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

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



Case Details

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VAERS ID: 1003494 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-18
Onset:2021-01-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK 5730 / 2 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   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: acetaminophen, 650 mg= 2 tab, Oral, q6hr, PRN amLODIPine, 10 mg= 2 tab, Oral, Daily aspirin, 81 mg= 1 tab, Chewed, Daily atorvastatin, 40 mg= 1 tab, Oral, Q Bedtime Keppra, 1000 mg= 2 tab, Oral, every 12 hr levothyroxine, 75 mcg= 1 tab
Current Illness: Recent hemorrhagic stroke
Preexisting Conditions: Seizure disorder, prior subdural bleed status post cranioplasty, bipolar disorder, hypertension, hyperlipidemia, and vasovagal syncope
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Possible transverse myelitis developing 2 days after vaccine injection. Death on day 9 after vaccination


VAERS ID: 1003587 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-05
Onset:2021-01-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELO140 / 1 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Asthenia, Death, Fatigue, Mobility decreased, Pneumonia aspiration
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   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: synthroid, pantoprazole, clonazepam, allopurinol, allbuterol inhaler, Decadron
Current Illness: congestive heart failure
Preexisting Conditions: congestive heart failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My father was in weak condition to begin with. He didn''t get out of bed for the next few days after receiving the vaccine. The little amount that he ate was consumed in bed. He began aspirating his food which lead to pneumonia. He wasn''t strong enough to fight off the pneumonia even with antibiotics. He died on 1/23/21. While he might have passed soon in any case, I believe that the vaccine may possibly have increased his weakness/exhaustion thereby hastening his demise.


VAERS ID: 1003624 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-25
Onset:2021-01-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypotension, Oxygen saturation decreased, Peripheral coldness, Pyrexia, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 25
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: cyancobalamin, insulin detemir, potassium chloride, reno caps, sevelemer, sodium polystyrene sulfonate, midodrine, acetaminophen,
Current Illness: PNA
Preexisting Conditions: MSSA, DM, ESRD/HD, HTN
Allergies: metaformin and sulfa
Diagnostic Lab Data: done at hospital
CDC Split Type:

Write-up: Patient awake at 0300. When going into the room to get him ready for dialysis he was cold to touch, unresponsive other than to sound, and nonverbal. O2 sat was 67 via finger probe. Oxygen immediately initiated and a venturi mask retrieved and initiated. When unable to arouse him via sternal rub this RN called 911. Send to ED. Febrile 39.2 and hypotensive 58/43. Admitted. unknown after that as patient expired in hospital.


VAERS ID: 1005533 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-01-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cognitive disorder, Death
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   Days after onset: 0
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 89yo with type 2 DM, HT, pacemaker and prior COVID+ in Nov 2020. Shortly after administration of 2nd Covid vaccine, patient began to have increased cognitive decline and 2 days after he expired at the facility


VAERS ID: 1004206 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-01-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-23
   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: TYLENOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No adverse event was reported.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Death; A spontaneous report was received from a nurse concerning a 91-year-old, female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and died two days later. The patient''s medical history included dementia. Concomitant medications reported included paracetamol. On 21 Jan 2021, approximately two days prior to her death, the patient received the first of two planned doses of mRNA-1273, intramuscularly for prophylaxis of COVID-19 infection. On 23 Jan 2021, the patient died. The nurse reporting the event stated that the patient''s death was considered as due to "natural causes" and that she was not aware of any new-onset symptoms of illness prior to the patient''s death. The patient was described as "fragile" and was under hospice care at the time of her death. An autopsy was not performed. Action taken with the drug in response to the event is not applicable. The patient died on 23 Jan 2021. The cause of death was natural cause of death related to dementia. Autopsy was not performed.; Reporter''s Comments: This case concerns a 91-years-old female patient, with medical history of dementia, who experienced a serious unexpected event of death. This event occurred 2 days after first dose of mRNA-1273, lot # unknown. At the time of death, the subject was very fragile and was in hospice care. Concomitant medication included Tylenol. Treatment details were not provided. The doctor considered that the death was due to natural causes. However, autopsy was not performed. Very limited information regarding this event has been provided at this time. Based on the limited information available, it is difficult to assess a cause and effect relationship. The benefit-risk relationship of Moderna''s COVID-19 vaccine is not affected by this report.; Reported Cause(s) of Death: Natural cause of death related to dementia


VAERS ID: 1004645 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-05
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 INC2021096325

Write-up: Pfizer vaccine caused the death; This is a spontaneous report from a non-contactable consumer. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiration date were not reported), via an unspecified route of administration on an unspecified date at a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The reporter claimed that Pfizer vaccine caused the death of the doctor (patient). No further details reported. No follow-up attempts are possible. Information about lot and batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Pfizer vaccine caused the death


VAERS ID: 1004811 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-09
Onset:2021-01-23
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Bone fragmentation, Computerised tomogram abnormal, Computerised tomogram spine, Death, Headache, Injury, Road traffic accident, Spinal compression fracture, Spinal stenosis, Subdural haematoma, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Osteoporosis/osteopenia (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: unknown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT lumbar spine: L4 compression fracture w/ retropulsion of fragments causing moderate narrowing of spinal canal
CDC Split Type:

Write-up: On 1/23/21 the patient had a single-car accident, slid off icy road into snowbank. She was seen in our ER, diagnosed w/ trauma and L4 compression fracture. She was transported to Hospital for further trauma workup. We believe she was treated and released. On 1/31/21 the patient had a headache but did not seek medical attention. In the morning of 2/1 she became unresponsive and was pronounced dead on the scene when EMS arrived. Autopsy showed a left temporal subdural hematoma.


VAERS ID: 1004864 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-01-28
Onset:2021-02-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Diabetes mellitus, Endotracheal intubation, Fall, Hypertension, Malaise, Pulse absent, Pulseless electrical activity, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), 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), Accidents and injuries (narrow), Hypertension (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Apixiban 5mg BID Aspirin 81mg daily Atorvastatin 40mg daily gabapentin 600mg TID Soliqua (glargine/lixisenatide) 60 units daily Lisinopril 20mg daily Metformin 1000mg BID Multivitamin 1 tab daily Pioglitazone 30mg daily
Current Illness: n/a
Preexisting Conditions: Atrial fibrillation hypertension hyperlipidemia Type 2 diabetes Heavy drinker
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired. Per Emergency MD note: "This is a 72-year-old male with what sounds like diabetes, atrial fibrillation, and hypertension who presents via EMS in cardiac arrest. It sounds like he received his Covid vaccine last week. Initially he had some mild effects from it. However over the last day or so he has felt very unwell. He apparently called his wife today and told her that he was not feeling well and so she returned home. Shortly thereafter he attempted to get up from his chair. He then collapsed and fell forward onto his face. Sounds like his wife had some difficulty rolling him over to perform CPR. When EMS arrived they found him in PEA. He received a total of 5 rounds of epinephrine. At some point they did have return of spontaneous circulation. However just prior to arriving in the emergency department they lost pulses again. The patient was intubated with an 8 oh endotracheal tube prior to arrival."


VAERS ID: 1004956 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-02-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Wife reported patient expired on 2/3/2021


VAERS ID: 1005020 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: No adverse event, Continue: [UNK], Comment: No reported adverse events
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Patient took vaccine and died two weeks later; Spontaneous report s were received from consumers via social media posts concerning an 86 year old male patient who received Moderna''s COVID-19 vaccine and died. There was no medical history provided. There were no concomitant medications provided. On approximately 06 Jan 2021, the patient received the first of two planned doses of mRNA-1273 (Batch # unknown), intramuscularly for prophylaxis of COVID-19 infection. All of the social media posts reported the patients death and, according to one post, the patient took two doses of Moderna''s vaccine and died two weeks later. The patient died on or before 23 Jan 2021. No additional information was provided. Very limited information regarding this event has been provided at this time. The benefit-risk relationship of Moderna''s COVID-19 vaccine is not affected by this report.; Reporter''s Comments: This case concerns a 86-year old male patient. The medical history and concomitant medication is not provided. The patient experienced Death. The event occurred approximately two weeks after receiving their second of two planned doses of mRNA-1273 (Lot unknown). Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the onset of the event, a causal relationship cannot be excluded and the event is considered possibly related to the vaccine. The benefit-risk relationship of Moderna''s COVID-19 vaccine is not affected by this report.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1005022 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2020-12-26
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Death, Pyrexia, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Respiratory distress; Anxiety; Fever; Passed away; A spontaneous report was received from a consumer concerning a female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and developed fever, respiratory distress, anxiety and passed away. The patient''s medical history was not provided. Concomitant product use was not provided. On an unknown date, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On an unknown date, within 24 hours of receiving the vaccine, the patient developed a fever, respiratory distress and anxiety. Treatment for the events included oxygen, morphine, and lorazepam. On the evening of 26 Dec 2020, the patient passed away. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on 26 Dec 2020. The cause of death was not reported. Plans for an autopsy were not provided.; Reporter''s Comments: This case concerns a female patient who received their first of two planned doses of mRNA-1273 (Lot unknown), and who experienced the serious unlisted events of death (unknown cause) and respiratory distress, the non-serious listed event of fever, and the non-serious unlisted event of anxiety. The events of respiratory distress, fever, and anxiety occurred within 24 hours of vaccination, while the event of death (unknown cause) occurred an unknown amount of time after vaccination. Very limited information has been provided regarding the circumstances leading to death and additional information has been requested. Based on the current available information and temporal association between the use of the product and the onset of events after vaccination, a causal relationship cannot be excluded.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1005130 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-06
Onset:2021-02-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Report of patient expired on 2/3/2021


VAERS ID: 1005164 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-01-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 9
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: unresponsive Narrative: 74yo patient with pacemaker, type 2 DM, parkinson''s and history of syncopal epsisodes presented to emergency dept on Jan 24th. He was observed and discharged on Jan 26th back to the home where he continued to have cognitive decline and later passed away on 2/2/2021


VAERS ID: 1005217 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-27
Onset:2021-01-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   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: albuteron, gabapentin, levothyroxine, loperamide, pantoprazole, potassium, pravastatin, triamterine, ventolin
Current Illness:
Preexisting Conditions: asthma, CHF, Hypokalemia, hypothyroidism
Allergies: Morphine, penicillin, quinidine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nursing home called 911 for decline in condition. Patient transported to ER where she was admitted to inpatient care and expired 1/30 at 16:13


VAERS ID: 1005276 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-01-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chemotherapy, Chills, Death, Malaise, Metastases to bone, Metastases to liver, Prostate cancer metastatic, Prostatic specific antigen increased
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Tumour markers (narrow), Prostate malignant tumours (narrow), Prostate tumours of unspecified malignancy (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-18
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills 1 day after vaccine administration; found dead by family 1/18/2021 Narrative: Per patient family report, patient said the next day after vaccination that he didn''t feel well because of chills. Patient was found dead at home by his family on January 18th. He was a 74yo man with castrate resistant prostate cancer and liver and bone metastases with rising PSA, status post intravenous chemotherapy 1/7/21


VAERS ID: 1005301 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-26
Onset:2021-02-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Feeding disorder, SARS-CoV-2 test positive, Tissue injury, Weight decreased, Wound
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: Vitamin B-12
Current Illness: COVID-19
Preexisting Conditions: Dementia, Dysphagia, HTN, Diabetes Mellitus Type 2, Hypercholesterolemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 1/8/21. She demonstrated a decline in appetite and the ability to feed herself d/t this illness, but no respiratory or other symptoms. She received COVID-19 vaccine #2 on 1/26/21. She demonstrated an SDTI wound to the Lt. heel on 1/27/21. On 1/31/21 she was noted to have a significant weight loss. She was admitted to services on 2/1/21 with comfort care orders. On 2/2/21 she was observed to be without vital signs. Orders were for DNR, and CPR was not initiated in accordance with that order. She was pronounced dead at 0112 on 2/1/21.


VAERS ID: 1005377 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-05
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   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: Significant other reported patient expired "a week before 2nd vaccine was due".


VAERS ID: 1005455 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-29
Onset:2021-01-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Respiratory arrest, Retching, Withdrawal of life support
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Gallbladder not working, one kidney functioning at 25%
Preexisting Conditions: Rheumatoid arthritis
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: We don''t know what happened. 25 hours after the shot, he started gagging and stopped breathing. He was pronounced at OSF at 8:07pm after we took him off life support.


VAERS ID: 1005499 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-02
Onset:2021-02-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood lactic acid, Dizziness, Dyspnoea, Endotracheal intubation, Hypotension, Presyncope, Syncope, Tachypnoea, Vomiting, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: Acetaminophen calcium carbonate/vitamin D3 fluoxetine ibuprofen cholecalciferol
Current Illness:
Preexisting Conditions: depression, hearing difficulties, osteoporosis, hyperlipidemia, PVD, breast cancer in situ, hypertension, aortic aneurysm
Allergies: Adhesive tape-silicone celecoxib hydrocodone-acetaminophen pravastatin
Diagnostic Lab Data: Lactic Acid 5.6 on admission, WBC 9.2 on admission
CDC Split Type:

Write-up: Moderna Vaccine Lot 029K20A Patient received second dose of vaccine on 2/2/21. Within 30 minutes patient had a near syncopal episode. She felt lightheaded and shortly after had episode of nonbloody vomiting. Hypotensive 81/69 and started on levophed. Alert and orientated. Lungs clear, abdomen benign on admission. Patient had no reaction when received first dose of the vaccine. Patient developed worsening shortness of breath, tachypnea, Afib with RVR, hypotension and required intubation and multiple pressors.


VAERS ID: 1005568 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-05
Onset:2021-01-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Pt. deceased.


VAERS ID: 1005686 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-02-03
Onset:2021-02-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: 1. Jardiance 10 mg - take 1 tablet PO QAM 2. Xarelto 20 mg - take 1 tablet PO QAM 3. Metoprolol Succinate ER 25 mg - take 1 tablet PO QAM 4. Potassium Cl ER 20 mEq - take 1 tablet PO (M,W,F) 5. Gabapentin 100 mg - take 1 tablet PO QAM, 2 ta
Current Illness: n/a
Preexisting Conditions: CHF, HTN, HLD, pacemaker, DM, and severe osteoarthritis leading to chronic back pain and the use of a scooter for mobility.
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: death. No known symptoms or complaints. found unresponsive in bed. Released to funeral home as the Medical Examiner will not perform and autopsy. Dr. will sign the DC.


VAERS ID: 1006168 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-26
Onset:2021-01-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Dyspnoea, Fatigue, General physical health deterioration, Haemodialysis, Hypotension, Hypoxia, Lung infiltration, Mechanical ventilation, Pneumonia, SARS-CoV-2 test negative, Vasopressive therapy
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient, who was a pharmacist, developed fatigue and shortness of breath hours after receiving vaccine. Two days later, on 01/28/2021, the patient went to local urgent care for worsening shortness of breath and was referred to Hospital for worsening dyspnea and hypoxia. The patient was admitted to the hospital We was found to have bilateral pulmonary infiltrates and treated for pneumonia with Rocephin and azithromycin. He was tested for COVID-19 multiple times, but each of the results were negative. Despite the negative results, there was high clinical suspicion for COVID-19 and the patient was started on Remdesivir and Decadron. The patient''s oxygen requirements continued to worsen and the patient was transferred to another facility for higher level of care. There his hypoxia worsened and he required mechanical ventilation. Patient then developed hypotension and required vasopressors for blood pressure support. Furthermore, patient developed acute renal failure requiring hemodialysis. Despite mechanical ventilation with FiO2 100%, and for vasopressors, patient clinically deteriorated and family decided to palliatively extubate on 02/05/2021.


VAERS ID: 1006216 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medications the resident was currently recieving: AmLODIPine Besylate Tablet 5 MG Losartan Potassium Tablet 50 MG Melatonin Tablet 5 MG Povidone-Iodine Solution 10 % Remeron Tablet 15 MG (Mirtazapine) Tamsulosin HCl Capsule 0.4 MG Lactobaci
Current Illness: None
Preexisting Conditions: ESSENTIAL (PRIMARY) HYPERTENSION ATRIOVENTRICULAR BLOCK, COMPLETE NONRHEUMATIC AORTIC (VALVE) STENOSIS WITH INSUFFICIENCY PAROXYSMAL ATRIAL FIBRILLATION HYPOXEMIA BRADYCARDIA, UNSPECIFIED PRESENCE OF UROGENITAL IMPLANTS
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Notes of the checks/events with resident: 18:36 2/2/21 Resident had no complaint of pain, swelling, redness or warmth to vaccine site. No signs and symptoms of fever, chills, tiredness or headache. T 97.2 02:50 2/3/2021 Resident received 2nd COVID vaccine. No complaint of pain, swelling, redness or warmth to vaccine site. No signs and symptoms of fever, chills, tiredness or headache. T 98.1 07:15 2/3/2021 Resident was observed not breathing. 911 was contacted along with the doctor. Resident was confirmed having passed away.


VAERS ID: 1006220 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-24
Onset:2021-01-31
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatine phosphokinase, Blood culture, Blood fibrinogen, Blood lactate dehydrogenase, Blood lactic acid, Blood test, C-reactive protein, COVID-19 pneumonia, Chest X-ray, Cough, Differential white blood cell count, Fibrin D dimer, Full blood count, Liver function test increased, Metabolic function test, Mobility decreased, N-terminal prohormone brain natriuretic peptide, Procalcitonin, Productive cough, Prohormone brain natriuretic peptide, Respiratory failure, Respiratory viral panel, Serum ferritin, Troponin, Urine analysis, Wheezing
SMQs:, Liver related investigations, signs and symptoms (narrow), 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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-12
   Days after onset: 12
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: Hime Meds: Tylenol Arthritis tablets, Lipitor, Baclofen, Celexa, Cardizem CD, Claritin-D, Myrbetriq, Remeron and Rhythmol
Current Illness: PMH: Former smoker, paroxysmal atrial fibrillation, sleep apnea, hypertension and osteoarthritis. Admitted to the hospital on 2/3/21 with complaints of non-productive cough for 2-3 days prior to admission and generalized weakness. His O2 sats upon admission was 83% and he was wheezing upon exam. He walks with a walker at baseline and does not use oxygen at home.
Preexisting Conditions: PMH: Former smoker, paroxysmal atrial fibrillation, sleep apnea, hypertension and osteoarthritis
Allergies: NKA
Diagnostic Lab Data: Chest Xray, Blood cxx2, Resp panel, CMP, Ferritin, CRP, Lactate< procalcitonin, D-dimer, Creatinine kinase, Troponin, proBNP, LDH, Fibrinogen, CBC w diff, Urinalysis
CDC Split Type:

Write-up: Pt from home via EMS. Pt reports increased weakness since getting the covid vaccine on the 24th. Pt is normally ambulatory at baseline, but has not been able to get around his house. Pt was found to be 83% on RA and was audibly wheezing per EMS. No history of respiratory issues. Denies fever, but has had a productive cough. A&O x4. Pt received Duoneb treatment in route. Acute respiratory failure with hypoxia , Pneumonia due to COVID-19 virus , Elevated LFTs. Patient admitted to hospital on 2/3 and is still inpatient


VAERS ID: 1006228 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 057G20A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Atelectasis, Blood culture, Blood pressure decreased, Chest X-ray abnormal, Death, Dyspnoea, Haematology test, Laboratory test, Lethargy, Oxygen saturation decreased, Pyrexia, Rales, Rhonchi, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: desmopressin 0.01% nasal spray 1 spray NS BID, dezlansoprazole 60 mg PO Daily, Escitalopram 10mg PO Daily, folic acid 1mg PO daily, furosemide 20mg PO daily, lorazepam 1mg PO TID PRN MDD 3mg in 12H, losartan potassium 100mg PO daily, macula
Current Illness: none known.
Preexisting Conditions: atrial fibrillation, hypertension, high cholesterol, PUD, kidney stones, osteoarthritis, osteoporosis, seizure, anxiety, depression, hypothyroidism, melanoma
Allergies: cephalosporins, codine, diazepam, morphine, penicillins, phenobarbital, sulfailamide, clindamycin
Diagnostic Lab Data: hemetology, chemistry, blood culture, UA, CXR.
CDC Split Type:

Write-up: 2/2/21-1000-patient presented to the local emergency room with complains of fever, shortness of breath and decreased oxygen sats. temp 101.7, pulse 102, respirations 36, BP 141/92, oxygen 94%. Lung sounds crackles bilaterally with rhonchi on the left. patient worked up for sepsis, CXR shows mild atelectasis. blood pressure dropped, and continued to drop through treatment requiring levophed drop to be initiated. Patient POA determined that this would not be her sister''s wishes and made the decision to make patient comfort care status. 2/3/21- patient lethargic throughout night. 0640-patient demise.


VAERS ID: 1006289 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-28
Onset:2021-02-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: unknown
Current Illness: none
Preexisting Conditions: HTN: Renal failure with hemodialyis; hypercholesterolemia; reflux; behavioral disorders
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: death- 2/1/2021


VAERS ID: 1006303 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-28
Onset:2021-02-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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: see nursing home record
Current Illness: none
Preexisting Conditions: CVA; HTN; vascular dementia; BPH; neurogenic bladder; COVID positive on 9/12/2020.
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: death- 2/1/2021


VAERS ID: 1006316 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-28
Onset:2021-02-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: see nursing home record
Current Illness: none
Preexisting Conditions: Trach; tube feeder; ileostomy; HTN; CAD; HLD; hypothyroidism; renal cell carcinoma; prostate cancer; Previously COVID positive but unkown date- it was before entering nursing home.
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: death- 2/2/2021


VAERS ID: 1006416 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-13
Onset:2021-01-31
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of a heart attack on 1/31/21, 2.5 weeks after vaccination


VAERS ID: 1006577 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-04
Onset:2021-01-31
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 073K20A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away within 60 days of receiving a COVID vaccine


VAERS ID: 1006633 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Cardiac failure, Cardio-respiratory arrest, Chest pain, Death, Dyspnoea, Pneumonia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EARLY SUNDAY MORNING THE PATIENT BEGAN VOMITTING AND SHORT OF BREATH AND CHEST AND BACK PAIN. SHE CODED WHEN SHE GOT IN THE ER AND LATER PASSED AWAY THE MONDAY. DIAGNOSIS WAS PNEUMONIA AND HEART FAILURE PER STEP DAUGHTER.


VAERS ID: 1006640 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-03
Onset:2021-02-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 PFIZER / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Anaemia, Analgesic drug level decreased, Anxiety, Bacterial test negative, Basophil percentage increased, Bilirubin urine, Blood bicarbonate decreased, Blood gases, Blood magnesium decreased, Blood pH decreased, Blood smear test, Blood urine absent, Bradycardia, Brain oedema, Cardiac arrest, Cardio-respiratory arrest, Chromaturia, Computerised tomogram head abnormal, Crystal urine absent, Culture urine, Death, Drug screen negative, Endotracheal intubation, Eosinophil percentage increased, Fibrin D dimer increased, Gastrointestinal haemorrhage, Glucose urine absent, Haematocrit decreased, Haemoglobin decreased, Head discomfort, Human chorionic gonadotropin negative, Hypoxia, International normalised ratio increased, Lymphocyte percentage decreased, Mean cell haemoglobin decreased, Mean cell volume decreased, Mechanical ventilation, Monocyte percentage decreased, Musculoskeletal stiffness, Neutrophil count normal, Nitrite urine absent, PCO2 normal, PO2 normal, Platelet count decreased, Poisoning, Protein urine absent, Prothrombin time prolonged, Pulse absent, Pulseless electrical activity, Red blood cell count decreased, Red blood cell nucleated morphology, Red blood cells urine positive, Red cell distribution width normal, Resuscitation, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Seizure like phenomena, Specific gravity urine increased, Specific gravity urine normal, Sulphur dioxide test, Syncope, Troponin I increased, Urinary sediment present, Urine abnormality, Urine ketone body absent, Urine leukocyte esterase, Urobilinogen urine decreased, White blood cell count normal, White blood cells urine positive, pH urine normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Tumour lysis syndrome (broad), Proteinuria (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Naltrexone 25mg PO daily, chlordiazepoxide 25mg was 2/4 at 1:25pm for CIWA 9
Current Illness: Alcohol use disorder, facial laceration, alcohol intoxication, secondary syphillis
Preexisting Conditions: Alcohol use disorder
Allergies: NKDA
Diagnostic Lab Data: UR COLOR Yellow [3873] 02/05/21 01:16 UR CLARITY HAZY [3873] 02/05/21 01:16 UR SPECIFIC GRAVITY 1.010 1.001 - 1.035 [3873] 02/05/21 01:16 URINE PH 7.0 UNITS 5.0 - 9.0 [3873] 02/05/21 01:16 UR PROTEIN 100 mg/dL "Neg " [3873] 02/05/21 01:16 UR GLUCOSE 150 mg/dl "Neg " [3873] 02/05/21 01:16 UR KETONES NEG mg/dL "Neg " [3873] 02/05/21 01:16 UR BILIRUBIN NEG mg/dL "Neg " [3873] 02/05/21 01:16 UR BLOOD MOD mg/dl "Neg " [3873] 02/05/21 01:16 UR NITRITE NEG mg/dL "Neg " [3873] 02/05/21 01:16 UR UROBILINGEN NEG L mg/dL "<2.0" [3873] 02/05/21 01:16 UR L.ESTERASE NEG "NEG" [3873] 02/05/21 01:16 RBC/HPF 262 /HPF [3873] 02/05/21 01:16 WBC/HPF 5 /HPF [3873] 02/05/21 01:16 UR EPITHELIAL CELLS [none] /HPF [3873] 02/05/21 01:16 UR-BACTERIA [none] /HPF [3873] 02/05/21 01:16 WBC CLUMPS [none] /HPF [3873] 02/05/21 01:16 UR-TRIPLE PHOS CRYSTALS [none] [3873] 02/05/21 01:16 UR-CA+OXALATE CRYSTALS [none] [3873] 02/05/21 01:16 UR-URIC ACID CRYSTALS [none] [3873] 02/05/21 01:16 UR-AMORPHOUS SEDIMENT RARE [3873] 02/05/21 01:16 UR-BUDDING YEAST [none] [3873] 02/05/21 01:16 URINE HCG Neg [3873] 02/05/21 01:16 Internal QC Hcg PASS [3873] 02/05/21 01:16 Comment: rare MUCOUS Urine sent for culture. Res Site Test name Result Flg Units Ref. range Code Result Dt/Time Cannabinoids UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 50 ng/mL" Methadone, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 200 ng/mL" Cocaine Screen, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 150 ng/mL" Buprenorphine Screen, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 10 ng/mL" Internal QC Ur Tox Screen PASS [3873] 02/05/21 01:32 Amphetamines, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 500 ng/dL" Barbiturates, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 200 ng/mL" Benzodiazepines, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 150 ng/mL" Methamphetamine, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 500 ng/mL" Opiates, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 100 ng/mL" Oxycodone, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 100 ng/mL" Phencyclidine Screen, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 25 ng/mL" Tricyclic Antidepressants,UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 300 ng/mL" Propoxyphene, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _SARS-CoV-2 NEGATIVE [3873] 02/04/21 23:49 Eval: Positive - The 2019 novel coronavirus (SARS-CoV-2) target nucleic acids are detected. Eval: Eval: Presumptive Positive - The 2019 novel coronavirus (SARS-CoV-2) target nucleic Eval: acids may be present. Sample is retested. For samples Eval: with repeated presumptive positive result, additional Eval: confirmatory testing may be conducted to differentiate Eval: between SARS-CoV-2 and SARS-CoV-1 or other Sarbecovirus Eval: currently unknown to infect humans, for epidemiological Eval: purposes or clinical management. Eval: Eval: Negative - The 2019 novel coronavirus (SARS-CoV-2) target nucleic acids are not detected. Internal QC SARSCOV2 Valid [3873] 02/04/21 23:49 Test name Result Flg Units Ref. range Code Result Dt/Time SO2 88.8 L % 90.0 - 100.0 [3873] 02/04/21 21:58 PH, BLOOD 7.16 L* 7.35 - 7.45 [3873] 02/04/21 21:58 PCO2 34.7 mmHg 30 - 40 [3873] 02/04/21 21:58 PO2 68 mmHg 58 - 70 [3873] 02/04/21 21:58 HCO3 12.6 L mmol/L 18.0 - 24.0 [3873] 02/04/21 21:58 Base Excess -16.8 L mmol/L <3.0 [3873] 02/04/21 21:58 TCO2 34.7 H mmol/L 19.0 - 25.0 [3873] 02/04/21 21:58 SAT 88.8 L % 90 - 99 [3873] 02/04/21 21:58 Oxy Hgb 87.0 % [3873] 02/04/21 21:58 Patient Temperature 92.0 Deg Far [3873] 02/04/21 21:58 COHB% 0.6 % 0.0 - 10.0 [3873] 02/04/21 21:58 METHB 1.5 H % <0.5 [3873] 02/04/21 21:58 Comment: AC RR 28 VT 400 FIO2 100 PEEP +5 Test name Result Flg Units Ref. range Code Result Dt/Time MAGNESIUM-09 0.9 L mg/dL 1.6 - 2.6 [3873] 02/04/21 22:20 Test name Result Flg Units Ref. range Code Result Dt/Time SALICYLATE-09 <1 mg/dL [3873] 02/04/21 22:20 ACETAMINOPHEN-09 <5 L mcg/mL 5 - 200 [3873] 02/04/21 22:20 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time TROPONIN I-09 2.6 H* ng/mL 0.0 - 0.3 [3873] 02/04/21 22:19 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time D-DIMER (TOP) $g5250 H ng/mL 0 - 230 [3873] 02/05/21 00:10 Eval: The HemosIL D Dimer assay is cleared by the FDA for 100% negative predictive value Eval: for results <230 ng/mL DDU, when used in conjunction with clinical pre-test Eval: assessment for the purpose of ruling out Deep Vein Trombosis (DVT) and/or Eval: Pulmonary Embolism (PE). Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _PT (TOP) 29.4 H sec 9.8 - 12.8 [3873] 02/04/21 22:20 _INR (TOP) 2.58 H 0.85 - 1.11 [3873] 02/04/21 22:20 name Result Flg Units Ref. range Code Result Dt/Time WBC-XE 5.70 10*3/uL 4.74 - 10.94 [3873] 02/05/21 00:30 RBC-XE 1.83 L M/uL 4.32 - 5.85 [3873] 02/05/21 00:30 HGB-XE 5.1 L* g/dL 12.6 - 17.3 [3873] 02/05/21 00:30 HCT-XE 18.6 L* % 38.2 - 52.4 [3873] 02/05/21 00:30 MCV-XE 101.6 H fL 81.7 - 96.6 [3873] 02/05/21 00:30 MCH-XE 27.9 pg 26.7 - 32.2 [3873] 02/05/21 00:30 MCHC-XE 27.4 L g/dL 31.4 - 34.7 [3873] 02/05/21 00:30 PLT-XE 37 L 10*3/uL 125 - 400 [3873] 02/05/21 00:30 MPV-XE 10.6 fL 8.7 - 11.8 [3873] 02/05/21 00:30 NEUT% 74.2 % 47.2 - 74.4 [3873] 02/05/21 00:30 LYMPH% 20.0 % 17.9 - 42.6 [3873] 02/05/21 00:30 MONO% 1.2 L % 3.0 - 9.0 [3873] 02/05/21 00:30 EO% 0.7 % 0.0 - 4.6 [3873] 02/05/21 00:30 BASO% 0.2 % 0.0 - 1.1 [3873] 02/05/21 00:30 NRBC 0.5 /100WBC 0.0 - 1.0 [3873] 02/05/21 00:30 IM GRAN% 3.7 H % 0.0 - 1.0 [3873] 02/05/21 00:30 RDW-XE 14.9 % 12.2 - 15.1 [3873] 02/05/21 00:30 NEUT# 4.24 10*3/uL 1.56 - 6.13 [3873] 02/05/21 00:30 LYMPH# 1.14 L 10*3/uL 1.18 - 3.74 [3873] 02/05/21 00:30 MONO# 0.07 L 10*3/uL 0.24 - 0.86 [3873] 02/05/21 00:30 EO# 0.04 10*3/uL 0.04 - 0.36 [3873] 02/05/21 00:30 BASO# 0.01 10*3/uL 0.01 - 0.08 [3873] 02/05/21 00:30 IG# 0.21 10*3/uL [3873] 02/05/21 00:30 NRBC# 0.03 H 10*3/uL 0.00 - 0.01 [3873] 02/05/21 00:30 SEGS 72 % 55 - 75 [3873] 02/05/21 00:30 BANDS 9 H % 0 - 3 [3873] 02/05/21 00:30 LYMPHS 14 L % 20 - 35 [3873] 02/05/21 00:30 MONOS 1 L % 2 - 8 [3873] 02/05/21 00:30 EOS 1.0 % 1.0 - 4.0 [3873] 02/05/21 00:30 META 3.0 H % <0.0 [3873] 02/05/21 00:30 Reactive Lymphs 3 #/100 WBC [3873] 02/05/21 00:30 NUCLEATED RBC/100WBC 1 #/100 WBC [3873] 02/05/21 00:30 MICROCYTOSIS 1+ [3873] 02/05/21 00:30 HYPOCHROMIA 1+ [3873] 02/05/21 00:30 PLT SMEAR EST Reduced [3873] 02/05/21 00:30 RBC COLOR/SIZE ABNORMAL [3873] 02/05/21 00:30 Comment: Notified/Readback Rec''d: PHARM/ED/2.4.21@2159/DD Verified by Repeat Analysis. NO Platelet Clumps Present NO Cells Resembling Immunoblasts Are Present PLATELET ESTIMATE= 36,000 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _CALCULATED OSMOLALITY 306 H mOsm/kg 275 - 295 [3873] 02/04/21 22:19 Eval: Neonatal: may be as low as 266 Eval: $g60 yrs old: 280 - 301 ALCOHOL-09 <10 L mg/dL "<10" [3873] 02/04/21 22:19 LIPASE-09 26 U/L 13 - 60 [3873] 02/04/21 22:19 T BILI-19 0.3 mg/dL 0.1 - 1.2 [3873] 02/04/21 22:19 Eval: Per manufactures instructions, intereferance substance of IgG $g28 gm/L Eval: may affect Total Bilirubin results. Clincal judgement is recommended. No Eval: significant interference was shown in the bilirubin concentration Eval: ranges $g5.9 mg/dL, medical risk for the newborn population is most Eval: unlikely. GLUCOSE-RANDOM-09 101.0 mg/dL 74.0 - 106.0 [3873] 02/04/21 22:19 Eval: NEONATES: 40 - 60 mg/dL Eval: CHILDREN: 60 - 100 mg/dL BUN-09 3.0 L mg/dl 6.0 - 20.0 [3873] 02/04/21 22:19 Eval: 18 - 60 year old = 6-20 mg/dL Eval: 60 - 90 year old = 8-23 mg/dL CREATININE <0.5 L mg/dL 0.5 - 1.5 [3873] 02/04/21 22:19 SODIUM-09 148.0 H mEQ/L 136.0 - 145.0 [3873] 02/04/21 22:19 POTASSIUM-09 1.5 L* mEQ/L 3.5 - 5.1 [3873] 02/04/21 22:19 Eval: PLASMA reference range: 3.4 - 4.5 mmol/L CHLORIDE-09 134.3 H mEQ/L 98.0 - 107.0 [3873] 02/04/21 22:19 CO2-09 5.0 L* mEQ/L 22.0 - 29.0 [3873] 02/04/21 22:19 ANION GAP-09 9.00 0.00 - 14.00 [3873] 02/04/21 22:19 CALCIUM-09 2.8 L* mg/dL 8.6 - 10.2 [3873] 02/04/21 22:19 T PROTEIN-09 1.5 L gm/dL 6.6 - 8.7 [3873] 02/04/21 22:19 ALBUMIN-09 0.7 L gm/dL 3.5 - 5.2 [3873] 02/04/21 22:19 ALK PHOS-09 43.0 IU/L 37.0 - 108.0 [3873] 02/04/21 22:19 Eval: CHILDREN: Eval: <1 day old: <260 U/L Eval: 6 days-6 months: <467 U/L Eval: 1-3 yrs: <292 U/L Eval: 1-12 years: <312 U/L Eval: 13-17 yrs(f): <195 U/L Eval: 13-17 yrs(m): <406 U/L AST-09 463.0 H IU/L 10.0 - 32.0 [3873] 02/04/21 22:19 ALT-09 89.0 H IU/L 10.0 - 33.0 [3873] 02/04/21 22:19 ESTIMATED GFR N/A mL/min [3873] 02/04/21 22:19 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time LACTATE-09 70.7 H* mg/dL 4.5 - 19.8 [3873] 02/04/21 22:02 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _ABO Group A [3873] 02/04/21 22:39 _Rh Positive [3873] 02/04/21 22:39 Antibody Screen Negative [3873] 02/04/21 22:39
CDC Split Type:

Write-up: In discussion with Dr., medical director at Detox, she arrived night of 2/3/21 was quite intoxicated so was not going through any withdrawal. She was getting vitals and CIW checked regularly. First dose of chlordiazepoxide 25mg was 2/4 at 1:25pm for CIWA 9. She had repeat vitals at 5:50pm, CIWA 1, vitals: P 67, 118/79, 94% on RA, T 98.3. she had complained of some "pressure in her head" and feeling anxious, but otherwise denied other complaints. she was talking with others in the group, then other patients report she suddenly started having seizure like activity around 6:45pm, med techs came to help and found her stiff, gurgling. they tried to get vitals on her, called 911, noticed that at 6:54pm she had lost a pulse and they started CPR. paramedics arrived at 7:08pm and she was brought to ED. Pt BIBA in cardiac arrest. Pt was at Detox Center when she was reported to have seizure-like activity followed by collapse. She was found to be pulseless and CPR initiated by staff members. EMS arrived and performed approx 15 min of CPR and gave pt epi x 3 and bicarb. No shocks administered but they did not report a rhythm. In the emergency room the patient arrived and was found to be pulseless with PEA arrest, CPR was initiated, patient was intubated. ROSC ultimately achieved, patient remained very acidotic despite ventilator adjustment, head CT revealed cerebral edema. Pt also found to be profoundly anemic with a hemoglobin of 5 and platelets of 37, she was thought to be GI bleeding so medications for this were initiated. Patient then became more hypoxemic with bradycardia, consultation with neurosurgery and critical care medicine at tertiary care center deemed ongoing CPR futile. Patient arrested at 2:30AM on 2/5, pronounced dead at 2:48AM.


VAERS ID: 1006662 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-22
Onset:2021-01-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Haemoptysis, Muscle spasms
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had 2nd vaccine, went home and started having "cramping" in all of her muscles. It became bad enough that she was taken to local ED where she then started coughing up blood, required intubation and about 6 hrs later, died.


VAERS ID: 1006994 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Condition aggravated, Death, Thrombotic thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin Excedrin Extra Strength gabapentin lansoprazole Lantus Solostar U-100 Insulin lisinopril Ozempic phenazopyridine Prelief Vitamin B-12 vitamin D3-vitamin K2 (MK4) zolpidem
Current Illness:
Preexisting Conditions: Diabetes Hyperlipidemia
Allergies: penicillin and sulfa
Diagnostic Lab Data: CT scans plus transport to an out of state hospital. No records from that hospital to report.
CDC Split Type:

Write-up: Patient had one occurrence of thrombotic thrombocytopenic purpura in 1996 for which she had plasma exchange therapy in 1996. No other occurrence since 1996 until she received her first dose of the Pfizer covid vaccine.


VAERS ID: 1007033 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-22
Onset:2021-02-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Decompressive craniectomy, Fatigue, Glomerular filtration rate, Headache, Platelet count normal, SARS-CoV-2 test negative, Subdural haematoma, Surgery, White blood cell count increased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ? acetaminophen (TYLENOL) 500 mg tablet, Take 500 mg by mouth once daily as needed for mild pain (level 1-3)., Disp: , Rfl: ? amLODIPine (NORVASC) 10 mg tablet, Take 10 mg by mouth every evening. , Disp: , Rfl: ? ascorbic acid (VITAMI
Current Illness: History of headaches
Preexisting Conditions: Memory impairment, headaches, hypertension, prostate cancer, prior stroke
Allergies: None
Diagnostic Lab Data: 2/1/2021: WBC 11.1, PLT 229, GFR $g60, COVID Rapid PCR test was negative.
CDC Split Type:

Write-up: Patient presented to emergency room on 2/1/2021 with a chief complaint of having a chronic headache and fatigue following receipt of the Moderna vaccine 10 days prior. Following examination by the physician, the patient was diagnosed with an acute subdural hematoma. The patient subsequently underwent decompressive surgery, however demonstrated worsening neurologic status over the next several days and ultimately expired on 2/4/2021.


VAERS ID: 1007310 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dry skin, Dyspnoea, Failure to thrive, Hypopnoea, Lethargy, Mouth breathing, Pain, SARS-CoV-2 test negative, Skin warm, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine, lorazepam
Current Illness: ALTERED MENTAL STATUS, UNSPECIFIED CARDIAC ARREST, CAUSE UNSPECIFIED UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERIPHERAL VASCULAR DISEASE, UNSPECIFIED COVID-19 Resolved 1-1-21 AGE-RELATED COGNITIVE DECLINE CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY UTI
Preexisting Conditions: ALTERED MENTAL STATUS, UNSPECIFIED CARDIAC ARREST, CAUSE UNSPECIFIED UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERIPHERAL VASCULAR DISEASE, UNSPECIFIED COVID-19 AGE-RELATED COGNITIVE DECLINE CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY UTI
Allergies: none
Diagnostic Lab Data: Rapid Covid test on 2/3/2021 for discharge- negative
CDC Split Type:

Write-up: view 2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning. view 2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed. view 2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth view 2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive. view 2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2 every 4 hours for MONITORING Resident passed. view 2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident''s passing this am view 2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger PRN Administration was: Unknown Resident expired @ 0604 [linked] view 2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o''s for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body. view 2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute. view 2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger PRN Administration was: Effective Follow-up Pain Scale was: 2 [linked] view 2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid. view 2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable. view 2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort. view 2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger PRN Administration was: Effective [linked] view 2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger medicated for air hunger, RR 28 to 32/ min view 2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn. view 2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition. view 2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB PRN Administration was: Effective Follow-up Pain Scale was: 2 [linked] view 2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.''s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.''s condition.CRNP updated on pt.''s condition, delay in d/c and daughter''s wishes. No n/o''s at this time. view 2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided. view 2/4/2021 10:34 Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today. view 2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident''s O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula. view 2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware. view 2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c''d to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c. view 2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time. view 2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o''s at this time. view 2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time. view 2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB PRN Administration was: Effective [linked] view 2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB PRN given for SOB after elevation of HOB not effective. view 2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o''s at this time. view 2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative. view 2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker every day shift for covid testing for 1 Day Completed and negative. view 2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy describe skilled service: Nursing, therapy assessment: V.S. 97.8 79 18 138/84 Orientation: Oriented to self only. Oxygen: O2 sat 94% on RA Edema: Trace edema noted BLE. Pedal pulses present. Pain: Denies pain or discomfort at this time. Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL''s. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation. view 2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care.


VAERS ID: 1007371 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-19
Onset:2021-01-29
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Cough, Death, Decreased appetite, Diarrhoea, Dry mouth, Dyspnoea exertional, Gait disturbance, Influenza, Productive cough, SARS-CoV-2 test, Sputum discoloured, Weight decreased
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No current outpatient medications on file.
Current Illness: None known
Preexisting Conditions: Transplant patient.
Allergies: Not on File
Diagnostic Lab Data: COVID test at PCP 2/3/21
CDC Split Type:

Write-up: Called PCP, from the note: I got my shot on Jan 19. But last Friday I have been down with a horrible flu. I''m wearing diapers because of uncontrollable diarrhea. I can''t leave my sofa to walk over to my desk because I''ll be so out of breath. I have a cough that produces a pink or gold Phelm I have dry mouth. I have no appetite I''m so weak and have lost 15 pounds. Don''t know what to do. My next Covid is shot is feb 11 Called employer on 2/3/21 but hung up. Tried calling multiple times to follow up. In triage she stated she had a COVID test scheduled and had spoken with her PCP. COVID test through PCP: 2/4/21 She passed away the night of 2/4/21


VAERS ID: 1011771 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 2021-02-04
   Days after onset:1
Entered: 2021-02-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / UNK LA / -

Administered by: Other       Purchased by: Other
Symptoms: Cerebrovascular accident, Death, Dyspnoea, Hypertensive cerebrovascular disease, Loss of consciousness, Type 2 diabetes mellitus, Unresponsive to stimuli, Vascular dementia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: Patient with history advanced vascular dementia, hypertensive cerebrovascular disease and stroke, T2DM. Received her second dose of Pfizer COVID-19 vaccine at approximately 14:00 and was reported to have expired at home at 20:55. Dr. (Medical Director) spoke with patient''s son/caregiver 2/4/21. Son reports that patient was in her usual health yesterday morning, deemed well enough by son to travel for vaccination. He reports she had no bothersome symptoms after either first or second vaccinations. Specifically denied rash, wheeze, and difficulty breathing. Son was with patient throughout the day. In the evening, when preparing for bed, he noted she became suddenly unresponsive in a similar fashion as she has done several times in past years. While in all previous such episodes she recovered within minutes, last evening she did not regain consciousness, experiences a brief period of labored breathing, and died. Patient''s son called 911 and the patient''s body was brought to the medical examiners. The medical examiner declined to proceed with autopsy. Patient''s son is not interested in autopsy. Patient''s son reports confidence that his mother''s underlying hypertensive/diabetic cardiovascular disease is the natural cause of her death. Other Relevant Hx: Symptoms: & Death Treatment:


VAERS ID: 1011983 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2020-12-22
Onset:2021-01-26
   Days after vaccination:35
Submitted: 2021-01-27
   Days after onset:1
Entered: 2021-02-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 3 RA / -

Administered by: Other       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Atrial fibrillation, Bacterial test positive, Bilirubin conjugated, Blood albumin, Blood bilirubin, Blood creatinine increased, Blood culture negative, Blood urea nitrogen/creatinine ratio, Bronchoscopy abnormal, Chest X-ray abnormal, Chest tube insertion, Condition aggravated, Culture urine negative, Cystatin C increased, Death, Dyspnoea, General physical health deterioration, Hepatic enzyme increased, Hypoxia, Intensive care, Ischaemic hepatitis, Klebsiella infection, Lung infiltration, Pneumonia, Protein total, Respiratory failure, SARS-CoV-2 test negative, Serratia infection, Spinal cord injury, Stenotrophomonas infection, Tachycardia, Tracheal aspirate culture
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Other Medication acetaminophen, albuterol/ipratropium, amlodipine, ascorbic acid, atorvastatin, baclofen, buspirone, calcium carbonate with vitamin D, cholecalciferol, dexmedetomidine, diltiazem, docusate, esomeprazole, famotidine, fentanyl
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Collection DT Spec CoV19BF COVIDIg 01/21/2021 14:10 NASAL Not Detected 01/12/2021 04:00 SERUM 0.03 01/11/2021 12:35 NASAL Not Detected Collection DT Spec WBC BUN Creat Cystn-C 01/25/2021 04:00 BLOOD 15.28 H 01/25/2021 04:00 PLASM 64 H 1.3 2.46 H 01/24/2021 04:00 PLASM 56 H 1.1 01/24/2021 04:00 BLOOD 13.16 H 01/23/2021 04:40 BLOOD 14.02 H 01/23/2021 04:00 PLASM 52 H 0.9 01/23/2021 04:00 BLOOD 7.93 01/22/2021 04:00 BLOOD 10:58 H 01/22/2021 04:00 PLASM 49 H 0.9 01/21/2021 04:00 PLASM 47 H 1.0 01/21/2021 04:00 BLOOD 7.39 01/20/2021 04:00 PLASM 30 H 0.8 01/20/2021 04:00 BLOOD 9.10 01/19/2021 04:00 PLASM 17 0.7 L Collection DT Spec Protein Albumi TotBili DirBili AST AlkPhos 01/25/2021 04:00 PLASM 5.6 L 3.2 L 1.1 1096 H 504 H 51 01/24/2021 04:00 PLASM 6.0 L 3.2 L 0.8 1482 H 699 H 57 01/23/2021 04:00 PLASM 5.5 L 2.9 L 0.6 1778 H 1044 H 53 01/22/2021 04:00 PLASM 5.7 L 2.6 L 0.4 2135 H 1579 H 49 01/21/2021 17:00 PLEUR 1.3 01/14/2021 04:00 PLASM 6.8 3.2 L 0.4 15 21 57 01/13/2021 04:00 PLASM 6.3 L 3.0 L 0.3 14 18 53 01/12/2021 04:00 PLASM 5.8 L 2.7 L 0.3 11 17 55
CDC Split Type:

Write-up: Narrative: See "Other Relevant History" in Section 6 above Other Relevant Hx: 76yo man with a history of for C5 tetraplegia 2/2 cervical stenosis leading to neurogenic bowel/bladder (chronic suprapubic catheter) and chronic respiratory failure with tracheostomy, severe dysphagia s/p G tube placement and multiple aspiration pneumonias, COPD GOLD III, hx MRSA bacteremia (7/2018) and E coli bacteremia (12/2019). Patient transferred from Spinal Cord Injury until to ICU on 1/11/2021 due to worsneing dyspnea, hypoxia (80s) and tachycardia and was found to have acute hypoxic respiratory failure likely 2/2 multifocal pneumonia. CXR findings of "There is interval increase in patchy airspace infiltrates and consolidation in bilateral lungs concerning for pneumonia" Patient was started on vancomycin and pip/tazo on 1/11 and tracheal aspirate cultures were obtained for VAP diagnosis which ultimately grew Serratia liquifaciens and Proteus mirabilis. Infectious Diseases was consulted who recommended a switch to ertapenem therapy for a total 10 day course for VAP. UCx/BCx remained negative. On 1/20, a therapeutic bronchoscopy was completed with cultures growing Stenotrophomonas maltophilia and pan-S Klebsiella pneumoniae. The following day a chest tube was inserted and the course of ertapenem completed but vancomycin was continued. By 1/22, patient developed shock liver with ALT/AST 2135/1579 from normal range the day prior and SCr increased to 1.3 from baseline 0.7/cystatin C of 2.46 up from 1.15. Levofloxacin was added for Stenotrophomonas coverage. By 1/25, patient''s clinical status continued to decline and Cardiology was consulted for new onset Afib with RVR. Discussion was documented with patient''s family who requested DNR. Patient passed away in the early AM on 1/26. Demise does not appear to be related to COVID-19 vaccination but occurred in recent timeframe. Symptoms: ElevatedLiverEnzymes & death, pneumonia, afib


VAERS ID: 1008041 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-01-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Disorientation, Fall, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, bisacodyl supplement, levsin (hyscyamine)
Current Illness: gout
Preexisting Conditions: congestive heart failure diagnosis, alzheimers
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: itchy skin, swelling, disorientation that led to a fall


VAERS ID: 1008758 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-16
Onset:2021-01-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Diarrhoea, Full blood count, Metabolic function test, Nausea, Pallor, Urine analysis
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix 10mg Aqupril Coumadin
Current Illness:
Preexisting Conditions: Thrombocytopenia, A-fib, CHF, Spinal stenosis, Renal stent
Allergies: Codine
Diagnostic Lab Data: CBC CMP uranalysis
CDC Split Type:

Write-up: Patient began feeling nauseated on 1/18/21 around 6pm, and had uncontrolled diarrhea, reported that she did not feel right. Staff reported to this writer, that her skin tone was gray in tone and she just didn''t look good. She was transferred to the HOSPITAL ER VIA AMBULANCE.


VAERS ID: 1015838 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-02
Onset:2021-02-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Aspiration, Cardiac arrest, Chills, Cough, Dyspnoea, Endotracheal intubation, Influenza virus test negative, Loss of consciousness, Pulseless electrical activity, Pyrexia, Resuscitation, SARS-CoV-2 test negative, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Patient was admitted to hospital from home in cardiac arrest. Hx of hypertension, hyperlipidemia, type 2 diabetes (not on insulin) and bilateral carotid artery stenosis. The patient was reportedly at his baseline health on 2/2/21. He received the 2nd dose of COVID vaccine around 1000AM on 2/2/21. Reportedly started running fever of 100.1 and chills the afternoon of 2/2/21. Around 7:00PM he started having dry cough and was complaining of breathing difficulties. He subsequently vomited multiple times (was eating pizza and aspirated) then lost consciousness. His wife called 911, did CPR and EMS reported he in PEA at scene and was intubated. Transported to hospital. SARS CoV-2 and influenza negative.


VAERS ID: 1009266 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-24
Onset:2021-02-07
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Adult failure to thrive, Decreased appetite, Eating disorder, Failure to thrive, Refusal of treatment by patient
SMQs:, Neonatal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin 40 mg tablet furosemide 20 mg tablet lamotrigine 200 mg tablet lisinopril 2.5 mg tablet meclizine 12.5 mg tablet metoprolol tartrate 50 mg tablet miconazole nitrate 2 % topical cream nystatin 100,000 unit/gram topical powder Re
Current Illness: Kidney Stones
Preexisting Conditions: CVA, AFib, SSS, Epilepsy, Vascular Dementia
Allergies: Garlic; IV contrast, Iodine containing; mirabegron
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with failure to thrive symptoms prior to 2nd dose, not eating, not taking medications.


VAERS ID: 1009813 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-01
Onset:2021-01-25
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became immobile on 1/25/21 (4 days after receiving Moderna COVID-19 vaccine). He died on 1/27/21


VAERS ID: 1009866 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-29
Onset:2021-01-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 LA / IM

Administered by: Pharmacy       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? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown new pt
Preexisting Conditions: unknown
Allergies: penicillins
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: pt was given vaccine on the afternoon of 01-29-2021. Pt was administered the moderna covid-19 shot into the deltoid muscle of this pt. Pt was observed and left pharmacy. on 2-6, pts daughter calls pharmacy, and says the night of 1-29, after recieveing the vaccine, her mother had a hemmorhagic stroke and passed away


VAERS ID: 1009991 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-02-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Circulatory collapse, Death, Endotracheal intubation, Mechanical ventilation, Pharyngeal swelling, Pulse absent, Respiration abnormal, Resuscitation, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Believed to have chronic atrial fibrillation, believed not to be on anticoagulants
Allergies: No severe allergies reported on questionaire
Diagnostic Lab Data:
CDC Split Type:

Write-up: 73-year-old man s/p first dose of Pfizer at 10:20 AM Ambulated comfortably to exit after 20 minutes in observation but 10:45 collapsed while exiting the building 10:47 CPR initiated 10:49 medical team/EMS found no pulse, agonal respirations, ventricular fibrillation Paramedics and team performed ACLS; of note patient was intubated 7.5 ETT with bilateral breath sounds on ventilation; paramedic reported easy intubation with no apparent throat swelling; 11:02 transported to Emergency Department 11:30 Pronounced dead at Emergency Department


VAERS ID: 1010025 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Guam  
Vaccinated:2020-12-30
Onset:2021-01-09
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK - / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifediac, Losartan, Atorvastatin, Allopurinol, Glipizide, Pantoprazole, Amoxicillin
Current Illness: NIDDM, CHF, HTN, HLD
Preexisting Conditions: NIDDM, CHF, HTN, HLD
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Expired


VAERS ID: 1010114 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-01-28
Onset:2021-02-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: anemia, NIDDM, ESRD on Hemodialysis, AFib, CAD S/P CABG, COPD , HTN, recently diagnosed with COVID in September, 2020.
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data: Presumptive negative for COVID
CDC Split Type:

Write-up: Patient passed away (Dead on Arrival on presentation to ER) on 02/03/2021


VAERS ID: 1020134 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-01-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Asthenia, Atrial fibrillation, Blood calcium decreased, Blood chloride normal, Blood creatinine increased, Blood culture, Blood lactic acid increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Carbon dioxide normal, Cardiac arrest, Cardiac failure congestive, Cardio-respiratory arrest, Chest pain, Death, Dizziness, Dyspnoea, Fall, Frequent bowel movements, Gaze palsy, Haematocrit decreased, Haemoglobin decreased, Loss of consciousness, Lung disorder, Malaise, Mechanical ventilation, Muscle rigidity, Orthopnoea, Orthostatic hypotension, Platelet count normal, Polyuria, Posturing, Productive cough, Pulmonary oedema, Pulse absent, Respiratory arrest, Restlessness, Resuscitation, Seizure, Sputum discoloured, Tachypnoea, Troponin I increased, Unresponsive to stimuli, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Akathisia (broad), Dystonia (broad), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 1/29 CBC: WBC 12.8, Hgb 11.7, Hct 35.3, PLT 227 01/29 CMP: Na++ 142, K+ 4.1, CL 106, CO2 29, BUN 45, Creat 2.04, Ca++ 8.7 1/25 Trop-I 0.06
CDC Split Type:

Write-up: anxious, restless, weak, dizzy, felt "horrible". Continued to C/O symptoms,. At 01:15, patient lost consciousness , then stopped breathing and lost pulse. Narrative: Patient was first vaccinated for COVID 19 on 1/8/21. On 1/24/21: 61 year old presents to E.R. with CC of chest pain/sob, with multiple medical conditions including hypertension, atrial fibrillation on apixaban, cardiomyopathy with poor EF, dyslipidemia, COPD, CVA, lung CA s/p radiotherapy, PTSD, depression, Churg Strauss Syndrome, Sjogren''s syndrome presented with chief complaint of chest pain or shortness of breath. He has been having worsening shortness of breath the past few days, also complains of cough productive of yellowish sputum, no hemoptysis. He complains of left upper chest pain with no radiation. There is no diaphoresis, palpitations or lightheadedness. He denies fever or chills. He complains of having fallen a few times recently, thus he passed out. Could not say if there were seizures activity. Admitted to 3D Tele. On 1/27, Pt advises he had episode of substernal CP this am. RN advises pt was in afib w/ RVR at a rate $g140 at time of CP. Pt CP improved w/ prn NTG. Pt HR improved after daily medications. Pt sts his CP has resolved. Pt admits to continued dyspnea. Increased trop, transferred. 1/28, struggling with orthopnea and cough. He has no peripheral edema. He does have intermittent chest pain. Patient having periods of A-Fib RVR with non-sustained rates of 140''s-150''s 1/29 more chest pain at 04:00, relieved with NTG. HR = AF, with RVR 145. At about 08:00, Cardiology sees patient and signs off, "shortness of breath and cough not due to heart failure as evidenced by orthostatic hypotension and no improvement in symptoms with diuresis. Consider underlying lung disease vs acute pulmonary disease." No pulmonary consult noted. 1/29 Patient received 2nd dose COVID19 vaccine at about 3:30-4p. No notes from staff on this event. No notes from MD that this was discussed and still part of the plan. 1/29 nurse''s note: At around 2240 Pt was able to rest briefly but is now restless and anxious again. Tachypneic, stating he feels so weak and dizzy and overall just feel horrible. Continuing to get up frequently to have small soft bowel movements with assistance. Pt also stated ever since he got "that shot" he hasn''t felt well. When asked what shot pt replied "COVID shot." Pt did receive 2nd dose of COVID vaccine 1/29 at 1530. Around 2250 Spoke w MOD to relay above information and overall concern for pt, asked for MOD to come to bedside to evaluate pt. MOD states he''s handing off to oncoming MOD and they will come to bedside to see pt. Around 2300 oncoming MOD called and all above and previous information discussed Around 2310 MOD came to bedside to see pt. Will continue to monitor closely. 01/30/2021 ADDENDUM Around 0115 pt called for help to use bedside commode to urinate and have BM. Assisted x2 to BSC. While sitting on BSC pt''s eyes rolled back and pt made postures consistent with a seizure, body became very rigid. Pt was unresponsive still with pulse. Lifted patient back to bed with 3 staff assist. Pt stopped breathing and lost pulse. Chest compressions started immediately and Code Blue called at 0120. 1/30 Hospitalist note: Called for CODE BLUE AGAIN AT 4:53. While on Vent after s/p Code blue for reasons not clear patient went into Asystole and code called second time. Patient had a prolonged CPR and was actually called off at 5:17 but he started having pulse and agonal resp. he was placed on Levophed and D5NS. He got a total of 9 amps of epi, 3 amps od Bicarb and 1amp of D50. Trope bumped from 0.12 to 0.43 prior to this he already was on ASA, Apixiban for afib. Cards are on board for his CHF for his pulmonary edema Lasix ordered. Hid lactic acid is elevated. Blood cultures pending. Started Zosyn and is on Levophed. Continue to monitor. Updated patients Mom and she requested to do everything at this point. Coded again at 5:40, survived, but AOD writes a death note(?) Coded for the 4th time at 08:18. Family at beside, Mother asks for code to be stopped.


VAERS ID: 1020135 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-30
Onset:2021-01-24
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Contusion, Craniocerebral injury, Death, Fall, Femoral neck fracture, Haemoglobin decreased, Head injury, Intensive care, Joint injury, Lower urinary tract symptoms, Lung opacity, Pneumonia, Respiratory failure, SARS-CoV-2 test, Skin laceration, Transfusion, Upper respiratory tract infection, Walking aid user
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: 92 yo male seen in clinic on 12/30/2020 for transfusion, hbg 6.9. PMH includes HLD, CKD, myelodysplastic syndrome, DM, prostate cancer, HTN. Pt also received COVID19 Pfizer vaccine the same day. The patient denied any prior severereaction to this vaccine or its components. Post-transfusion, patient had a mechanical fall (per patient he was seated and used the cane to help him stand. However the cane slipped on the floor causing the patient to fall, patient hit his head and injured his right hip, no loss of consciousness at the time). Rapid response team was called and patient was admitted to the ED. Pt was found to have subcapital right femoral neck fracture, scalp contusion, and TBI (per ED provider''s note). Ortho evaluated and said patient wasn''t a surgical candidate. During his hospitalization, patient tested positive for COVID19 on 1/12/2021, pt was asymptomatic at the time. On 1/13/2021, pt exhibited mild URI symptoms, no respiratory distress. He was started on cetirizine, Montelukast, albuterol, and inhaled steroids to manage his symptoms. Dexamethasone was started on 1/14/2021. Chest Xray was ordered on 1/17/2021, pt''s respiratory was slowly getting worse, resting O2 sats were in the high 80s and low 90s with IS. On 1/18/2021, CXR shows patchy bilateral airspace opacities suspious for pneumonia of bacterial or viral etiology. Pt was started on remdesivir 01/18/2021 (5 doses, from 1/18-1/22/2021). Pt required 5-6 LPM of oxygen at rest. Pt was then transferred to the ICU. His oxygen demand continued to increase and his condition worsened. On 2/14/2021, pt started to desat into the 70s on max high flow. Patient/family agree to comfort care. Medical cause of death was listed as "acute hypoxic respiratory failure due to COVID19." Patient expired 1/24/2021.


VAERS ID: 1010235 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-05
Onset:2021-02-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Computerised tomogram
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? Yes
Died? Yes
   Date died: 2021-02-15
   Days after onset: 10
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: A fib Type 2 diabetes
Allergies: None
Diagnostic Lab Data: Ct scan
CDC Split Type:

Write-up: Stroke. Massive brain bleed right side


VAERS ID: 1010899 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021102020

Write-up: On the two people who died, one in (State name) and one in (State name); This is a spontaneous report from a contactable other HCP. This other HCP reported similar events for 2 patients. This is 1 of 2 report. An unknown age male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecific date at single dose for covid-19 immunization. Medical history and concomitant drug were not reported. It was reported that patient was died. Cause of death unknown. Outcome of the event was fatal. Information on the lot/batch number has been requested.; Sender''s Comments: Death with unknown cause is considered related to BNT162B2 for reporting purpose. Information is very limited. Case will be reassessed once receiving additional information, including cause of death. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-2021102049 same reporter/drug/event, different patient; Reported Cause(s) of Death: On the two people who died, one in (State name) and one in (State name)


VAERS ID: 1010900 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021102049

Write-up: patient died; This is a spontaneous report from a contactable Other Healthcare Professional (HCP). This Other HCP reported similar event for 2 patients. This is 2nd of 2 reports. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date at single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that patient died on an unspecified date. Cause of death unknown. Outcome of the event was fatal. It was unknown if an autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: The causal relationship between BNT162B2 and the event death cannot be excluded as the information available in this report is limited and does not allow a medically meaningful assessment. This case will be reassessed once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-2021102020 same reporter/drug/event, different patient; Reported Cause(s) of Death: patient died


VAERS ID: 1010989 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-04
Onset:2021-01-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Death, Dyspnoea, Hypertension, Intracranial aneurysm, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-04
   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: Arthritis; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Brain aneurysm; Anaphylactic reaction; Collapsed; BP sky rocketed; Shortness of breath; A spontaneous report was received from a consumer concerning a 69-year-old female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and experienced blood pressure skyrocketed, shortness of breath, loss of consciousness, massive anaphylactic reaction, and brain aneurysm. The patient''s medical history, as provided by the reporter, included high blood pressure and arthritis. Products known to have been used by the patient, within two weeks prior to the event, included an antihypertensive. On 04 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. Twenty-two minutes later she had a massive anaphylactic reaction. She experienced shortness of breath, blood pressure skyrocketed, and loss of consciousness. She was taken to the emergency room. The patient had a brain aneurysm and never recovered. No treatment information was provided. The patient died on 04 Jan 2021. The cause of death was reported as brain aneurysm. Plans for an autopsy were not provided.; Reporter''s Comments: This case concerns a 69-year-old, female patient with a medical history of hypertension, who experienced fatal, serious, unexpected events of Anaphylactic reaction, hypertension, dyspnea, loss of consciousness and brain aneurysm. The events occurred 22 minutes after the first dose of mRNA-1273 was administered. No treatment information was provided. The patient never recovered and died. The cause of death was reported as brain aneurysm. Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Additional information has been requested.; Reported Cause(s) of Death: Brain aneurysm


VAERS ID: 1011130 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-07
Onset:2021-01-17
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Body temperature increased, COVID-19, Carbon dioxide normal, Cough, Death, Differential white blood cell count normal, Fibrin D dimer increased, Full blood count, Haematocrit normal, Haemoglobin normal, Platelet count normal, Red blood cell count normal, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aricept Acetaminophen Citalopram Diltiazem Lisinopril Synthroid Vitamin D 3
Current Illness: NONE
Preexisting Conditions: Aricept Acetaminophen Citalopram Diltiazem Lisinopril Synthroid Vitamin D 3
Allergies: NKA
Diagnostic Lab Data: 1/18: CBC: WBC-4.57, RBC-4.50, H/H-13.4/42.2; BUN/CREA-15/0.62; BUN/CREA RATIO-24.19 Platelet- 227,Calcium-8.8, Sodium-136, K+ 4.0, Chloride-104, CO2-28. PCR-+ Covid-19, D-dimer- 1.09 1/21- D-dimer 1.90
CDC Split Type:

Write-up: Temp of 100.1 and unproductive cough on 1/17; temp of 100.4 1/28; O2 desaturation 88% on RA 1/28; Diagnosed with Covid-19 on 1/18/2021 Patient passed away on 1/29/2021


VAERS ID: 1011149 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-22
Onset:2021-02-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8261 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Death
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: acetaminophen 325 mg tablet Take 2 tablet by mouth every four hours as needed for pain. aripiprazole 15 mg tablet TAKE 1 TABLET BY MOUTH EVERY EVENING. Aspirin Low Dose 81 mg tablet,delayed release Take 1 tablet by mouth once a day. atorvas
Current Illness: paronychia of right index finger
Preexisting Conditions: Borderline Intellectual Functioning.*Paranoid Schizophrenia.*Depression.*Anxiety.*Diabetes Type II.*Esophageal Reflux.*Hiatal Hernia.*Diverticulosis.*CAD.*COPD.*NSTEMI.*Constipation.*BPH.*Urethral Stricture.*Hearing Deficit.*Sleep Apnea- uses C-PAP.*Hypercholesteremia.*HX Pancytopenia.*CHF.*Right Eye Floaters.*Hyponatremia.*Vit D Deficiency.*Dysphagia-moderate.*Hypertension.*
Allergies: PCN, ACE inhibitors, erythromycin, Tamsulosin, ranexa, sulfasalazine, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed heart arrhythmia and was unable to be revived.


VAERS ID: 1011222 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-05
Onset:2021-01-17
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Asthenia, Death, Diet refusal, Fatigue, Feeding disorder, General physical health deterioration, Moaning, Somnolence, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medicine to keep blood pressure from dropping and medicine for AFIB (irregular heart)
Current Illness: Dementia. Physical health was good. Hospice was thinking of releasing her because she was doing so well.
Preexisting Conditions: Dementia. I am told that 20 other residents passed in January after the vaccine was administered. A monthly death count very high for the care home.
Allergies: Allergies to grass and environment and a touch of asthma
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mom received the Covid 19 vaccine on Jan 5, 2021 and became very about a week later. I was informed that she tested positive for Covid 19 on January 14th. One January 17th she became very tired and weak and would not eat. Hospice called me and told me that she was in a decline state. I saw her on January 25 and 26 and she was just sleeping and could not open her eyes. Her vitals were good and she seemed to understand when I talked to her - she would squeeze my hand and moan but she could not talk or open her eyes. My mom passed away on January 27, 2021 just 22 days after receiving the Covid 19 vaccine. She was very think to begin with and being to weak and tired to eat resulted in her losing even more weight. Some of the other residents were given fluids to help and they recovered. My mom was not given fluids. I believe there were 20 deaths in her care home for the month of January when they vaccinated. This was an alarming number of deaths for the home. The facility had very few Covid deaths in 2019 and 2020. I asked every week if they had any Covid and or Covid deaths and this amount was shocking to me and the workers there.


VAERS ID: 1011362 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-28
Onset:2021-01-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MOD/013L20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD Diabetes
Allergies:
Diagnostic Lab Data: An autopsy is being performed
CDC Split Type:

Write-up: Patient''s son came to the vaccine clinic today 2/8/2021, stated that his father 2/24/1948 passed away the same day as the vaccine.


VAERS ID: 1011440 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-26
Onset:2021-01-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: unanticipated death


VAERS ID: 1011487 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-06
Onset:2021-02-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, albuterol, Norvasc, Eliquis, Voltaren, Neurontin, lidocaine, Cozaar, Mevacor, Lopressor, Prilosec, Miralax, Senna, Renvela, Kayexolate, Incruse Ellipta, Vit. B complex, Coumadin
Current Illness:
Preexisting Conditions: ESRD (dialysis fistula), peripheral vascular disease (R mid-foot amputation), cardiac disease (pace-maker), malnutrition (cachexic), possible liver disease (distended abdomen)
Allergies: Protein Supplement
Diagnostic Lab Data: CPR/ ACLS initiated on 2/6/2021
CDC Split Type:

Write-up: Received Covid vaccine in am. Last seen by family at 17:30 pm and observed to be well. About an hour later he collapsed, unresponsive. A 911 call was initiated at 18:29. Paramedics arrived to find the patient in cardiac arrest. CPR/ACLS was initiated, but resuscitation was unsuccessful. Pt. was transported to MC where he was pronounced dead at 19:32. There was no sing of an injection site reaction, nor of allergic reaction..


VAERS ID: 1011492 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-07
Onset:2021-01-27
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood calcium normal, Blood chloride increased, Blood creatinine normal, Blood potassium normal, Blood sodium normal, Blood urea increased, COVID-19, Death, Dysphagia, Full blood count, Haematocrit normal, Haemoglobin decreased, Lethargy, Metabolic function test, Oxygen saturation decreased, Platelet count normal, Polymerase chain reaction positive, Red blood cell count decreased, SARS-CoV-2 test positive, White blood cell count normal
SMQs:, Acute renal failure (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (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: 2021-01-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram Miralax Isosorbide Mononitrate Lactulose Melatonin Milk of Magnesium, Protnix, Acetaminophen, Senna-S, Zyprexa, Aspercreme lot
Current Illness: NONE
Preexisting Conditions: CAD, Bradycardia, HTN, Hyperlipidemia, Protein Calorie Malnutrition, GERD, STEMI, Vitamin D deficiency
Allergies: Macrobid
Diagnostic Lab Data: CBC and BMP 12/2/2021-not Covid-19 related: WBC 6.17 RBC 3.80 HGB 11.2 HCT 36.6 Platelet Count 234 BUN/CREA 22/0.64 Creatinine 0.64 Calcium 9.0 Sodium 144 Potassium 3.9 Chloride 111 1/18/2021- PCR positive.
CDC Split Type:

Write-up: 1/18/2021- Tested positive for Covid-19. 1/20 Patient lethargic, unable to swallow. 1/24 Although 90% O2 sat on RA, it has decreased from her baseline ranging at high 90''s. 1/27/2021 Patient passed.


VAERS ID: 1011577 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Death, Increased bronchial secretion, Productive cough, Rhinorrhoea, Secretion discharge, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol sulfate nebulization hyoscyamine sulfate atropine sulfate lorazepam concentrate morhpine sulfate metolazone lasix benadryl robitussin levothyroxine fluocinonide cream nystatin cream remeron spironolactone tylenol extra strength tr
Current Illness: Was started on hospice between first dose of vaccine (1/7/21) and second dose (2/4/21), primarily for inability to control fluid balance due to heart failure and kidney failure. Started to have increased edema and respiratory symptoms (nasal drainage, raspy voice but denied sore throat) and tested negative for COVID twice starting 1/5/21 and 1/7/21 (day of first vaccine), and once again after the vaccine, increased confusion at that time and continued between vaccination. Later the nasal drainage was attributed to fluid overload. UTI on 1/11/21. Hospice referral by MD on 1/15/21.
Preexisting Conditions: History of type 2 diabetes, benign prostatic hyperplasia, heart failure, hypertension, constipation, vitamin D deficiency, hypothyroidism, chronic kidney disease stage 3, insomnia, tinea corporis, macular degeneration, polyosteoarthritis, UTIs. Short term memory difficulties. Resided in LTCF for 3 years prior to death.
Allergies: no known allergies
Diagnostic Lab Data: None performed due to hospice status.
CDC Split Type:

Write-up: Resident expired on 2/5/21 at 03:35pm, about 25 hours after second dose of vaccine. At breakfast, resident was spitting a lot of secretions, coughing up liquids from nose and phlegm, facial swelling, which were all symptoms that he was struggling with prior to both doses of COVID vaccine, but had increased more than prior incidences on 2/5/21. Gurgling noted in upper airways, hyscolamine given, bath given to loosen secretions, morphine given. Family notified and came into facility for compassionate care visit around 1300. 1400 HR was 3 and RR was 2, but increased back to 60 and 12 within 20 minutes. Then resident expired at 1535.


VAERS ID: 1011595 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-28
Onset:2021-02-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Azotaemia, Blood creatinine increased, Blood urea increased, Brain natriuretic peptide, Cardiac arrest, Death, Full blood count, Metabolic function test, Renal failure, Ventricular fibrillation, Vital signs measurement
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (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 (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   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: Glimepiride Tablet 1 MG,hydrALAZINE HCl Tablet 10 MG,Pantoprazole Sodium Tablet Delayed Release 40 MG,Meclizine HCl Tablet,Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG,Senna Tablet 8.6 MG (Sennosides),Furosemide Tablet 20
Current Illness: ACUTE RESPIRATORY FAILURE WITH HYPOXIA, COPD, CHF, HTN, ANEMIA IN CHRONIC KIDNEY DISEASE, TYPE 2 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, HYPERLIPIDEMIA, UNSPECIFIED, DEMENTIA, AFIB, CKD STAGE 4, BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS, UNSPECIFIED ASTHMA, UNCOMPLICATED, HYPERPARATHYROIDISM, UNSPECIFIED
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: BNP, CBC, CMP
CDC Split Type:

Write-up: On 2/5/2021 resident noted to be azotemic. Creatinine up to 3.8 and BUN in 80''s. He was started on NS hydration. On 2/7/2021 he was noted without VS, per MD notes, possible VF arrest, renal failure; death unclear exact cause.


VAERS ID: 1011677 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-07
Onset:2021-01-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood albumin decreased, Blood creatinine increased, Blood thyroid stimulating hormone normal, Blood urea increased, COVID-19, Decreased appetite, Food refusal, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin increased, Lethargy, Platelet count normal, Red blood cell count decreased, Refusal of treatment by patient, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (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: 2021-01-26
   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: Acetaminophen Tablet Exelon Patch Lisinopril Tablet Metoprolol Tartrate Tablet Protonix
Current Illness: 01/16/2021 Pt had bried unresponsive episode
Preexisting Conditions: Alzheimer''s disease, Hx of TIA, Vitamin D deficiency, HTN, Syncope and collapse, Hyperlipidemia.
Allergies: NKA
Diagnostic Lab Data: 1/07/2021 CBC/BMP: WBC-10.86 RBC- 3.76 HGB-106 HCT- 34.6 Platelet count-282 BUN/CREA-33/1.49 ALBUMIN-2.5 GFR-32 12/29- TSH -1.930
CDC Split Type:

Write-up: Lethargic, refusing medications and meals. 1/11/2021- Covid+, poor appetite.


VAERS ID: 1011732 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-02-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away with in 60 days of receiving COVID vaccine series


VAERS ID: 1011774 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-03
Onset:2021-02-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPRIN CLOPIDOGREL LISINOPRIL NITROQUICK FINASTERIDE AMLODPINIE PRAVASTATIN TAMSULOSIN
Current Illness: CAROTID ARTERY STENOSIS CORONARY ARTERY DISEASE PACEMAKER CABG, 4-VESSEL BPH
Preexisting Conditions: SAME AS ABOVE
Allergies: NONE KNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Cardiac arrest resulting in death on the third day post vaccine administration, 0224. Reported syncopal event post toileting. Rescue measures attempted but not successful. Time of death 0358, 02/06/2021.


VAERS ID: 1011834 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-02-06
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away within 60 days of receiving COVID vaccine series


VAERS ID: 1011894 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-12-29
Onset:2021-02-04
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient passed away within 60 days of receiving COVID vaccine


VAERS ID: 1011905 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-08
Onset:2021-01-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, General physical health deterioration, Lethargy, SARS-CoV-2 test positive
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Refused medications on day of vaccine. Aspirin Tablet 81 MG(Last dose 1/6 8am), Docusate Sodium Tablet 100 MG(Last dose 1/6 8am), FLUoxetine HCl Capsule 20 MG(Last dose 8am), Lisinopril Tablet 10 MG(Last dose 1/6 8am), Melatonin Tablet 3 MG
Current Illness: Recent overall decline with generalized weakness, refusal of meals and medications, weight loss, and frequent falls. 1/5 Overall decline reviewed with APRN and ADPOA updated. 1/6-CBC WNL, BUN/Cr 55/1.93, GFR 24. Admitted to Hospice Services on 1/6. Covid Antigen Test negative on Jan 4th, 5th, 6th, 7th, 8th, & 9th. Covid positive on 1/10.
Preexisting Conditions: Dementia , Expressive aphasia, right-sided neglect and right sided weakness, high fall risk. S/P CEREBRAL INFARCTION DUE TO THROMBOSIS CORONARY ARTERY ANEURYSM ESSENTIAL (PRIMARY) HYPERTENSION PAROXYSMAL ATRIAL FIBRILLATION ABNORMAL RESULTS OF KIDNEY FUNCTION STUDIES CEREBRAL ANEURYSM, NONRUPTURED
Allergies: NKA
Diagnostic Lab Data: Covid positive on 1/10 without respiratory signs or symptoms. Considered recovered on 1/22 from acute illness.
CDC Split Type:

Write-up: Ongoing decline overall. Remained on Hospice with increased lethargy documented on 1/20/21 and progressively worsening thereafter.


VAERS ID: 1011929 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-01-21
Onset:2021-01-27
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / UNK AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Death, Dyspnoea, Dyspnoea exertional, Fatigue, Lethargy
SMQs:, Anaphylactic reaction (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), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 8
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: hypercholesterolemia
Allergies: none
Diagnostic Lab Data: The coroners office has not confirmed with us a cause of death yet and continues to investigate her death. They have not shared with the family any results from medical or laboratory tests related to their post-mortem analysis.
CDC Split Type:

Write-up: Within a few days, my mother started reporting profound fatigue and shortness of breath while conducting routine household activities. She no longer had to energy for her daily exercise walks and became increasingly lethargic. She died in her sleep while taking an afternoon nap on Thursday, February 4th. I am highly concerned this could be a vaccine related.


VAERS ID: 1011935 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-06
Onset:2021-02-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Death, Dyspnoea, Fatigue, Malaise, Oxygen saturation decreased, Resuscitation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-08
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known drug/food allergies
Diagnostic Lab Data: Pulse Ox #1 (home) - 92% (2/8 PM) Pulse Ox #2 (home) - 90% (2/8 PM) Pulse Ox #3 (emergency department) - 60% (2/8 PM) *All results were patient reported
CDC Split Type:

Write-up: Patient received his second dose of Moderna COVID vaccine on 2/6 at 12:40PM. Patient was observed for 15 minutes post-vaccination with no adverse events. On the evening of 2/6 (time unknown) the patient began to develop dry cough and fatigue. He was checked by a physician at that time (who was a family member). Patient continued to feel unwell into Sunday. His lungs were clear when checked Sunday afternoon (time unknown). At approximately 5:30pm on 2/7 the patient began experiencing sudden onset shortness of breath. A pulse ox was conducted at that time and it was 92%, and again shortly thereafter and it was 90% (as reported by family member). 9-1-1 was contacted at this time. CPR was initiated when he arrived at the emergency department, pulse ox was 60% (as reported by family member). The patient passed away shortly thereafter on 2/8/2021.


VAERS ID: 1012021 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-01-07
Onset:2021-01-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Hypoglycaemia, Respiratory tract congestion, SARS-CoV-2 test positive, Tremor
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tenormin Tylenol Extra Strength
Current Illness: None
Preexisting Conditions: CAD, Anemia, CKD Stage 3, Type 2 DM, HTN, Hyperlipidemia
Allergies: Codeine
Diagnostic Lab Data: 1/19/2021 Binax Card now antigen test+ positive for Covid-19, she became symptomatic the day of testing positive.
CDC Split Type:

Write-up: Resident on Hospice. 1/18 Hand Shaky. 1/19- Covid +19. 1/20 Desat 85% on RA, provided 2L O2 supplement= 97% 1/20 congestive cough, 1/28- RR-28;1/29- Hypoglycemia 1/30-NPO. 1/30-resident passed away.


VAERS ID: 1012047 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-01
Onset:2021-02-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Acidosis, Cardiac arrest, Encephalopathy, Endotracheal intubation, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Besylate; Antacid Suspension; Atorvastatin Calcium; Atropine Sulfate; Clozaril; Cyanocobalamin; metformin HCl; Metoprolol Tartrate; Tylenol
Current Illness: DMII
Preexisting Conditions: Tobacco use, Schizophrenia, DMII, Bipolar, HTN, COVID 19 hx,
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden death 2/7/21 @ 0309 Started acute encephalopathy & required intubation Soon after intubation went into cardiac arrest Likely severe acidosis.


VAERS ID: 1012604 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-11
Onset:2021-02-05
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1012612 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol apixiban diclofenac exenatide finasteride furosemide lantus novolog liptor lotrel metoprolol succinate pantoprazole levothyroxine tasulosin tiotropium-olodaterol
Current Illness: COPD exacerbation 2 weeks prior
Preexisting Conditions: Atrial fibrillation on anticoagulation benign prostatic hyperplasia CKD stage 3 Chronic obstructive pulmonary disease - on baseline 2L NC supplemental O2 Gastro-esophageal reflux disease Hyperlipidemia Hypertension Hypothyroidism Obstructive sleep apnea Type 2 diabetes mellitus asbestosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized on 31 Jan for COVID pneumonia after 3 days of increasing baseline supplemental O2 requirements and dyspnea and ultimately died on comfort care on 3 Feb 2021.


VAERS ID: 1012703 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-01-07
Onset:2021-01-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood calcium normal, Blood chloride increased, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, COVID-19, Carbon dioxide normal, Confusional state, Cough, Differential white blood cell count normal, Ear haemorrhage, Fibrin D dimer increased, Full blood count, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin normal, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Metabolic function test, Nucleated red cells, Platelet count normal, Rales, Red blood cell count decreased, Red cell distribution width normal, SARS-CoV-2 test positive, Thrombosis, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (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: 2021-01-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin Tablet 81 MG clonazePAM Tablet 0.5 MG Colace Capsule 100 MG DULoxetine HCL Furosemide Tablet 20 MG Norvasc Tablet 10 MG Potassium Chloride ER CapsulE QUEtiapine Fumarate Tablet Galantamine Hydrobromide Tablet
Current Illness: Intermittent delusional periods-followed by Generations Mental Health.1/6 Increased BLE edema, BP trending up. Acute visit with APRN, N.O. started Lasix & KCL. CBC and BMP ordered for 1/8 with elevation in BMP/Creatinine. Lasix and KCL placed on hold. On palliative services presently.
Preexisting Conditions: Alzheimer?s Disease/Depression; HTN; CAD, CKD, AAA w/o Rupture, no surgical intervention per ADPOA, Dyslipidemia, GERD.
Allergies: HEPARIN LATEX BLEACHED SHEETS
Diagnostic Lab Data: 1/14-Covid Antigen test positive 1/14-11:49 am D-DIMER-32.33 WBC 8.71 RBC 4.55 HGB 12.9 HCT 41.4 MCV 91.0 MCH 28.4 MCHC 31.2 RDW-CV 12.6 MPV 10.1 Platelet Count 225 NRBC Automated 0.0 RDW-SD 41.7 Glucose 125 BUN 29 Creatinine 2.34 Calcium 9.4 Sodium 140 Potassium 4.2 Chloride 107 CO2 24 BUN/Creatinine Ratio 12.39 GFR 27
CDC Split Type:

Write-up: 1/14/2021-0545, blood noted left and right ear. 0715, vomited x 1. Covid Antigen positive. Acute MD visit-basilar crackles right and coughing. Increased confusion.


VAERS ID: 1012717 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM

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

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

Write-up: Patient that received his first dose of Pfizer vaccine on 2/1/2021 passed away on 2/2/2021. No further information is available at this time.


VAERS ID: 1012795 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-02-05
Onset:2021-02-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension, Coronary Artery Disease, Previous Myocardial Infarction, Atrial Fibrillation, Hyperlipidemia, Arthritis
Allergies: Adhesive Tape, Niacin, Banana, Bandaids, Benzodiazepines, Calcium Channel Blockers, Digoxin, Hydralazine, Levaquin, Minoxidil, Tomatoes, Oranges
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered second dose of Pfizer vaccine in Nursing Home on 2/5/2021 around noon and was found unresponsive at 5:03AM the following day 2/6/2021. Patient arrived to Hospital in cardiopulmonary arrest and was pronounced dead.


VAERS ID: 1012894 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-02-05
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Fatigue, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen Amiodarone 100mg Diclofenac 1% gel Furosemide 40mg tablet Hydralazine 50mg tablet Metoprolol 100mg tablet Potassium Chloride 10meqER tablet Warfarin 2.5mg tablet
Current Illness: Anxiety A. Fib Cardiac Pacemaker Cerebral Infaction CHF Urinary Incontinence
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1-2 days after vaccine, pt developed weakness, fatigue, body aches, nausea, headache and poor appetite. Pt was admitted to the hospital on 2/5/21 and death occured on 2/6/21


VAERS ID: 1012926 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2020-12-31
Onset:2021-01-31
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Chest X-ray, Decreased appetite, Fatigue, Hypotension, Pneumonia, Rales
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 6
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: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED ATRIAL FIBRILLATION, ESSENTIAL (PRIMARY) HYPERTENSION ATRIOVENTRICULAR BLOCK, COMPLETE, NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED, PERSONAL HISTORY OF PULMONARY EMBOLISM,
Allergies: NKA
Diagnostic Lab Data: Chest x-ray in the ED
CDC Split Type:

Write-up: Early in the shift on January 31 resident was noticed to be more tired than usual and was not eating well. Lung sounds were crackly and resident was found to be hypotensive. He was evaluated in emergency department. He was diagnosed with pneumonia. Received a loading dose of antibiotic and returned to facility.


VAERS ID: 1013006 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: herbal medicines such as ginger, garlic, beetroot and a herbal reboot, No perceptions or over the counter drugs
Current Illness: no illness
Preexisting Conditions: High cholesterol
Allergies: No allergies
Diagnostic Lab Data: Awaiting coroner report and lab results
CDC Split Type:

Write-up: Patient complained of soreness in muscles morning after receiving the shot. She went about her day had a smoothie, spoke to people and also went for a walk came home and went into her jacuzzi tub and consequently passed away while in the tub. She was found by her husband at around 545pm, time of death is unknown and cause of death is currently pending.


VAERS ID: 1013041 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-15
Onset:2021-01-31
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown-Patient doesn''t not regularly use our pharmacy
Current Illness: None
Preexisting Conditions: Heart failure
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccine was administered on 1/15/2021 and death occurred on 1/31/2021.


VAERS ID: 1013051 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-24
Onset:2021-02-06
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Facial paralysis, Hemiparesis, Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 7
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg, Citalopram 10mg, Furosemide 40mg, Insulin glargine, Losartan 50mg, Metoprolol 25mg, Vitamin B-12 1000mcg
Current Illness:
Preexisting Conditions: Dementia, Congestive Heart Failure, Diabetes, Osteoarthritis
Allergies: No known allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 2/6/21 at 6:00PM, resident experienced sudden left facial droop, left arm and left leg weakness. She was sent to hospital and they confirmed she had an acute ischemic stroke.


VAERS ID: 1013087 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-23
Onset:2021-01-30
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown-Patient does not regularly use our pharmacy
Current Illness: None
Preexisting Conditions: Heart problems
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received vaccine on 1/23/2021 and death occurred on 1/30/2021.


VAERS ID: 1013095 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-02-03
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: See list below. Flomax 0.4 mg 1 Cap P.O. QD Tylenol 500mg 2 tabs PO PRN Carbidopa/levodopa 25-100mg PO 3 tab PO TID CoQ10 1 cap PO QD B12 1 tab PO QD Omega-3 Fatty Acids-Vitamin E 1,000mg 1 Cap PO QD Timolol 0.25% 1 gtt OU BID Finasterid
Current Illness: Unknown.
Preexisting Conditions: See list below. Glaucoma, Hyperlipidemia, Inguinal Hernia, Hx-Gi bleed, Mandibular salivary gland removal- 2012, Hx-TIA, Hypertension, Lumbar disc disease, Parkinsonism, Pancreatitis history
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was technically a resident of retirement community, however, he chose to live independently at home at his current home. Only his spouse actually resides at retirement community. Patient received the second dose of the Moderna vaccine via pharmacy vaccination clinic at retirement community on 2/3/2021. He was found deceased in his home by a certified nursing assistant on 2/4/2021 at approximately 10:00am.


VAERS ID: 1013145 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-05
Onset:2021-02-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient texted a friend on 2/7/2021 c/o arm pain and feeling tired. I don''t know if he was taken to a hospital. Autopsy today.


VAERS ID: 1013297 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-02
Onset:2021-02-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anal incontinence, Chest pain, Death, Fatigue, Malaise, Urinary incontinence
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lovaza, Ibersantan, Flomax, Amaryl, Prednisolone, B-12 sublingual, Horse Chestnut Extract, Iron, Crestor, Xarelto, Triplix, Klonopin, Elavil, Folic Acid, Lantus, Tri Sleep, Elavil
Current Illness: NONE
Preexisting Conditions: DIABETES TYPE 2 POLIMIALGYA HIGH BLOOD PRESSURE HIGH CHOLESTEROL STENT PACE-MAKER
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient was vaccinated at 11:30am. By 7pm he started presenting symptoms of fatigue, chest pain. Patient urinated and defecated in himself. Was not feeling well. Patient died at 10:30pm.


VAERS ID: 1014559 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-04
Onset:2021-02-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: Atenolol Plavix HCTZ MYAMBUTOL Omeprazole RAnexa Sertraline Simvastatin Rifampin ASA Nitroglycerin Latanoprost Imodium Fish oil MVI Combigan Vitamin D Butalbital
Current Illness:
Preexisting Conditions: CAD Migraine Hyperlipidemia
Allergies: Codeine Hydrocodone Hydroxyzine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unsure if related to vaccine, but wanted to report event of death due to brain bleed on evening of administration of the vaccination.


VAERS ID: 1014628 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20R / 1 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: a long list
Current Illness: none
Preexisting Conditions: melanoma, skin cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 8 hours.


VAERS ID: 1014659 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-01-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   Days after onset: 8
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: hypothyroidism
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Four days after being vaccinated, she developed pneumonia and died 8 days later.


VAERS ID: 1014740 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-04
Onset:2021-02-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Agonal rhythm, Cardiac arrest, Death, Fall, Heart rate irregular, Loss of consciousness, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: Lisinopri, Sertraline, pravastatin, alendronate, Cetirizine, Vitamin D3,
Current Illness: no acute illnesses
Preexisting Conditions: HTN, Cavernous hemangioma of liver, RBBB, hx of bilateral carotid bruits, hx of squamous cell carcinoma of right hand, arthralgia of both knees, spondylolisthesis at L3-L4, DDD thoracic, ovarian cyst, hx of pneumonia, cholelithiasis w/o obstruction, liver lesion, depression, hyperlipidemia, hypercalcemia, vitamin d deficiency, osteoporosis, former smoker, depression
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found down at home with agonal respirations and per EMS asystole, received 2 rounds of epi at her house with return of spontaneous pulses, lost pulse again in route to ER and another round of epi was given, CPR in progress when arrived at hospital. Prior to this patient''s husband states he heard her fall in the bathroom but did not immediately check on her as he states that this has happened before. He checked on her 10 min later and that''s when he found her unconscious. Daughter called 911 and she began CPR. No previous complaints of headache, chest pain, back pain, fever or chills. Husband states patient was drinking that evening which is not unusual for her. Patient died at hospital.


VAERS ID: 1014774 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-13
Onset:2021-01-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: None Reported
Allergies: None Reported
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: We were informed the patient passed away 2 days after receiving the vaccine. We do not have any details about what happened, we were informed by one of his employees. We have no knowledge that this had anything to do with the vaccination in any way.


VAERS ID: 1014865 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-23
Onset:2021-02-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Death, Malaise, Pneumonia, Renal failure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: Tested positive for Covid in November
Preexisting Conditions: Muscular dystrophy
Allergies: n/a
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: He had not been feeling well after his second Covid vaccination (on 01/23/2021) and was found unresponsive in his room at the nursing home (late evening on 02/02/2021). He was taken to a hospital where they did tests and he had pneumonia and kidney failure, but he was being transferred to a larger hospital when he arrested and died (02/03/2021)


VAERS ID: 1015465 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-21
Onset:2021-02-07
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ELO140 / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL1283 / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Heart rate abnormal, Pulse absent, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen [OTC] tablet; 500 mg; amt: 500 MG; oral Special Instructions: 1 TABLET BY MOUTH EVERY 4 HOURS AS NEEDED As Needed PRN 1, PRN 2, PRN 3, PRN 4, PRN 5, PRN 6, PRN 7, PRN 8, PRN 9, PRN 10 03/14/2020- Open Ended Prescription Artifi
Current Illness: U07.1 2019-nCoV acute respiratory disease (Primary) N39.0 Urinary tract infection, site not specified (Admission) K21.9 Gastro-esophageal reflux disease without esophagitis G89.4 Chronic pain syndrome E66.01 Morbid (severe) obesity due to excess calories M54.2 Cervicalgia F41.9 Anxiety disorder, unspecified (History of) G47.00 Insomnia, unspecified E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E03.9 Hypothyroidism, unspecified F06.30 Mood disorder due to known physiological condition, unspecified I50.22 Chronic systolic (congestive) heart failure I10 Essential (primary) hypertension M81.0 Age-related osteoporosis without current pathological fracture Z95.0 Presence of cardiac pacemaker F39 Unspecified mood [affective] disorder C85.84 Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb F31.62 Bipolar disorder, current episode mixed, moderate K59.09 Other constipation Z45.2 Encounter for adjustment and management of vascular access device D64.9 Anemia, unspecified Z79.01 Long term (current) use of anticoagulants Z51.81 Encounter for therapeutic drug level monitoring M17.9 Osteoarthritis of knee, unspecified M15.0 Primary generalized (osteo)arthritis I87.2 Venous insufficiency (chronic) (peripheral) F31.9 Bipolar disorder, unspecified C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites I73.9 Peripheral vascular disease, unspecified F32.9 Major depressive disorder, single episode, unspecified I89.0 Lymphedema, not elsewhere classified Q24.5 Malformation of coronary vessels I42.8 Other cardiomyopathies E03.9 Hypothyroidism, unspecified J30.9 Allergic rhinitis, unspecified Z86.718 Personal history of other venous thrombosis and embolism R33.9 Retention of urine, unspecified K42.9 Umbilical hernia without obstruction or gangrene Z90.89 Acquired absence of other organs R20.8 Other disturbances of skin sensation L03.111 Cellulitis of right axilla I87.2 Venous insufficiency (chronic) (peripheral) Z87.81 Personal history of (healed) traumatic fracture H04.121 Dry eye syndrome of right lacrimal gland R42 Dizziness and giddiness R53.81 Other malaise F48.2 Pseudobulbar affect R06.02 Shortness of breath H26.9 Unspecified cataract C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site H53.2 Diplopia E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene G89.4 Chronic pain syndrome E78.5 Hyperlipidemia, unspecified G47.33 Obstructive sleep apnea (adult) (pediatric) G60.8 Other hereditary and idiopathic neuropathies K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding I48.91 Unspecified atrial fibrillation J02.9 Acute pharyngitis, unspecified (Preliminary) F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features Z46.89 Encounter for fitting and adjustment of other specified devices R09.81 Nasal congestion Z46.89 Encounter for fitting and adjustment of other specified devices M25.562 Pain in left knee L53.9 Erythematous condition, unspecified R29.3 Abnormal posture F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified T81.30XA Disruption of wound, unspecified, initial encounter R05 Cough (Preliminary) F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features S28.222A Partial traumatic amputation of left breast, initial encounter Z48.3 Aftercare following surgery for neoplasm F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features R41.841 Cognitive communication deficit N63.0 Unspecified lump in unspecified breast H25.012 Cortical age-related cataract, left eye (Preliminary) H25.011 Cortical age-related cataract, right eye (History of) H25.091 Other age-related incipient cataract, right eye Z23 Encounter for immunization Z74.1 Need for assistance with personal care M62.81 Muscle weakness (generalized) K59.00 Constipation, unspecified I49.9 Cardiac arrhythmia, unspecified E55.9 Vitamin D deficiency, unspecified (History of) L23.9 Allergic contact dermatitis, unspecified cause (History of) F33.8 Other recurrent depressive disorders (History of) Z11.1 Encounter for screening for respiratory tuberculosis D51.9 Vitamin B12 deficiency anemia, unspecified (History of) R13.11 Dysphagia, oral phase N18.31 Chronic kidney disease, stage 3a G44.021 Chronic cluster headache, intractable (Preliminary) C50.912 Malignant neoplasm of unspecified site of left female breast
Preexisting Conditions: U07.1 2019-nCoV acute respiratory disease (Primary) N39.0 Urinary tract infection, site not specified (Admission) K21.9 Gastro-esophageal reflux disease without esophagitis G89.4 Chronic pain syndrome E66.01 Morbid (severe) obesity due to excess calories M54.2 Cervicalgia F41.9 Anxiety disorder, unspecified (History of) G47.00 Insomnia, unspecified E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E03.9 Hypothyroidism, unspecified F06.30 Mood disorder due to known physiological condition, unspecified I50.22 Chronic systolic (congestive) heart failure I10 Essential (primary) hypertension M81.0 Age-related osteoporosis without current pathological fracture Z95.0 Presence of cardiac pacemaker F39 Unspecified mood [affective] disorder C85.84 Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb F31.62 Bipolar disorder, current episode mixed, moderate K59.09 Other constipation Z45.2 Encounter for adjustment and management of vascular access device D64.9 Anemia, unspecified Z79.01 Long term (current) use of anticoagulants Z51.81 Encounter for therapeutic drug level monitoring M17.9 Osteoarthritis of knee, unspecified M15.0 Primary generalized (osteo)arthritis I87.2 Venous insufficiency (chronic) (peripheral) F31.9 Bipolar disorder, unspecified C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites I73.9 Peripheral vascular disease, unspecified F32.9 Major depressive disorder, single episode, unspecified I89.0 Lymphedema, not elsewhere classified Q24.5 Malformation of coronary vessels I42.8 Other cardiomyopathies E03.9 Hypothyroidism, unspecified J30.9 Allergic rhinitis, unspecified Z86.718 Personal history of other venous thrombosis and embolism R33.9 Retention of urine, unspecified K42.9 Umbilical hernia without obstruction or gangrene Z90.89 Acquired absence of other organs R20.8 Other disturbances of skin sensation L03.111 Cellulitis of right axilla I87.2 Venous insufficiency (chronic) (peripheral) Z87.81 Personal history of (healed) traumatic fracture H04.121 Dry eye syndrome of right lacrimal gland R42 Dizziness and giddiness R53.81 Other malaise F48.2 Pseudobulbar affect R06.02 Shortness of breath H26.9 Unspecified cataract C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site H53.2 Diplopia E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene G89.4 Chronic pain syndrome E78.5 Hyperlipidemia, unspecified G47.33 Obstructive sleep apnea (adult) (pediatric) G60.8 Other hereditary and idiopathic neuropathies K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding I48.91 Unspecified atrial fibrillation J02.9 Acute pharyngitis, unspecified (Preliminary) F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features Z46.89 Encounter for fitting and adjustment of other specified devices R09.81 Nasal congestion Z46.89 Encounter for fitting and adjustment of other specified devices M25.562 Pain in left knee L53.9 Erythematous condition, unspecified R29.3 Abnormal posture F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified T81.30XA Disruption of wound, unspecified, initial encounter R05 Cough (Preliminary) F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features S28.222A Partial traumatic amputation of left breast, initial encounter Z48.3 Aftercare following surgery for neoplasm F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features R41.841 Cognitive communication deficit N63.0 Unspecified lump in unspecified breast H25.012 Cortical age-related cataract, left eye (Preliminary) H25.011 Cortical age-related cataract, right eye (History of) H25.091 Other age-related incipient cataract, right eye Z23 Encounter for immunization Z74.1 Need for assistance with personal care M62.81 Muscle weakness (generalized) K59.00 Constipation, unspecified I49.9 Cardiac arrhythmia, unspecified E55.9 Vitamin D deficiency, unspecified (History of) L23.9 Allergic contact dermatitis, unspecified cause (History of) F33.8 Other recurrent depressive disorders (History of) Z11.1 Encounter for screening for respiratory tuberculosis D51.9 Vitamin B12 deficiency anemia, unspecified (History of) R13.11 Dysphagia, oral phase N18.31 Chronic kidney disease, stage 3a G44.021 Chronic cluster headache, intractable (Preliminary) C50.912 Malignant neoplasm of unspecified site of left female breast
Allergies: Iodinated Contrast- Oral and IV Dye, Penicillins (PCN)
Diagnostic Lab Data:
CDC Split Type:

Write-up: DISCOVERED UNRESPONSIVE WITHOUT PULSE, RESPIRATIONS, HEART BEAT ON 2/7/21 AT 0435 A.M. RESIDENT WAS DNR STATUS.


VAERS ID: 1015630 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died of a heart attack; A spontaneous report was received from a consumer concerning a 56-year-old male patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and died due to a heart attack. The patient''s medical history was not provided. Products known to have been used by the patient, within two weeks prior to the event, included additional medications. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. - On an unknown date, the reporter stated the patient received Moderna''s COVID-19 vaccine and sometime after he was found dead by his bedside around 02:30 am. The patient died on an unknown date. The cause of death was due to a heart attack. Plans for autopsy were not provided.; Reporter''s Comments: This case concerns a 56 year old, male patient, who experienced fatal unexpected event of myocardial infarction. The event occurred on an unspecified date after mRNA-1273 (Lot# Unknown). Treatment details not provided. Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Additional information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1015670 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-29
Onset:2021-01-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, SARS-CoV-2 test positive, 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-18
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Dementia
Allergies:
Diagnostic Lab Data: Test Date: 20210102; Test Name: Covid test; Result Unstructured Data: Test Result:Positive; Test Date: 20210115; Test Name: Xrays; Result Unstructured Data: Test Result:covid Poss pockets all in her lungs
CDC Split Type: USPFIZER INC2021104685

Write-up: Xrays showed covid Poss pockets all in her lungs on 15Jan; Xrays showed covid Poss pockets all in her lungs on 15Jan; This is a spontaneous report from a contactable consumer. An 85-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 29Dec2020 at single dose for covid-19 immunisation. Medical history included dementia. Concomitant medications were not reported. Patient popped hot 02Jan2021 along with 4 others on the hall she lived. Within 9 days 50+ patients were positive. All had the vaccine the same day. Patient was test positive on 02Jan2021. She was on day 12 of her quarantine when she started to get worse. She was unresponsive by 16Jan2021 and passed 18Jan2021. We were with her from 14Jan2021 to 18Jan2021. But had not been allowed to visit with her since Mar2020. And what post treatment pairs well with it? Publicly we hear Remdesivir and Bamlanivimab but these patients only received a general antibiotic and some vitamins. Death cause was Xrays showed covid Poss pockets all in her lungs on 15Jan2021. No autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the information available, a possible contributory role of the suspect products cannot be excluded for the reported event of positive for corona virus infection for the lack of efficacy of the vaccine. However, based on the mechanism of action of the vaccine, it is unlikely the patient would have fully developed immunity for the vaccine to be effective, due to the number of days passed since the vaccine is given. Case will be reevaluated based on follow-up information; Reported Cause(s) of Death: Xrays showed covid Poss pockets all in her lungs on 15Jan


VAERS ID: 1015671 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-13
Onset:2021-01-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain upper, Apparent life threatening event, Computerised tomogram abnormal, Computerised tomogram intestine, Death, Intestinal perforation
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Neonatal disorders (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MEMANTINE; DICLOFENAC; CARBIDOPA/LEVODOPA; QUETIAPINE; LEXAPRO; TYLENOL; GLUCOSAMINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis; Dementia
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: CT; Result Unstructured Data: Test Result:bowel perforation; Comments: CT showed a bowel perforation in the small bowel
CDC Split Type: USPFIZER INC2021107105

Write-up: bowel perforation; pain in her upper abdomen; This is a spontaneous report from a contactable consumer. An 86-year-old female patient received the 2nd dose of bnt162b2 (BNT162B2) at single dose on 13Jan2021 for Covid-19 immunisation, administerd at nursing home/senior living facility Medical history included dementia, arthritis. No known allergies. Patient was not pregnant. Patient had not COVID prior vaccination. Concomitant medication in 2 weeks included: memantine (manufacturer unknown) 10 mg BID, diclofenac (manufacturer unknown) BID, carbidopa, levodopa (manufacturer unknown) 25-100 mg TID, quetiapine (manufacturer unknown) 12.5 mg q HS, escitalopram oxalate (LEXAPRO) 10 mg q HS, paracetamol (TYLENOL) 650 mg BID, glucosamine (manufacturer unknown) drink. The patient received the 1st dose of bnt162b2 (BNT162B2) at single dose on 24Dec2020 for Covid-19 immunisation. No other vaccine received in 4 weeks. The patient experienced bowel perforation and pain in her upper abdomen on 18Jan2021 07:30. The events resulted in Emergency room/department or urgent care, Life threatening illness (immediate risk of death from the event), and death. On 18Jan2021 07:30 AM, less than a week after the second shot, she had pain in her upper abdomen and was taken to the ER on 18Jan2021. CT showed a bowel perforation in the small bowel. She had never had bowel surgery or diverticulitis. She had been healthy other than her dementia and arthritis. Patient received treatment for the events: hospice and pain management. COVID-19 was not tested post vaccination. The cause of death was bowel perforation. An autopsy was not performed. Information about lot/batch number has been requested.; Reported Cause(s) of Death: bowel perforation


VAERS ID: 1015687 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-08
Onset:2021-02-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Cardiac arrest, Cough, Death, Dyspnoea, Headache, Intraosseous access placement, Laryngeal mask airway insertion, Oxygen saturation decreased, Pulse absent, Pulseless electrical activity, Pyrexia, Respiratory arrest, Resuscitation, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lipitor, pepcid, uloric, prozac, synthroid, lisinopril, troprol xl, multivitamin, niacin, nifedical xl, ranexa, demadex, xarelto
Current Illness: none
Preexisting Conditions: a fib, HTN, CAD, PTSD, CHF, anxiety, gout, reflux, high cholesterol, obese, hypothyroidism.
Allergies: nknda or food allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Almost immediate headache per wife. Developed fever around 4 pm. Headache all day. Took Tylenol at 4 and 10 pm. Gradual development of SOB and cough. Temp of 101.4 at 10 pm. pulse ox 92% at 10 pm. Went to sleep, woke up at 0050 with increasing SOB. Pulse ox 82%. Used albuterol inhaler, wife called emergency services at 0113. EMS arrived around 0130 to patient''s home. pulse ox 86%, coughing, sob, hard time breathing. Walked to stretcher. Became unresponsive. Found to have no pulse, stopped breathing. CPR initiated at about 0140. King airway placed in field, I/O in left tibia. Patient from PEA to asystole, to vfib, to asystole. ACLS followed. Unrecoverable asystole and patient time of death 0213.


VAERS ID: 1015773 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 mg,
Current Illness: skin rash
Preexisting Conditions: Demenita, GERD, Heart failure, Kidney disease, stage 3,
Allergies: Lisinipril, Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident passed away in her sleep. No s/s of adverse events leading up to the residents death. Resident was previously declining- MD stated the vaccine had nothing to do with the death.


VAERS ID: 1015996 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-01-01
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 30
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: Family reported patient expired 1/31/2021.


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