 days from receiving the second dose of the vaccine, the patient developed symptoms of shortness of breath and fatigue, for which the SARS-COV-2 test was conducted the next day. The patient was hospitalized and received casirivimab and imdevimab but did not require to get admitted to the ICU or require mechanical ventilation. There were no previous transplant except for the kidney transplant. The patient was discharged to home without oxygen supplement. None of the patients had anti-SARS-CoV-2 spike protein antibody checked after vaccination or disease and the viruses were not sequenced. On follow up after 30 days, it was known that the patient was dead. However, it was reported that patient recovered from COVID-19 and death was unrelated. Company Comment: this is a case of lack of effect, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable. Regarding AE "death" the assessment was: unlikely related, based on reporter causality, the long latency between vaccination dates and death (more than 62 days), and because the patient had other concomitant medical conditions that could be potentially confounders (immunosupressive therapy, transplant) This case was linked to MOD-2021-313024, MOD-2021-313114, MOD-2021-313115 (Patient Link).; Sender''s Comments: this is a case of lack of effect, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable. Regarding AE "death" the assessment was: unlikely related, based on reporter causality, the long latency between vaccination dates and death (more than 62 days), and because the patient had other concomitant medical conditions that could be potentially confounders (immunosupressive therapy, transplant); Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1692350 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
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 INC202101169379

Write-up: His grandmother received the Pfizer COVID 19 vaccine and died 3 days later; This is a spontaneous report from a contactable consumer or other non-healthcare professional (reporter''s grandson reported for his grandmother). A 71-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: 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''s medical history and concomitant medications were not reported. On an unspecified date, the patient experienced that his grandmother received the Pfizer COVID 19 vaccine and died 3 days later. It was reported that caller''s grandmother who was 71-year-old received the Pfizer COVID 19 vaccine and died 3 days later. He wanted to talk to medical information department about why there was no FDA information on the boxes about who is liable before he gets the vaccine. He worked in the medical field but was not a medical professional and he has seen the packaging there was just a QR code and a fact sheet. His questions are one, he has to sign a form before he gets the vaccine. He has a lawyer, and they said its still under emergency use. His lawyer was saying that the company he works for was not liable if anything happens. He was a single father with two kids. His question was after seeing on the news that said its 100% approved but the lawyer was saying it was not. Other countries are saying it was not even a pandemic. He has to weigh out the pros and cons and he wants to know if it''s safe. Product quality complaint was reported as yes. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up activities closed. Batch/lot number not available for [vaccine/BNT162B2].; Reported Cause(s) of Death: His grandmother received the Pfizer COVID 19 vaccine and died 3 days later


VAERS ID: 1692359 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-11
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 INC202101172389

Write-up: Brother died; This is a spontaneous report from a contactable consumer or other non-healthcare professional. A 36-years-old male patient received bnt162b2 (BNT162B2, PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), via an unspecified route of administration on an unspecified date (Batch/Lot number and Expiry date was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On an unspecified date, the patient experienced brother died. During the phone call received, the reporter stated, "I want to thank you for your vaccine, it was most likely that, that got my 99-year-old aunt, she would''ve died in her sleep anyway at 104. No cane, no walker. Full head of hair. Something slipped up the heart now. You''re the responsibility party. This man from the (inaudible) brother died. He was 36 years old, I don''t know if that was yours." 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.; Reported Cause(s) of Death: Brother died


VAERS ID: 1692895 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-02
Onset:2021-09-08
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cardiac arrest, Computerised tomogram thorax abnormal, Cough, Death, Lung consolidation, Lung opacity, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Interstitial lung disease (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), Guillain-Barre syndrome (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: 2021-09-11
   Days after onset: 3
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: ASA, vit D, iron, gabapentin, simvastatin, tramadol
Current Illness: Cellulitis w/ lymphedema
Preexisting Conditions: CKD, DMT2, venous stasis, anemia, DM, cirrhosis
Allergies: APAP, ACE-I, omeprazole
Diagnostic Lab Data: Covid + 9/8/21, symptoms, fever, cough, weakness Imaging: CT chest showing patchy bibasilar groundglass and consolidative opacities.
CDC Split Type:

Write-up: Breakthrough case on 9/8. Unfortunately passed from cardiac arrest on 9/11/21


VAERS ID: 1692936 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-11
Onset:2021-05-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Inflammatory bowel disease
SMQs:, Ischaemic colitis (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nugenix
Current Illness: diabetes Type II
Preexisting Conditions: diabetes Type II
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: complained of "inflamed bowels" on May 14,2021 then shortly expired that day.


VAERS ID: 1693148 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Life support, Pulse absent
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefdinir 300 mg capsule BID Duloxetine 30 mg DR capsule daily Ergocalciferol (Vitamin D-2) 50,000 capsule weekly Fenofibrate 145 mg tablet daily Insulin aspart 25 units SQ TID before meals Lisinopril 5 mg tablet daily Pravastatin 20 mg
Current Illness: Patient was being seen in emergency department for abdominal pain status post a fall, being treated for UTI (with cefdinir) since previous week
Preexisting Conditions: 3 abdominal hernias, hypertension, diabetes, neuropathy, hyperlipidemia
Allergies: Ibuprofen (unknown) Morphine (headache)
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Death Patient was being prepared for discharge. Found pulseless in room around 1845 which was roughly 3 hours post vaccination. Additional therapies given during ED stay were IV fluids and IV acetaminophen. ACLS initiated and continued for ~45 minutes. Time of death called at 1928


VAERS ID: 1693272 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-15
Onset:2021-07-26
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   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: Coreg 25 mg twice a day; Enteresto twice a day; Zetia 10 mg once a day; Crestor 40 mg once a day; Fenofibrate 200 mg once a day; Celexa 20 mg once a day; Lantus insulin once daily; Humalog Insulin three times a day with meals
Current Illness: None
Preexisting Conditions: Heart disease Diabetes Obesity
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient verbally reported to me (spouse) that since receiving the vaccine he would have on and off "weird" feelings in his chest at times. He never sought medical attention for this particular issue despite his medical history. He received his first dose of the Pfizer - BioNTech vaccine on 03/25/2021 Lots number EP6955. Second dose was as noted on 04/15/2021 Lot number EP0153


VAERS ID: 1693366 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-11
Onset:2021-05-10
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: High BUN Congestive heart failure
Preexisting Conditions: Edema, eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1693704 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-08
Onset:2021-05-23
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Death, Pulmonary thrombosis, Toxicity to various agents
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Drug abuse and dependence (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: depression, anxiety
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: The decedent was found deceased at home on 05/23/2021. The decedent''s cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021.


VAERS ID: 1693771 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute left ventricular failure, Acute respiratory failure, Asthenia, Death, Dyspnoea, Echocardiogram, Extra dose administered, Stress cardiomyopathy
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 9
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: 2/20/2021 , 1/23/2021 , COVID 19, moderna
Other Medications: metoprolol, methotrexate, folic acid
Current Illness: none
Preexisting Conditions: rheumatoid arthritis, osteoporosis, odynophagia
Allergies: aspirin, HCTZ, penicillin
Diagnostic Lab Data: echo cardiogram 9/5, 9/6, 9/10/2021
CDC Split Type:

Write-up: weakness, SOB, takotsubo cardiomyopathy , acute systolic heart failure, acute hypoxemic respiratory failure pt expired


VAERS ID: 1694105 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-16
Onset:2021-09-02
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

Administered by: Public       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, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHRONIC LUNG DISEASES
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT EXPIRED ON 09/02/2021


VAERS ID: 1694121 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-05
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
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? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: DM MORBID OBESTITY
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT EXPIRED ON 09/05/2021


VAERS ID: 1694228 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-27
Onset:2021-09-08
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CAD; chronic kidney disease; history of DVT;
Allergies: unknown
Diagnostic Lab Data: PCR COVID-19 test on 8/14/21
CDC Split Type:

Write-up: Tested positive for COVID-19 on 8/14/21 via PCR; Admitted to hospital on 8/16/21;


VAERS ID: 1694248 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-09-10
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 3 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: 2021-09-10
   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: COPD; Hypertension; acute and chronic respiratory failure with hypoxia
Allergies: unknown
Diagnostic Lab Data: COVID-19 PCR on 9/5/21
CDC Split Type:

Write-up: Tested positive for COVID-19 on 9/5/21 via PCR; Admitted to hospital on 9/5/21; Died on 9/10/21.


VAERS ID: 1694281 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-05-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Death, Escherichia infection, Intensive care, Myocardial necrosis marker increased
SMQs:, Myocardial infarction (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 70
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: went in ICU for 10 days after vaccine for Ecoli and was diagnosed with elevated heart enzymes. Every time we had to go to hospital for next 8 weeks his enzymes were elevated. He died on 07/16/2021 due to a "heart episode" what ever that means.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death


VAERS ID: 1694308 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-20
Onset:2021-05-19
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Aortic valve replacement, Cardiac procedure complication, Death, Haemorrhage, Laboratory test, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Januvia, metformin, ibesartan, atorvastatin, levothyroxin, ferrous sulfate, iron, potassium, centrum, super b complex, fish oil, low dose aspirin, cinnamon, vitamin c, cranberry, calcium- magnesium-zinc tab Flexeral, as needed
Current Illness: Leaky heart valve
Preexisting Conditions: Diabetic
Allergies: Old style iodine dye
Diagnostic Lab Data: I don?t know what test they did at the hospital.
CDC Split Type:

Write-up: Surgery was done at on 5/19/21 to replace her aortic valve. While other complications came up, all of the fixes worked. Everything was repaired. My Mother?s blood would not clot. They were unable to close her following surgery. They tried again over night to stop the bleeding but her blood would still not clot. She had stopped all of her blood thinning medications days earlier than suggested prior to surgery. She died the next morning. Had her blood clotted I believe she would be here today. I believe her blood did not clot because of her two doses of this vaccine.


VAERS ID: 1694393 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-25
Onset:2021-08-31
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Myocardial infarction, Respiratory failure, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 1
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: Severe sepsis, acute CVA, MI,CHF, UTI, CAD, OSA, BPH,HTN, lymphoma
Preexisting Conditions: CVA MI CHF OSA HTN lymphoma
Allergies: adhesives
Diagnostic Lab Data:
CDC Split Type:

Write-up: hypoxic respiratory failure, CVA, MI, UTI, Death


VAERS ID: 1694414 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-09-12
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 0
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: Morphine 3mg every 4 hrs with prn dosing of morphine 2-4mg every 15 min; ativan 1 mg every 4 hrs with .5mg ever 30 min as needed or 1mg every 15 min as needed; haldol .5mg ever 30 min as needed; robinul .4mg every 4 hrs as needed; dulcolax
Current Illness: AKI; Hyponatremia; metabolic acidosis; history of PE.
Preexisting Conditions: Extensive centrilobular emphysema
Allergies:
Diagnostic Lab Data: Antigen positive.
CDC Split Type:

Write-up: Pt succumbed to COVID-19 virus on 9/12/2021 after being diagnosed on 8/28/21.


VAERS ID: 1694456 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-08-20
Onset:2021-08-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Diarrhoea, Fatigue, Nausea, Pain, Thrombosis
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: The first dose which was on 7/29/21 for Covid 19.
Other Medications: Memantine, Retevmo, men''s one multivitamin, hydrocodone/aspirin (not regularly)
Current Illness: Stage 4 lung cancer, mild side effects after 1st and 2nd shot, sinus infection.
Preexisting Conditions: Stage 4 lung cancer - diagnosed 03/2021
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 3-4 hours was having mild side effects such as fatigue, soreness. The next 2 days his symptoms became more severe with nausea, chills, diarrhea. The 2nd day he developed a blood clot in his stomach and died as a result.


VAERS ID: 1694459 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-28
Onset:2021-08-27
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 8
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: 08/27/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Hospitalization and death. From vital records: CARDIORESPIRATORY FAILURE, HYPOXIA, COVID-19 PNEUMONIA, Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed


VAERS ID: 1694567 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-24
Onset:2021-08-21
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s sister states that after receiving the 2nd dose of Phizer 06/24/2021, Pt. passed away suddenly 08/21/2021. Unknown Autopsy preformed.


VAERS ID: 1694568 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-19
Onset:2021-03-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, Flovent, doxycycline, drospirenone and ethinyl estradiol, and Zoloft
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: pulmonary embolism


VAERS ID: 1694602 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-09-07
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

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

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

Write-up: Dose 1 Pfizer 2/26/2021 lot # EN6205 Pt had a cardiac arrest at home 9/7/2021, died in the Emergency Room on 9/7/2021. Not a Covid related death.


VAERS ID: 1694624 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-12
Onset:2021-09-12
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pneumonia aspiration, 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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: dementia, cva, cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lot numbers not available for vaccines. Pt died on 9/12/2021 of aspiration pneumonia and respiratory failure. This is not a covid related death


VAERS ID: 1694644 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-15
Onset:2021-07-19
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Chills, Cough, Death, Dyspnoea, Fatigue, Headache, Hypertension, Myalgia, Nasal congestion, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), 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), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 07/22/2021 PCR+ COVID-19 test at Health center; 07/31/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 7/19/2021: Fever $g100.4, Chills, Muscle or body aches, Runny nose/Congestion, Sore throat, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Fatigue or tiredness, Headache. Death 7/31/2021, from vital records: CARDIAC ARREST, COVID 19 POSITIVE, Per vital records, Other Significant Conditions include: HYPERTENSION. place of death: HOSPITAL-EMERGENCY ROOM/OUTPATIENT.


VAERS ID: 1694645 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-22
Onset:2021-09-04
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase increased, Anxiety, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood potassium increased, Blood sodium normal, Blood urea increased, COVID-19, Cardiac telemetry, Coma, Death, Hypotension, Pain, Pulmonary mass, SARS-CoV-2 test positive, Sepsis, Streptococcus test positive, Unresponsive to stimuli, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   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: 09/04/2021, COVID-19 (NAA), Positive
CDC Split Type:

Write-up: HOSPITAL COURSE: This is a 66-year-old male with history of hep C cirrhosis, BPH with chronic retention, methamphetamine/tobacco/PTSD/homelessness, mesothelioma and non-small cell carcinoma of the lung s/p chemo/XRT, and middle lobectomy/thoracotomy at medical facility in 2013. He had a hospitalization in July 2020 where he was noted to have recurrent pulmonary malignancy, but was not a surgical candidate. He was counseled to discharge to Transitional Care but he instead requested discharge to the street. He repeated has declined appropriate care when in the hospital, and he has repeatedly left the hospital against medical advice and without appropriate follow-up plan in place. He was interviewed by Dr. on 7/2 who documented fixed delusions but capacity to make his own medical decisions, feeling patient''s interpretation of facts "did not appear to be unduly influenced by delusion". I discussed the patient''s care with admitting physician, and we agreed that in the combination of social and medical chaos, and noting a prior decision by another Dr. not to proceed with surgical intervention of a pulmonary mass, that heroic resuscitative efforts would be futile, and patient should be limited code - no compressions or intubation. Dr., palliative care, reviewed chart and also agrees that No Code is appropriate. On the last day of hospitalization, September 8, 2021, this patient was seen and examined at the bedside and he was comatose and did not respond to voice, touch, or a sternal rub. For maintenance of an adequate blood pressure this patient was on a maximal dose of vasopressin at 20 mL/h. This patient was noted with severe acute kidney injury on admission and on the day of discharge his sodium was 139, potassium 5.6, BUN 144, and creatinine 5.22. This patient was seen in consultation by the nephrology service but his blood pressure was too low to allow hemodialysis. If the patient''s white blood count was 16.7 on the day of discharge. Total bilirubin was elevated at 3.7, AST 49, ALT 74, and serum albumin was low at 1.4. Blood cultures on admission September 4, 2021 were positive for Streptococcus pneumonia a and Staphylococcus hominis. This patient was receiving appropriate IV antibiotic therapy during this hospitalization. The patient again was comatose and given the constellation of the severe end organ damage in the setting of severe sepsis the patient was subsequently transitioned to comfort care and end-of-life care. I discussed this case with Dr. with the nephrology service and Dr. with the palliative care service and we all agreed that a transition to comfort care was the best treatment plan for this patient. In the morning on September 8, 2021 I did not renew the patient''s treatment with IV vasopressin and I discontinued all IV antibiotic therapy. Telemetry was also discontinued. IV morphine and IV Ativan were ordered for treatment of pain and anxiety respectively. This patient subsequently expired at 12:45 PM on September 8, 2021. I was unable to make contact with any family members or any possible DURABLE POWER OF ATTORNEY for this patient. The mortuary on duty was contacted this afternoon. This patient was pronounced expired on September 8, 2021 at 12:45 PM.


VAERS ID: 1694688 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-09-08
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, COVID-19, Confusional state, Cough, Death, Melaena, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), 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: 2021-09-13
   Days after onset: 5
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: CHRONIC CONDITIONS INCLUDE CHF, ESRD, DM2, HTN
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . PT ADMITTED FOR EVALUATION OF MELENA, CONFUSION, COUGH, BACK PAIN. PT PASSED AWAY 9/13/21


VAERS ID: 1694705 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-29
Onset:2021-08-03
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chest pain, Cough, Death, Myalgia, Pain, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (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: 2021-08-18
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Mellitus, Hypertension/High Blood Pressure, Former smoker
Allergies:
Diagnostic Lab Data: 08/06/2021 Antigen+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case. Symptoms started 8/3/2021: Fever $g100.4, Muscle or body aches, Cough (new onset or worsening of chronic cough), Chest pain, Hospitalized for unknown duration. Death. From vital records: COVID-19, PNEUMONIA, ACUTE RESPIRATORY FAILURE, Per vital records, COD ICD Codes include: Not yet coded; Other Significant Conditions include: N/A, place of death: HOSPITAL-INPATIENT, MEDICAL CENTER; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: MACHINE ADJUSTER, MANUFACTURING


VAERS ID: 1694712 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-08-22
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: 2021-08-25
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, hx of diabetes, long term immunosuppression; positive COVID test, pneumonia


VAERS ID: 1694754 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: eliquis, basaglar insulin, plavix, gabapentin, lipitor, senna, miralax, tylenol,momeprazole, repaglinide, flomax, amiodarone, bumex, metoprolol, tramadol,melatonin, entresto, multi vitamin
Current Illness: s/p Rt BKA 8/25/21, ICD 9/3/21
Preexisting Conditions: DM, HTN, CHF, PVD, BPH, s/p lt BKA, severe, CAD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was last seen at approximately 3:00pm. He was alert and responsive. He offered no complaints. At 4:32pm the RN went into his room and found him unresponsive, absent of vital signs. CPR was immediately initiated and (!! was activated. 911 EMS responded at 4:45p and continued CPR. Th patient was prounced dead at 5:09pm.


VAERS ID: 1694755 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-05
Onset:2021-08-25
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Extubation, Intensive care
SMQs:, Angioedema (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: Asthma, CAD, Fibromyalgia, Hear Valve disorder, HTN, lumbar radiculopathy, lumbar spondylosis
Allergies: Codeine, Darvon, Demerol, PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to medical center 8/25/2021 on the COVID unit. Moved to ICU on 9/4 and intubated. Extubated on 9/12 and expired


VAERS ID: 1694787 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-23
Onset:2021-09-11
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   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 tested postive for covid and hospitalizied on 09/07/2021 . Patient expired 9/11/2021. unable to complete section 21 for patient died will not allow me to enter date.


VAERS ID: 1694810 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-13
Onset:2021-09-11
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Cardiac disorder, Chest X-ray abnormal, Chronic kidney disease, Computerised tomogram thorax abnormal, Endotracheal intubation, General physical health deterioration, Hypoxia, Mechanical ventilation, Pulmonary embolism, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), 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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (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: 2021-09-11
   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: Hypertension, GERD, chronic iron deficiency anemia, HLD and history of prostate cancer
Allergies: Doxycycline hyalate, levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient initially developed symptoms of COVID on 8/10 with + test on 8/15. Patient was previously admitted from 8/17- 8/23 at hospital for COVID pneumonia and acute hypoxic respiratory failure. Was treated with steroids, remdesivir and antibiotics. Discharged home on oxygen , steroids and antibiotic. Returned to hospital on 8/25 due to hypoxia despite home oxygen. O2 sats on arrival at 80% and placed on Vapotherm with improved oxygenation. Chest xray showed worsening bilateral multifocal pneumonia. Required intubation and mechanical ventilation on 8/28. Found to have pulmonary embolism throughout lungs and evidence of right heart strain on CTA on 8/30. Started anticoagulation with heparin. Acute worsening of chronic kidney disease and started on CRRT and levophed. Due to continued deterioration family decided on comfort care on 9/11.


VAERS ID: 1694811 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-01
Onset:2021-08-20
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cardio-respiratory arrest, Death, End stage renal disease
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 14
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: Patient reported being vaccinated with Moderna. However I was unable to find record of this vaccination. Admitted on 08/20/21 with COVID, acute respiratory failure, CKD stage 5, and possible UTI. Discharged on 08/23 but readmitted on 08/25 for worsening symptoms. Patient placed on high flow without improvement. Patient experienced 2 "code" events on 09/03 and expired.


VAERS ID: 1694851 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-09-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Cough, Death, Dizziness, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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: 2021-09-12
   Days after onset: 2
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: Patient is an 81yo female with PMHx of CAD, ischemic cardiomyopathy, Breast CA with mets, DM II, HTN, Systolic CHF, Anemia, PAD
Allergies:
Diagnostic Lab Data: COVID+ PCR on 9/10/21
CDC Split Type:

Write-up: Patient presented to the hospital on 9/1/21 with weakness and dizziness. The patient developed a cough around 9/5/2021, although the patient stated that is a chronic cough. The patient had a fever on 9/6/2021 of 100.2. On 9/10/21 she tested positive for COVID. Her maximum Oxygen requirement was 5L on 9/10/21. On 9/12 the patient expired.


VAERS ID: 1694955 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-09-01
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / 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: 2021-09-11
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALLOPURINOL, ASPIRIN, CLOBETASOL OINTMENT, DICYCLOMINE, DULOXETINE, ESCITALOPRAM, FUROSEMIDE, IPRATROPIUM-ALBUTEROL NEB, LISINOPRIL, MAGNESIUM, METOPROLOL, OMEGA 3, OMEPRAZOLE, OXYCODONE-ACETAMINOPHEN, POTASSIUM CHLORIDE, SPIRIVA INHALER, S
Current Illness: UNKNOWN
Preexisting Conditions: ANEMIA, ANXIETY, ATRIL FIBRILLATION, SKIN CANCER, COPD, DEPRESSION, CONSTIPATION, FATIGUE, GOUT, HYPERTENSION, IBS, NEUROGENIC BLADDER, OSTEOARTHRITIS, SYSTOLIC CONGESTIVE HEART FAILURE, ALCOHOLISM WITH HX ALCOHOL WITHDRAWAL
Allergies: LATEX, NICKEL
Diagnostic Lab Data: ABBOTT ID NOW COVID-19 VIRUS MOLECULAR TEST POSITIVE 9/11/2021
CDC Split Type:

Write-up: HOSPITALIZATION AND DEATH RELATED TO COVID-19 AFTER BEING FULLY VACCINATED


VAERS ID: 1695504 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-08
Onset:2021-09-12
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, SARS-CoV-2 test positive, Wheezing
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 (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brief Hospital Course: # Acute Hypoxic Respiratory Failure 2/2 COVID-19 Pneumonia - vaccination status: Janssen - COVID-19 + on 9/4, out of isolation on 9/19 - continue dexamethasone 6mg x 10 days, final day 9/12 - completed remdesivir x5 days - albuterol HFA 2p q4-6hr prn cough, wheeze, SOA - Wean O2 as tolerated, titrate to goal saturations $g88-90% - guaifenesin, benzonatate, APAP prn - Therapeutic Anticoagulation (PMID: 34351721) with heparin gtt, though lost IV access overnight and renal function precludes use of other agents - pulmonology following - being treated for CAP with azithro + ceftriaxone - on 9/11, discussions with family lead to decision to transition to comfort measures only. Patient died at 2020 PM on 9/11/2021


VAERS ID: 1695753 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-08
Onset:2021-09-11
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ferrous gluconate, furosemide, Medrol dose pak, metoprolol succinate, omeprazole, ropinirole, simvastatin, warfarin, Flovent HFA
Current Illness:
Preexisting Conditions: atrial fibrillation, diastolic heart failure, hypertension, iron deficiency anemia, knee osteoarthritis, h/o TIA
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted with severe COVID19 on 9/10/2021 and subsequently declined and deceased on 9/11/2021


VAERS ID: 1696049 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-02
Onset:2021-07-29
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Death, Diarrhoea, Exposure to SARS-CoV-2, Patient isolation
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 7
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: Chronic Lung Disease (COPD), Hypertension, chronic anemia, ischemic cardiomyopathy,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: symptomatic as of 07/30/2021 with cough and diarrhea - reports COPD, chronic anemia, ischemic cardiomyopathy, and hypertension - admitted to hospital on 07/24/2021, discharged 07/30/2021 - returned to nursing home and placed on COVID unit to isolate - fully vaccinated, Pfizer, 01/12/2021, 02/02/2021 - other positive residents and staff at facility - expired under hospice care on 08/05/2021


VAERS ID: 1696066 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-02
Onset:2021-08-15
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / -

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

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

Write-up: Patient hospitalized and died due to COVID-19. Patient was fully vaccinated.


VAERS ID: 1696115 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-08-02
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized and died due to COVID-19. Patient was fully vaccinated.


VAERS ID: 1696131 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-24
Onset:2021-08-08
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Cough, Death, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Renal Disease, Hypertension, Anemia, Hyperlipidemia, Hypothyroidism, hypercalcemia, hypernatremia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to ED from local nursing facility with shortness of breath, fever and cough. Patient had CK D stage III, anemia, hyperlipidemia, hypothyroidism, hypertension, hypercalcemia, and hypernatremia. Patient is fully vaccinated. Patient died.


VAERS ID: 1696195 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-10
Onset:2021-09-09
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: S/P COLON CANCER HTN DM CHRONIC SMOKER CONTINUOUS USE OF 02
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPIRED ON 09/09/2021


VAERS ID: 1696219 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-23
Onset:2021-03-28
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Feeling abnormal, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodipine besylate NORVASC 5 MG Take 1 tablet (5 mg total) by mouth 2 (two) times daily. cyclobenzaprine HCl FLEXERIL 10 MG Take 1 tablet (10 mg total) by mouth 3 (three) times daily as needed for Muscle spasms. diphenoxylate HCl/atropin
Current Illness: Diffuse disease of connective tissue (HCC) M35.9 12/10/2020 - Present Encounter for general adult medical examination with abnormal findings Z00.01 11/19/2020 - Present Chronic diarrhea K52.9 5/20/2020 - Present Simple chronic bronchitis (HCC) J41.0 5/20/2020 - Present Body mass index (BMI) of 21.0 to 21.9 in adult Z68.21 3/2/2020 - Present Elevated sed rate R70.0 11/20/2019 - Present Anemia in chronic kidney disease N18.9, D63.1 11/14/2019 - Present Renal osteodystrophy N25.0 11/14/2019 - Present Cervicalgia M54.2 10/1/2019 - Present Benign hypertensive renal disease I12.9 7/23/2019 - Present Chronic renal insufficiency, stage III (moderate) N18.30 7/23/2019 - Present Myelodysplastic syndrome (HCC) D46.9 7/23/2019 - Present Vitamin D deficiency E55.9 7/23/2019 - Present Seasonal allergic rhinitis due to pollen J30.1 7/17/2019 - Present Mild carotid artery disease (HCC) I77.9 5/6/2019 - Present Essential hypertension I10 3/25/2019 - Present Primary insomnia F51.01 3/25/2019 - Present Mixed hyperlipidemia E78.2 3/25/2019 - Present Adjustment disorder with anxiety F43.22 3/25/2019 - Presen
Preexisting Conditions: Diffuse disease of connective tissue (HCC) M35.9 12/10/2020 - Present Encounter for general adult medical examination with abnormal findings Z00.01 11/19/2020 - Present Chronic diarrhea K52.9 5/20/2020 - Present Simple chronic bronchitis (HCC) J41.0 5/20/2020 - Present Body mass index (BMI) of 21.0 to 21.9 in adult Z68.21 3/2/2020 - Present Elevated sed rate R70.0 11/20/2019 - Present Anemia in chronic kidney disease N18.9, D63.1 11/14/2019 - Present Renal osteodystrophy N25.0 11/14/2019 - Present Cervicalgia M54.2 10/1/2019 - Present Benign hypertensive renal disease I12.9 7/23/2019 - Present Chronic renal insufficiency, stage III (moderate) N18.30 7/23/2019 - Present Myelodysplastic syndrome (HCC) D46.9 7/23/2019 - Present Vitamin D deficiency E55.9 7/23/2019 - Present Seasonal allergic rhinitis due to pollen J30.1 7/17/2019 - Present Mild carotid artery disease (HCC) I77.9 5/6/2019 - Present Essential hypertension I10 3/25/2019 - Present Primary insomnia F51.01 3/25/2019 - Present Mixed hyperlipidemia E78.2 3/25/2019 - Present Adjustment disorder with anxiety F43.22 3/25/2019 - Presen
Allergies: Contrast Dye Diphenhydramine
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Daughter called on 9/13/2021. Reports patient began having palpitations the day after the vaccine. She thought the palpitations was due to anxiety and did not wish to go to the ED. She had a friend who was passing away and she was slightly upset. She continued to have some symptoms. On 3/28/2021, she passed away.


VAERS ID: 1696271 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-09
Onset:2021-09-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Liver cirrhosis, DMII
Allergies: Metfomin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had vaccine on 9/9. Four days later he presented at local emergency room with blood clots in both legs. He died at the hospital the same day.


VAERS ID: 1696273 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-02-26
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Hypotension, Laboratory test, Mental status changes, Peripheral coldness, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, Hepatitis, HTN, Seizure
Allergies: PCN
Diagnostic Lab Data: Lab work, cxr, covid test-positive
CDC Split Type:

Write-up: Pt sent to ER via EMS for AMS and hypotension, cool to touch.


VAERS ID: 1696293 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-30
Onset:2021-02-23
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Fatigue, Jaundice, SARS-CoV-2 test
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-04
   Days after onset: 9
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: Cdiff, gout, HTN, skin cancer.
Allergies: Bactrim, benzoin topical tincture, cephalexin, ciprofloxacin, clindamycin, doxycycline, fluorouracil, polysporin, solaraze, tape, telfa, vicryl stiches.
Diagnostic Lab Data: Covid test on 2/23/21 and cxr.
CDC Split Type:

Write-up: Pt came to ER for jaundice on 2/23. Seen in ED again on 2/27 for weakness and fatigue.


VAERS ID: 1696347 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-09
Onset:2021-08-21
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Exposure to SARS-CoV-2, Gait disturbance, Headache, Lethargy, Respiratory tract congestion, Rhinorrhoea, Sinus disorder
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), 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: 2021-09-01
   Days after onset: 11
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: Cardiovascular disease, current smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is fully vaccinated and died due to COVID related causes. According to patient''s wife, he presented to hospital with sinus problem runny nose and congestion headache two days before the 8/21 and on 08/21/21 he became Lethargic and had a unsteady Gait prior to testing. Believe contracted Covid from church. Patient died nine days later.


VAERS ID: 1696376 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-31
Onset:2021-08-28
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient fully vaccinated and died of Covid related causes. The patient had shortness of breath, cough, and pneumonia. She was admitted to hospital where she passed away.


VAERS ID: 1696378 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-08-25
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19 pneumonia, Encephalopathy
SMQs:, Interstitial lung disease (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 3
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: COVID pneumonia, progressed to ARDS, severe encephalopathy


VAERS ID: 1696394 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-08-09
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, 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: 2021-08-19
   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: ASA, TYLENOL, FUROSEMIDE, OXYBUTYNIN, LEVOTHYROXINE
Current Illness:
Preexisting Conditions: HTN, CHF, THYROID DISEASE
Allergies: NKA
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: SOB WITH HOSPITALIZATION AND DEATH


VAERS ID: 1696431 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-16
Onset:2021-09-03
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 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: 2021-09-13
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATENOLOL, GABAPENTIN, HYDROCHLOROTHIAZIDE, HYDROCODONE-ACETAMINOPHEN, IBUPROFEN, LISINOPRIL, NITROGLYCERIN SL TAB, SIMVASTATIN, TRIAMCINOLONE CREAM
Current Illness: NONE
Preexisting Conditions: PROSTATITIS, CORONARY ARTERY DISEASE, DEPRESSION, HYPERLIPIDEMIA, HYPERTENSION
Allergies: NKA
Diagnostic Lab Data: NOW COVID-19 VIRUS MOLECULAR TEST POSITIVE 9/1/21
CDC Split Type:

Write-up: COVID INFECTION WITH HOSPITALIZATION AND DEATH WHILE FULLY VACCINATED


VAERS ID: 1696479 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-02
Onset:2021-08-02
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 22
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: Hospitalized due to COVID-19. Died 8/24/2021


VAERS ID: 1696480 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-11
Onset:2021-08-25
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood gases, COVID-19, Central venous catheterisation, Chest X-ray, Death, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), 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: 2021-08-26
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol, celecoxib, vit b-12, duloxetine, gabapentin, lorazepam, melatonin, metformin, potassium, ramelteon, rosuvastatin, tylenol
Current Illness:
Preexisting Conditions: OSA, back pain, depression, DM type 2, Restrictive lung disease, hyperlipidemia, HTN, morbid obesity, neuropathy fibromyalgia, osteoarthritis
Allergies: NKDA
Diagnostic Lab Data: ABGs, CXR 8/26
CDC Split Type:

Write-up: Covid positive week prior to admission, SOB, central line placement, intubation, vasopressors, patient expired


VAERS ID: 1696501 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma, Cardiac arrest, Condition aggravated, Death, Life support, Malaise, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), 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), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol & Nebulizer treatments Per Decedent''s wife, the Decedent does not have one particular PCP, but sees whoever is on duty at health clinic. Decedent''s wife stated that the clinic took him off all of his medications awhile ago, e
Current Illness: Asthma, Diabetes, Hypertension, & only has 1 Kidney (other Kidney was donated to mother)
Preexisting Conditions: Asthma, Diabetes, Hypertension, & only has 1 Kidney (other Kidney was donated to mother)
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Received the the 1st Pfizer COVID vaccine on 08/12/2021 and the 2nd Pfizer COVID vaccine on 09/02/2021. The Decedent''s wife had told Police that the Decedent was complaining about not feeling well ever since he got the 2nd vaccine. 09/12/2021 -- Decedent had an Asthma attack at 0400 hours. Per the Decedent''s wife, the Decedent did at least 10 Albuterol and Nebulizer treatments before calling for an ambulance at 1857 hours. While in the ambulance, the Decedent went unresponsive and then into Cardiac Arrest. EMS started CPR & ACLS procedures, and worked the Decedent for 1 hour before calling Time of Death at 2015 hours.


VAERS ID: 1696534 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-01
Onset:2021-08-22
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Respiratory arrest, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not specified
Current Illness:
Preexisting Conditions: Heart Failure, unspecified, Muscle weakness (generalized), Dysphagia, oropharyngeal phase, Unsteadiness on feet, Crohn''s Disease, unspecified, without complications, Weakness, Unspecified glaucoma, Unspecified dementia without behavioral disturbance
Allergies: Not specified
Diagnostic Lab Data: SARS-CoV-2 Antigen 8/22/2021 via nares swab
CDC Split Type:

Write-up: Moderna vaccines given on 1/5/21 and 2/1/21 at long term care facility. Patient tested positive for COVID on 8/22/2021. Patient died on 9/6/21 with cause of death documented as sudden respiratory arrest and COVID 19.


VAERS ID: 1696550 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-17
Onset:2021-07-23
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   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: Cardiovascular disease, Hypertension/High Blood Pressure, DEMENTIA
Allergies:
Diagnostic Lab Data: 07/25/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case. Asymptomatic. Hospitalization 7/23/2021-7/26/2021. Death on 7/26/2021. From Vital Records: COD = COVID 19 PNEUMONIA. was in hospice then transported to hospital where he died. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: DEMENTIA HEART DISEASE. Place of death: HOSPITAL-INPATIENT, ; certified by: PHYSICIAN; occ/ind.


VAERS ID: 1696554 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-09-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, aspirin, benzonatate, clopidogrel, gabapentin, lisinopril, metoprolol tartrate, risperidone, insulin aspart, insulin glargine, multivitamin, nystatin powder, PEG, pravastatin, pregabalin, docusate
Current Illness: Gangrene that lead to left below knee amputation
Preexisting Conditions: glaucoma, bipolar disorder, diabetes, hyperlipidemia, COPD, obesity, PAD, neuropathy, chronic pain
Allergies: atorvastatin, rosuvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was recently hospitalized for left BKA from 7/19-8/27 and transferred to rehab. Patient coded and passed away on 9/01. Death doesn''t not seemed attributed to vaccine based on patient''s PMH.


VAERS ID: 1696558 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-22
Onset:2021-03-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypercapnia, Infusion, Mechanical ventilation, Oxygen saturation decreased, Red blood cell abnormality
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pioglitazone, Tamsulosin, Timolol, Gabapentin, Metformin, Furosemide, Pantoprozole, Propafenone, Potassium CL, Vitamin B6, Iron, Vitamin C, Vitamin D, Magnesium.
Current Illness: None
Preexisting Conditions: Type II Diabetes
Allergies: Demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red Blood Cell Platelets deformed and fractured. Dr started infusions in April 12/2021. Patient was put on oxygen. Patient was transported to Hospital on June 8th, 2021. Once again the three doctors told me that his red blood cell platelets were deforming. That it was similar to anemia, but that he was given something. He was unable to expel CO2. They put him on a breathing machine but it was clear that he would not recover, his blood oxygen level remained low and dropped once the machine was removed per our direction on June 8th 2021. My father passed, the end result was death. My mother has also at the same time had similar difficulties and they both were vaccinated at the same time with the same Pfizer BioNTech vaccine.


VAERS ID: 1696571 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-08
Onset:2021-03-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray, Chest discomfort, Confusional state, Decreased appetite, Laboratory test, Nausea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: A-fib, cardiac ablation, hypercholesterolemia, HTN, pacemaker.
Allergies: Tegretol
Diagnostic Lab Data: CXR, positive covid test, lab work.
CDC Split Type:

Write-up: Pt came to ER with confusion, nausea, fever one week prior, loss of appetite, on/off pressure to chest.


VAERS ID: 1696588 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-07
Onset:2021-09-11
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Acidosis, Acute kidney injury, Acute respiratory failure, Anuria, Back pain, Blood creatinine increased, COVID-19, Central venous catheterisation, Computerised tomogram abdomen abnormal, Cough, Death, Diabetes mellitus, Dialysis, Gastrointestinal inflammation, Gastrointestinal wall thickening, General physical health deterioration, Haemodynamic instability, Hyperkalaemia, Hypotension, Hypothermia, Hypoxia, Lactic acidosis, Mechanical ventilation, Mental status changes, Obesity, Pancreatitis, Respiratory failure, SARS-CoV-2 test positive, Septic shock, Slow response to stimuli, Systemic inflammatory response syndrome, Vascular calcification
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), 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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 2
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: Admit date: 9/11/2021 Date of Death and Time: 09/13/21 at 12:05 Admitting Physician: Physician: Admission Diagnoses: Hyperkalemia [E87.5] Lactic acidosis [E87.2] Hypotension [I95.9] SIRS (systemic inflammatory response syndrome) (CMS/HCC) [R65.10] AKI (acute kidney injury) (CMS/HCC) [N17.9] Septic shock (CMS/HCC) [A41.9, R65.21] Left lower quadrant abdominal pain [R10.32] Diagnoses at Time of Death: Septic shock Acute kidney injury on CKD SARS-CoV-2 infection Acute hypoxemic respiratory failure History of atrial fibrillation History of hypertension Morbid obesity Diabetes mellitus History of hypothyroidism Admission Condition: critical Indication for Admission: Hospital Course: Patient was admitted with abdominal and back pain, cough and hypoxia. Documented to be hypotensive at the emergency department with evidence of worsening creatinine and hyperkalemia. CT imaging demonstrated peripancreatic, duodenal stranding with mild rectal wall thickening and vascular calcifications. Patient required vasopressors through central venous catheter as well as broad-spectrum antibiotics. She was known to have chronic kidney disease with new acute kidney injury, was treated with bicarbonate, calcium gluconate. Patient had worsening of her respiratory status and required bilevel positive airway pressure. She changed her CODE STATUS to DO NOT RESUSCITATE after admission. Was seen by nephrology with a recommendation for continued dialysis, started after placement of temporary dialysis catheter. Patient had worsening mental status becoming minimally responsive. Had progressive deterioration with increasing requirements for hemodynamic support, at some point on maximal dose of norepinephrine and phenylephrine. Testing was positive for SARS-CoV-2 for which she was treated with dexamethasone She continued to have deterioration of her overall status, hypothermic, acidemic, with severely elevated creatinine, anuria, dependent on noninvasive ventilatory support. This was discussed with her POA who mentioned that patient would not want to depend on artificial life-sustaining measures. A decision was made to change focus of care to comfort and aggressive management was discontinued Patient was pronounced deceased on September 13, 2021 at 12:05 PM Consults: Critical Care Nephrology Pulmonary and Critical Care Medicine


VAERS ID: 1696621 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-25
Onset:2021-08-23
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Malaise, Patient isolation, 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: 2021-08-29
   Days after onset: 6
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:
Current Illness:
Preexisting Conditions: Diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died of Covid related causes. According to patient''s daughter, her father was taken about 1 month ago with symptoms, waited 12 hours in the waiting room, was diagnosed with pneumonia, negative for Covid and returned. Symptoms worsened 1 to 2 weeks later on 08/24/2021. Was taken to ER and finally admitted to a room. Tested positive for Covid and isolated. Patient died about five days later.


VAERS ID: 1696626 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Positive airway pressure therapy
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 42
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: Alprazolam 0.25mg BID, Amlodipine 10mg daily, Aspirin 81mg Daily, Calcium 600+D daily, Famotidine 20 mg daily, Fexofenadine 180mg Daily PRN, Fish Oil 1000mg TID, Keppra 500 mg Daily
Current Illness:
Preexisting Conditions: b-cell lymphoma, GERD, HTN. Hx of Brain tumor
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital 8/30 c/o Can''t breath. Started on Nasal cannula at 4 L/min. 9/2 60 L/MIN heated high flow. 9/3 BIPAP. Expired 9/12


VAERS ID: 1696633 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-04
Onset:2021-09-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Alcoholic
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Received his first COVID vaccine on Saturday September 4th. He complained to family about feeling ill afterwards. He was found deceased on 9/8/2021.


VAERS ID: 1696698 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-19
Onset:2021-07-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, chlorthalidone, ibuprofen, losartan, psyllium powder, artificial tears
Current Illness: COVID
Preexisting Conditions: major depressive disorder, chronic pain syndrome, allergies, obesity, migraine, hyperlipidemia, PTSD, OSA, traumatic brain injury
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 7/28. Previous to this, he was COVID positive on 7/21 which he believes he got from his wife. Patient did have symptoms.


VAERS ID: 1696718 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-02
Onset:2021-08-17
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
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: 2021-08-25
   Days after onset: 8
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: Diabetes Mellitus, Cardiovascular disease, Hypertension/High Blood Pressure, dementia
Allergies:
Diagnostic Lab Data: 08/12/2021 Antigen+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/17/2021: Cough (new onset or worsening of chronic cough) and Shortness of breath or difficulty breathing. Hospitalized from 8/24/2021-8/25/2021. Died 8/25/2021.


VAERS ID: 1696737 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-01-13
Onset:2021-09-02
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Gangrene, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: DM, HTN,CAD,TOBACCO ABUSE, SCHIZOAFFECTIVE DISORDER, CVA,PAD,WET GANGRENE,
Allergies: nka
Diagnostic Lab Data: POSITIVE PCR 9/2/2021
CDC Split Type:

Write-up: PATIENT DEVELOPED ACUTE RESP FAILURE WITH HYPOXIA 2ND TO COVID PNEUMONIA, AKI,


VAERS ID: 1696749 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-13
Onset:2021-07-20
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Fatigue, Myalgia, Nausea, Pain, SARS-CoV-2 test positive, Vaccine breakthrough infection, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 23
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: 07/25/2021 PCR+ COVID-19 test at Nursing Home; 08/03/2021 PCR+ COVID-19 test at Nursing Home; 08/10/2021 PCR+ COVID-19 test at Nursing Home
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 7/20/2021: Muscle or body aches, Fatigue or tiredness, Nausea or vomiting. Living in a nursing home at time of positive COVID test. Death 08/12/2021


VAERS ID: 1696757 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was 11 years old and 8 months at the time of vaccine No side effects noted.


VAERS ID: 1696783 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-17
Onset:2021-09-04
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Cough, Dyspnoea, Nausea, SARS-CoV-2 test positive, Upper respiratory tract infection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ambien, ASA, Betapace, Budesonide-Formoterol, Duo-neb, Betamethasone, topical, Doxycycline, Eliquis, Iron, Glucophage, Mybertrig, Nitrostat, Prinivil, Verapamil
Current Illness: Unknown
Preexisting Conditions: AFib, Leukemia, Pacemaker, Sleep apnea
Allergies: Cephalosporins, PCN
Diagnostic Lab Data: 09/04/2021 SARS COV2 COVID 19 PCR (POSITIVE)
CDC Split Type:

Write-up: 09/04/2021 The patient presents with 1 week hx of of worsening shortness of breath. Per EMS, pt was evaluated at his PCP at onset due to viral symptoms. Pt was diagnosed with an URI and prescribed with antibiotics, ceased administration of at home medication. Pt was evaluated today by nurse at Assisted Living and was noticed to be experiencing increased shortness of breath. At arrival, EMS found pt on 82% room air. At ED bedside, pt has been experiencing shortness of breath with cough, nausea, and abdominal pain. Pt denies vomiting, fevers, chills, chest pain, diarrhea, and all other symptoms. Pt has recieved the COVID vax


VAERS ID: 1696788 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-24
Onset:2021-09-02
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Positive airway pressure therapy, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: pt presented to the Medical Center on 9/2 in respirator Distress pt placed on bipap, later intubated pt expired on 9/10/21 @ 1432


VAERS ID: 1696796 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-27
Onset:2021-08-31
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardioversion, Central venous catheterisation, Dyspnoea, Endotracheal intubation, Positive airway pressure therapy, Prone position, Respiratory distress, SARS-CoV-2 test positive, Supraventricular tachycardia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (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: 2021-09-03
   Days after onset: 3
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: ASA, Rosuvastatin, Amlodipine, Metoprolol, Losartan, Insulin, Mycophenolate, Tacrolimus
Current Illness: Unknown
Preexisting Conditions: Renal transplant, HTN, OSA, TIA, CVA, TBI w/SDH, Hyperlipidemia, DM, Skin CA
Allergies: No known allergies
Diagnostic Lab Data: unknown test site: Pt tested COVID+ 08/29/2021. 08/31/21 (repeated) SARS COV2 COVID 19 PCR (POSITIVE)
CDC Split Type:

Write-up: 08/31/2021 The patient presents with SOB, worsening 3 days ago. Pt tested positive 3 days ago for COVID 19 and note symptoms beginning 1 week ago. He arrived to ED in severe respiratory distress respiratory distress.. The onset was just prior to arrival. Patient is an 83 y/o male admitted to hospital on 8/31 after presenting to ED for evaluation of shortness of breath. He was found to have acute hypoxic respiratory failure secondary to COVID-19 pneumonia, quickly failed BiPAP and was intubated and proned in ED. He had SVT x2 episodes in ED requiring electrical cardioversion each time 100J. Started on levophed gtt after CVC placed in ED. Received bicarb IVP x3 + gtt.


VAERS ID: 1696812 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-08-18
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Dyspnoea, Exposure to SARS-CoV-2, Headache, Myalgia, Nasal congestion, Pyrexia, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 4
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: HCTZ, Amlodipine, Sertraline
Current Illness: Unknown
Preexisting Conditions: HTN
Allergies: No known allergies
Diagnostic Lab Data: SARS COV2 COVID 19 PCR 08/18/21
CDC Split Type:

Write-up: The patient presents with 8 day hx of viral symptoms. Pt reports to have been experiencing fevers, chills, cough, shortness of breath, myalgia, headache, nasal congestion, rhinorrhea, and headache. Recent sick contacts and COVID-19 exposure. Has administered with over the counter cold medicine. Denies all other acute systemic symptoms. The onset was 8 days ago. Associated symptoms: fevers, chills, cough, shortness of breath, myalgia, headache, nasal congestion, rhinorrhea, and headache, denies chest pain, denies abdominal pain, denies nausea, denies vomiting, denies dizziness and denies back pain.


VAERS ID: 1696820 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-08-27
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray abnormal, Death, Hypoxia, Mental status changes, Pneumonia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban 2.5 mg twice daily atenolol 100 mg daily, amlodipine
Current Illness:
Preexisting Conditions: Hypertension, hyperlipidemia, dementia, chronic heart failure, coronary artery disease, atrial fibrillation, glaucoma,
Allergies: No known allergies
Diagnostic Lab Data: COVID Positive on 8/19/2021; CXR showed multifocal pneumonia 8/27/2021
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/6/2021 and 3/27/2021. Patient was recently hospitalized for COVID-19 from 8/23/2021 to 8/26/2021. Patient presented to ED on 8/27/2021 due to repeated hypoxia. Dexamethasone and cefuroxime was administered. Throughout hospitalization, patient had significant change in mental status and continued weakness. Palliative care was consulted on 9/4/2021 and patient expired at 06:37 on 9/8/2021.


VAERS ID: 1696821 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-10
Onset:2021-07-03
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, Intensive care, Laboratory test, Mechanical ventilation, Nasopharyngitis, Oropharyngeal pain, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (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: 2021-08-06
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 31 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair; Spiriva; Vitamin
Current Illness: N/A
Preexisting Conditions: Lung Disease-Silicosis
Allergies: N/A
Diagnostic Lab Data: Hospitalization-testing, Pulmonologist Dr.
CDC Split Type: vsafe

Write-up: My husband and I both tested positive for Covid-19 after receiving the vaccine. He started to have symptoms like a cold, and it was like sinus symptoms. I also had sinus symptoms. He was prescribed Azithromycin and when it was gone a fever broke out. My husband throat was sore. He was admitted to the hospital and waited for a room for 24 hours. He was admitted directly to the Covid-19 ICU. He was tested again after being admitted on 07/10/2021 and he died on 08/06/2021. He had improved and he was supposed to come home and then I got a call that he had been intubated. He got Pneumonia after being on a ventilator. He lived for two more weeks but then he passed away.


VAERS ID: 1696822 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-24
Onset:2021-08-14
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bronchoalveolar lavage, COVID-19, Candida test positive, Cardiac arrest, Chest X-ray abnormal, Death, Dyspnoea, Life support, Lung consolidation, Lung infiltration, Mechanical ventilation, 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), 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), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 5 mg Oral 2 times daily, aspirin 81 mg Oral Daily, atorvastatin 40 mg Oral Nightly, calcium carbonate 200 mg calcium (500 mg) 1 tablet Oral Daily, carvedilol 12.5 mg Oral 2 times daily with meals, ergocalciferol (vitamin D2) 50,0
Current Illness:
Preexisting Conditions: Hypertension, hyperlipidemia, hypothyroidism, renal transplant
Allergies: Adhesive
Diagnostic Lab Data: COVID Positive on 8/15/2021; CXR showed Patchy infiltrates mid & lower lung with focal consolidation right midlung on 8/14/2021; Positive bronchial wash for Candida on 8/21/2021
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/27/2021 and 2/24/2021. Patient presented to ED on 8/14/2021 with complaints of shortness of breath. Medications administered: ascorbic acid, azithromycin, baricitinib, ceftriaxone, dexamethasone, epoprostenol, fluconazole, remdesivir, zosyn, vancomycin, and zinc. Throughout hospitalization patient continued to decompensate eventually requiring mechanical ventilation. Patient had brief episode of cardiac arrest. After family discussion, patient was taken off life support and expired on 9/9/2021.


VAERS ID: 1696824 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-02
Onset:2021-09-09
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Chest X-ray abnormal, Death, Dyspnoea, Pleural effusion, Pulmonary mass, Pulse absent, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: 2021-09-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: dexamethasone 6 mg; L. acidophilus/L.bulgaricus 100 million cell 1 g; sodium chloride 1,000 mg; furosemide 20 mg; metoprolol succinate 12.5 mg; aspirin 81 mg; atorvastatin calcium 20 mg; benzonatate 100 mg; cetirizine HCl 10 mg; cholecalcif
Current Illness:
Preexisting Conditions: Dementia, hyperlipidemia, osteoarthritis, thrombophlebitis, vertigo
Allergies: Iodinated contrast, penicillins, shellfish
Diagnostic Lab Data: COVID Positive on 8/11/2021; CXR showed bilateral pleural effusions with lower lobe atelectasis and right middle lobe and lingular interstitial nodularity on 9/9/29021;
CDC Split Type:

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/19/2021 and 2/2/2021. Patient was recently hospitalized for COVID 8/11/2021 to 8/17/2021. Patient presented to ED on 9/9/2021 with complaints of shortness of breath with increased oxygen requirements. Medications administered: levofloxacin and aspirin. Patient became unresponsive with no palpable pulse. Patient expired at 01:55 on 9/9/2021.


VAERS ID: 1696875 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-05-05
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Amyotrophic lateral sclerosis, Death, Electromyogram, Magnetic resonance imaging spinal, Nerve conduction studies
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 110
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish containing products
Diagnostic Lab Data: EMG/NCS and MRI of the Lumbar Spine.
CDC Split Type:

Write-up: Patient developed ALS shortly after his vaccine. He passed away within 4 months. It is unclear whether or not there is any relation to his development of ALS and his taking the vaccine - other than the association of timing. His wife felt strongly that this should be reported.


VAERS ID: 1696895 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-17
Onset:2021-08-05
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Intensive care
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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: Chronic Lymphocytic Leukemia, cardiovascular disease, chronic renal disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died of covid related causes. According to patient''s wife, patient was in critical care at the hospital and also had cancer. Patient''s wife says they haven''t went anywhere except for their oncology visit on 8/2. Patient died 13 days later after admitted to hospital.


VAERS ID: 1696901 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-02-24
Onset:2021-07-30
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 46
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: losartin, VitaminB, Gabapentin, montelukast, zoloft, donepezil,
Current Illness: dementia
Preexisting Conditions: dementia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hemorrhagic Stroke on 07/30/2021 died 08/03/2021


VAERS ID: 1696910 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-06
Onset:2021-07-29
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Confusional state, Death, Lethargy, Metabolic encephalopathy, SARS-CoV-2 test positive, Ultrasound scan normal, Urinary tract infection
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), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, atorvastatin, vitamin B12, Fish Oil, Glucosamine-chondroitin, lisinopril-hydrochlorothiazide, multiple vitamin, ocuvite
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, Diabetes mellitus 2 diet controlled, CKD stage 3a
Allergies: Penicillins
Diagnostic Lab Data: 7/29/21 chest xray: negative 7/30/21 US: Negative for clot 8/6/21 Chest xray: Bilateral patchy pneumonias which seems to have worsened slightly when compared to prior studies
CDC Split Type:

Write-up: Came to ER for confusion and possible low blood sugar on 7/29/21. Blood sugar 124 on arrival. Patient was lethargic and tested positive for COVID. Stable vitals temperature 99.7? 0 blood pressure 137/64 below pulse of 93 and 98% on room air. Also found to have acute metabolic encephaloprathy likely secondary to UTI and COVID19. Placed on ceftriaxone for UTI . During her stay she developed acute hypoxic respiratory failure, requiring opti-flow 90% and 60L. Likely from COVID pneumonia. Placed on dexamethasone and remdesivir. Required precedex for BP. Patient went comfort and passed away on 8/25/2021


VAERS ID: 1696937 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-20
Onset:2021-08-15
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Positive airway pressure therapy
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   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:
Current Illness:
Preexisting Conditions: Chronic Lung Disease, Autoimmune condition, immunosuppressive condition, pulmonary fibrosis, rheumatoid arthritis, chronic immunosuppression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized due to COVID-19. Patient is fully vaccinated. Placed on BiPAP in hospital and moved to ICU. Patient died due to COVID-19.


VAERS ID: 1697220 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-09-08
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Cardiac arrest, Chest X-ray, Death, Dyspnoea, Endotracheal intubation, Extra dose administered, Fatigue, Feeling abnormal, Malaise, Pulmonary embolism, Ultrasound chest, Ultrasound scan abnormal, Whole body scan
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Medication errors (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? No
Previous Vaccinations:
Other Medications: metforman, lisinopril, lovastatin, metoprolol
Current Illness: none
Preexisting Conditions: adult onset diabetes with meticulous care taken to center the blood readings
Allergies: no
Diagnostic Lab Data: Ultrasound, chest Xray, torso scan all on 9/8/21
CDC Split Type:

Write-up: She heard media urge all at-risk to get the booster (before they changed their stance later). She immediately went out and got it, her 3rd Moderna. It was a big reaction for her. I became aware after she called me to tell me how bad she felt. Several days of feeling very beaten down, fatigued and ill. She kept hydrated, though, and was able to start eating, and seemed to be getting better. Day 9 I talked with her, she was tired by up and about, and thought she was getting better. Morning of day 10, my wife got the alert call, rushed over, confirmed to them that it was a 911 for real. I rushed over and held her upright while ambulance was enroute. She was having trouble breathing, couldn''t get enough (couldn''t get enough) air in her lungs. She said to me: "This could be it. I''ve had a good life." But she was on the road to being a centenarian, riding her exercise bike regularly, an iron-clad diet to keep her diabetes in check, etc. She had multiple cardiac arrests enroute and in the emergency room. While stabilized with extreme blood thinners, (suspected Pulmonary embolism confirmed by ultrasound), they took her for a scan, where they found MULTIPLE pulmonary embolisms in BOTH lungs. She died less than an hour later, even on the breathing machine with a team of attendants. She wanted to not be a burden on the medical resources and I checked with them during this event and they said they had the capacity and that she was the sickest person in the hospital by far, ''we have the resources now''. I signed the DNR after the (I think) 4th cardiac arrest to stop them from shattering more bones in her torso, about an hour before she died. She was intubated the whole time in the hospital.


VAERS ID: 1697353 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-09-04
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arteriosclerosis, Autopsy, Death, Fatigue, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: Flonase Nasal Spray Alegra
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: Final autopsy results are still pending
CDC Split Type:

Write-up: Complained of feeling very fatigued in the weeks following following the vaccination, but was heathy prior to the injection. Died of a massive heart attack exactly 3 months after the date of vaccination. Death certificate notes Atherosclerotic Cardiovascular Disease as the immediate cause of death.


VAERS ID: 1697379 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-16
Onset:2021-05-19
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adenocarcinoma, Asthenia, Brain neoplasm, Brain operation, Death, Dehydration, Gait inability, Haemoglobin decreased, Intracranial mass, Laboratory test, Lymphoma, Neck mass, Neoplasm, Ocular neoplasm, Pain
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Malignant lymphomas (narrow), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 92
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 5/19, there were two lumps grew on his left neck. He visited his family doctor on 6/2, and some exams were done. He got the exam report on 6/3. It showed that his hemoglobin dropped to around 12, and he is severely dehydrated. Second Covid shot on 6/6/2021, 2 weeks later, he couldn''t walk any more due to weakness and pain, around 6/21/2021. He went to the family doctor on 7/7, and did more test. His hemoglobin dropped to around 11 as the result showed on 7/8. He was sent to the emergency room at Hospital on 7/14. He found 1 lump in his brain and he was admitted to the hospital immediately. He was diagnosed lymphoma. There was no treatment. He was transferred on 7/15. They found 3 lumps in his brain. There was no treatment. He was then diagnosed Goblet Cell Adenocarcinoma. He was then transferred on 7/15 at 3am. He had open skull surgery on 7/28, and there 7 tumors in his brain, 1 in his right eye, and numerous in his body. No treatment. He passed away on 8/19.


VAERS ID: 1697946 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-30
Onset:2021-08-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiocardiogram, Atrioventricular block, Cardiac arrest, Cardiac function test, Cardiac operation, Chest pain, Death, Laboratory test, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 8
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: None
Current Illness: None
Preexisting Conditions: Arthritis in back
Allergies: None known
Diagnostic Lab Data: Full range of cardiac testing angiogram etc
CDC Split Type:

Write-up: Day 2 after injection complaining of chest pain...day 3 went to urgent care was sent home, told she just needed rest. Day 5 heart attack rushed to hospital. Day 6 testing, Day seven heart surgury for blockage...doctors refused to discuss what blockage was...no prior heart, blood pressure issues or cholesterol issues. Day 7 in recovery up and walking due to be released in 48 hours...Day 8 recovering then at 9pm suddenly full cardiac arrest unable to revive and died at 10:38 pm


VAERS ID: 1700082 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-09-01
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / SYR

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

Write-up: COVID ASSOCIATED DEATH; PT FULLY VACCINATED.


VAERS ID: 1700088 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-15
Onset:2021-08-13
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case had covid vaccine x 2. Last dose on 1/15/2021. Tested positive for COVId 19 on 8/13/2021. Was admitted to medical center on 8/30/2021 with COVID Pneumonia. Case expired while still hospitalized on 9/9/2021.


VAERS ID: 1700089 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-16
Onset:2021-09-13
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / SYR

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: 2021-09-13
   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: COVID RELATED DEATH; PT FULLY VACCINATED


VAERS ID: 1700097 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-22
Onset:2021-09-14
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / SYR

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: 2021-09-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; PT FULLY VACCINATED


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