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

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

Government Disclaimer on use of this data



Case Details

This is page 73 out of 227

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VAERS ID: 1723185 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-21
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Brain neoplasm malignant, Death
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH DUE TO CANCER OF THE BRAIN. RIGHT AFTER THE 2ND VACCINE, BLOOD PRESSURE SPIKES OF 200 BPM.


VAERS ID: 1723190 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-09-08
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna vaccine. Tested positive for COVID on 9/8/2021. Admitted to Medical Center on 8/29/2021 and expired while still hospitalized on 9/19/2021.


VAERS ID: 1723384 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood chloride decreased, Blood creatinine increased, Blood potassium normal, Blood sodium decreased, Blood urea increased, Confusional state, Haemoglobin decreased, International normalised ratio increased, Memory impairment, Occult blood positive, Platelet count decreased, Posture abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   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: Norco 5-325mg Ativan 0.5mg
Current Illness: A-fib Glaucoma Non-seasonal allergic rhinitis due to pollen Arthritis Hyperlipidemia Prostate cancer metastatic to bone
Preexisting Conditions: See above (item 11)
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 77 years old male with past medical history of A. fib on anticoagulation, glaucoma, prostate cancer on Lupron, arthritis, brought to the emergency room today for confusion and weakness. The patient reported that his weakness started around 6 AM when he woke up trying to go to pee. He reported that he was having trouble trying to keep his head up and he was confused as he does not know how to use his phone. However, he has no focal deficit. I believes he may have taken too much of his norco10mg as well. He cannot recall how often he took the med. He also claims to add tylenol 500mg To the norco 10 to help with his pain. I believe he call his neighbor and the neighbor called the ambulance and he was brought to the emergency room. On presentation, his heart rate was 107 but his systolic blood pressure was 93. Due to history of A. fib and on anticoagulation, the patient had a rectal exam and guaiac stool was strongly positive. He got Kcentra infusion to reverse the Eliquis. The work-up in the ER showed her the patient has INR 2.12, hemoglobin 11.8, platelet of 70, sodium 131, potassium 4.7, chloride 97, BUN 30 and creatinine 1.3. There is no chest x-ray, UA or CT scan of the head done. However, the patient denies any recent head injury. On the medical floor, the patient continued to be confused but no focal deficit or facial droop. He is quite confused and his answer is quite tangential. I spent around 30 minutes trying to get the history and it looks like he has been on new medication for his prostate cancer. It also sounds like he has been treated with a new medication for his A. fib. However, it sounds like the patient stopped these medications. However, he cannot provide me the exact name of the medication nor when he stopped taking them. It seems like the patient has leg swelling and he has been going on for about 6-week, after he started on the new medication to treat his A. fib. However, he reported that the medication was not helping his A. fib and he went back to his old medication. Other than that, his history is quite confusing as he is Talking mostly about his wife, who is being admitted to another hospital for possible CVA workup... ROS: Limited but (-) HA, visual changes, f,c,n/v, diarrhea, sob, chestpain, neckpain, lnew focal weakness, dysuria, dysphagia, dyspnea.


VAERS ID: 1723432 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-09-11
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 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: 2021-09-20
   Days after onset: 9
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death SHORTNESS OF BREATH U07.1, J12.82 - Pneumonia due to COVID-19 virus


VAERS ID: 1723439 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-12
Onset:2021-09-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 15
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death COVID-19 Pneumonia due to coronavirus disease 2019 Acute respiratory failure with hypoxia


VAERS ID: 1723558 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-27
Onset:2021-08-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Acute respiratory failure, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death SHORTNESS OF BREATH Non-ST elevation (NSTEMI) myocardial infarction Acute respiratory failure with hypoxia


VAERS ID: 1723566 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-08-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Cerebrovascular accident, Death, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death AKI (acute kidney injury) Cerebrovascular accident (CVA), unspecified mechanism Acute respiratory failure with hypoxia Acute kidney failure, unspecified Thrombocytopenia, unspecified


VAERS ID: 1723574 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-14
Onset:2021-08-20
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Death, Heart rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Guillain-Barre syndrome (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 15
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - Acute kidney failure, unspecified WEAKNESS - GENERALIZED RAPID HEART RATE


VAERS ID: 1723575 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-08-26
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 6
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute kidney failure, unspecified COVID-19 Acute respiratory failure with hypoxia Pneumonia due to coronavirus disease 2019


VAERS ID: 1723579 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-09-12
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood osmolarity decreased, COVID-19, COVID-19 pneumonia, Death, Hyponatraemia, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 9
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J12.82 - Pneumonia due to coronavirus disease 2019 U07.1 - COVID-19 N17.9 - Acute kidney failure, unspecified E87.1 - Hypo-osmolality and hyponatremia D69.6 - Thrombocytopenia, unspecified


VAERS ID: 1723582 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-09-15
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 5
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I63.9 - CVA (cerebral vascular accident) (CMS/HCC)


VAERS ID: 1723584 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-19
Onset:2021-09-22
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212C21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Death, Disturbance in attention, Dizziness, Insomnia, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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

Write-up: Mild Symptoms, insomnia, dizzy, loss of focused, Severe symptoms last two days - Died on Sept 7 - 2021 - couldn''t breathe.


VAERS ID: 1723828 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-05
Onset:2021-09-09
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Computerised tomogram thorax abnormal, Death, Pulmonary thrombosis, Thrombosis
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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bupropion, levothyroxine,lorsatan,gabapentin,hydochlorothorizide, lurasidone,cholecalciferol, zolpidem tartrate
Current Illness:
Preexisting Conditions: HTN, Hypothyroidism, PTSD, sleep disturbance,
Allergies: N/A
Diagnostic Lab Data: Chest CT. Approx 9/9/21
CDC Split Type:

Write-up: patient died on 9/13/21. He was healthy prior to sudden cardiac arrest at approx. 8:00 am on 9/9/21. His CT scan showed multiple clots in his right lung. Patient had no history of clots. He had no heart disease or lung disease. Origin of clots is unknown. Patient was 9 months post 2nd Covid vaccine. COULD THE VACCINE CAUSED THE CLOTS AT 9 months post vaccine?


VAERS ID: 1723877 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 - / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-03
   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:
Current Illness: afib, high blood pressure, diabetes
Preexisting Conditions: afib, high blood pressure, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death-emts tried to ressusitate


VAERS ID: 1725256 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No underlying issues
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210935156

Write-up: DEATH; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19; This spontaneous report received from a consumer (patient''s friend) via a company representative through social media concerned a 55 year old patient of unspecified sex, race and ethnicity. The patient''s height, and weight were not reported. The patient had no underlying issues. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration was not reported, batch number: unknown and expiry: unknown) dose and start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, the patient experienced covid-19 (suspected covid-19 and suspected clinical vaccination failure). On an unspecified date, in AUG-2021, the patient died from an unknown cause. It was unknown if an autopsy was performed. As per the reporter, ''''Unfortunately I have a 55 year old friend who died last month with Covid no underlying issues, Vaccinated with J and J.'''' The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of death was reported as fatal, suspected covid-19 was not recovered, and the outcome of suspected clinical vaccination failure was not reported at the time of death. This report was serious (Death, and Other Medically Important Condition). This report was associated with product quality complaint: 90000193814.; Sender''s Comments: V0: 20210935156-Covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210935156-Covid-19 vaccine ad26.cov2.s-Suspcted clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1725262 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210936591

Write-up: DEATHS; This spontaneous report received from a consumer via a company representative concerned 3 patients of unspecified sex, age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown expiry: unknown) dose, start therapy date were not reported 1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. "It was reported that, on an unknown date, JNJ vaccine caused 3 known deaths". The patients died from unknown cause of death. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the event death was fatal This report was serious (Death).; Sender''s Comments: V0: 20210936591-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1725384 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-11
Onset:2021-03-21
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Asthenia, Blood pressure measurement, Cerebrovascular accident, Dyspnoea, Hyperhidrosis, Hypotension, Inappropriate schedule of product administration, Malaise, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Bone cancer (In treatment for past 5 years); Hypercholesteremia; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Stomach ulcer
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: Blood pressure; Result Unstructured Data: Low
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: very agitated; couldn''t breathe/ lungs were low; stroke; weak/ very bad; yellow; was sweating a lot; I am not feeling well; blood pressure was very low; Inappropriate schedule of vaccine administered; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (stroke), AGITATION (very agitated), DYSPNOEA (couldn''t breathe/ lungs were low), ASTHENIA (weak/ very bad), YELLOW SKIN (yellow), HYPERHIDROSIS (was sweating a lot), MALAISE (I am not feeling well) and HYPOTENSION (blood pressure was very low) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002B21A and 042L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Stomach ulcer. Concurrent medical conditions included Bone cancer (In treatment for past 5 years), Hypercholesteremia and Hypertension. On 11-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 21-Mar-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). On 11-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ASTHENIA (weak/ very bad) (seriousness criterion hospitalization), YELLOW SKIN (yellow) (seriousness criterion hospitalization), HYPERHIDROSIS (was sweating a lot) (seriousness criterion hospitalization), MALAISE (I am not feeling well) (seriousness criterion hospitalization) and HYPOTENSION (blood pressure was very low) (seriousness criterion hospitalization). On 12-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (stroke) (seriousness criteria death, hospitalization and medically significant). On an unknown date, the patient experienced AGITATION (very agitated) (seriousness criterion hospitalization) and DYSPNOEA (couldn''t breathe/ lungs were low) (seriousness criterion hospitalization). The patient was hospitalized from 11-Apr-2021 to 12-Apr-2021 due to AGITATION, ASTHENIA, CEREBROVASCULAR ACCIDENT, DYSPNOEA, HYPERHIDROSIS, HYPOTENSION, MALAISE and YELLOW SKIN. On 21-Mar-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) had resolved. On 12-Apr-2021, HYPOTENSION (blood pressure was very low) outcome was unknown. The patient died on 12-Apr-2021. The reported cause of death was Stroke. It is unknown if an autopsy was performed. At the time of death, AGITATION (very agitated), DYSPNOEA (couldn''t breathe/ lungs were low), ASTHENIA (weak/ very bad), YELLOW SKIN (yellow), HYPERHIDROSIS (was sweating a lot) and MALAISE (I am not feeling well) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Apr-2021, Blood pressure measurement: low (Low) Low. Relevant concomitant medications included, cancer medications, cholesterol medications, blood pressure medications and some other unspecified medications were reported. Treatment information was not provided. The reporter was not sure if the patient has got Moderna vaccine itself. Patient was in treatment for cancer for past 5 years. His doctor has changed the pills a few years ago and he was not able to tolerate this change of pills as they were too strong. In an appointment with the doctor, patient was very agitated and could not breathe. Patient''s lungs were mentioned as too low. So the patient was with a machine that helped him to breathe properly. On 11-April-2021, patient was sent to the hospital. On 12-April-2021 past midnight, the patient died of a stroke. Company comment: This is a case of inappropriate schedule of vaccine administered for this 77-year-old male patient with medical history of stomach ulcer, hypercholesteremia and hypertension, who experienced the unexpected events of cerebrovascular accident, agitation, dyspnoea, asthenia, yellow skin, hyperhidrosis, malaise and hypotension. The events of asthenia yellow skin, hyperhidrosis, occurred 22 days after the second dose of mRNA-1273, and the remaining events occurred a day later. The rechallenge was not applicable as the events occurred after the second dose and no information about the first dose was disclosed. Causality for the events was not provided by the reporter. The benefit-risk relationship of mRNA-1273 is not affected by this report. Cerebrovascular accident is confounder by the history of bonecancer, hypercholesteremia, hypertension and advanced age. Reporter did not allow further contact; Sender''s Comments: This is a case of inappropriate schedule of vaccine administered for this 77-year-old male patient with medical history of stomach ulcer, hypercholesteremia and hypertension, who experienced the unexpected events of cerebrovascular accident, agitation, dyspnoea, asthenia, yellow skin, hyperhidrosis, malaise and hypotension. The events of asthenia yellow skin, hyperhidrosis, occurred 22 days after the second dose of mRNA-1273, and the remaining events occurred a day later. The rechallenge was not applicable as the events occurred after the second dose and no information about the first dose was disclosed. Causality for the events was not provided by the reporter. The benefit-risk relationship of mRNA-1273 is not affected by this report. Cerebrovascular accident is confounder by the history of bonecancer, hypercholesteremia, hypertension and advanced age.; Reported Cause(s) of Death: Stroke


VAERS ID: 1725559 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-23
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 INC202101221434

Write-up: my husband''s ex-wife died; This is a spontaneous report from a contactable consumer. This consumer reported that a female patient of unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The reporter stated that her husband''s ex-wife died. It was unknown if Autopsy Done. The outcome of the event was fatal. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: my husband''s ex-wife died


VAERS ID: 1725586 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Urinary tract infection
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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101226427

Write-up: He died within 5 minutes of getting the morphine.; hospitalized for a severe UTI; This is a spontaneous report from a contactable consumer or other non hcp. This consumer reported for a male patient (father). A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunization. The patient medical history and concomitant medications was not reported. The patient previously took Morphine and experienced allergic to morphine. It was stated that, the patient was older but very healthy. On an unspecified date, the patient experienced complicated severe UTI and was hospitalized, within 4 days he went from a nasal cannula to a BIPAP. He kept pulling at his BIPAP so the doctor used Morphine (for which he was allergic). He died within 5 minutes of getting the morphine. The vaccine started killing him and then the morphine finished him off. Therapeutic measures were taken as a result of the events. The seriousness of the events was serious and hospitalized. The outcome of the event was death and for complicated severe UTI was unknown. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up (21Sep2021): This follow-up is being submitted to notify that the batch number is not available despite the follow-up attempts made. Follow-up attempts have been completed and no further information is expected.; Reported Cause(s) of Death: He died within 5 minutes of getting the morphine.


VAERS ID: 1725595 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
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 INC202101227381

Write-up: Major heart attack; He kept getting sick back to back; This is a spontaneous report from a non-contactable consumer. This consumer reported for a male patient (reporter''s father) that a male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on Mar2021 (Batch/Lot number was not reported) as dose number unknown, single for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient suffered a major heart attack and passed was on 04Jul2021. Ever since the vaccine was given to him, he kept getting sick back to back in 2021. He was never diagnosed with anything before the shot. The outcome of event getting sick back to back was unknown. The outcome of event major heart attack was fatal. The patient died on 04Jul2021. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: major heart attack


VAERS ID: 1726206 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-02
Onset:2021-01-08
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Heart rate increased, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 54
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, lasix, amalodpine, placix, asa.
Current Illness: none. My husband got the first vaccine and experience a rapid heart rate approximately 6 days after, he received the second dose and had to go to the emergency room approximately 6 days later. When the Physican asked him if her had experience it rapid heart rate before he said "yes, but in went away " . His blood pressure was 199/ 119 , heart rate 220 at hospital. They sent us home and he DIED ON MARCH 3RD WITH THE EXACT SAME SYMPTOME. Pt. was a healthy person overall excerised daily and lived a really healthy lifestyle.
Preexisting Conditions: HTN, high lipids,
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rapid hearth rate after 1st and 2nd vaccine. He died .


VAERS ID: 1726211 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-19
Onset:2021-09-13
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Right Knee Bursitis
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on 9/13/2021. Verbally to be reported from a Pulmonary Embolism.


VAERS ID: 1726306 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-08-25
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute hepatic failure, Acute kidney injury, Ammonia normal, Arthralgia, Arthritis bacterial, Asthenia, Asymptomatic COVID-19, Bacteraemia, Blindness, Blindness unilateral, Blood bilirubin abnormal, COVID-19, Cerebrovascular accident, Computerised tomogram head normal, Confusional state, Death, Dyspnoea, Echocardiogram, Fatigue, General physical health deterioration, Hepatic cirrhosis, Hepatic encephalopathy, Hepatitis B test negative, Hepatitis C test negative, Hyperkalaemia, Hyponatraemia, Iritis, Joint fluid drainage, Joint injury, Joint swelling, Lethargy, Ligament sprain, Liver function test abnormal, SARS-CoV-2 test positive, Staphylococcal sepsis, X-ray limb normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Ocular infections (broad), Chronic kidney disease (broad), Arthritis (narrow), Tumour lysis syndrome (narrow), Tendinopathies and ligament disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet Blood Glucose Monitoring Suppl MISC ceFAZolin (ANCEF) 2 g/20mL SOSY syringe Insulin Pen Needle (BD ULTRA-FINE SHORT PEN NEEDLE 8 MM X 31G) lactulose (CHRONULAC) 10 GM/15ML solution Lancets (ONETOUCH DEL
Current Illness: 8.19.21: Acute Hepatic Encephalopathy (Office Visit) 8.25.21: ED visit - COVID-19 positive; fatigue 8.26.21: ED visit - shortness of breath; antibody infusion 8.30.21: Office visit 8.31.21: ED - knee injury; COVID; weakness
Preexisting Conditions: Acute on chronic diastolic heart failure Elevated LFTs Colonic polyp OSA (obstructive sleep apnea) Diabetes mellitus type 2, uncontrolled, without complications Squamous cell skin cancer, upper arm Tubular adenoma of colon Other cirrhosis of liver Thrombocytopenia, unspecified Type 2 diabetes mellitus with hyperglycemia Morbid (severe) obesity due to excess calories Body mass index (BMI) 45.0-49.9, adult Mixed hyperlipidemia Gastro-esophageal reflux disease without esophagitis Essential (primary) hypertension Long term (current) use of insulin Primary open-angle glaucoma, bilateral, mild stage Mild intermittent asthma without complication Pancytopenia Delta beta thalassemia Unspecified severe protein-calorie malnutrition Multiple comorbid conditions Counseling regarding advanced directives and goals of care End of life care
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.2.21); Deceased (9.17.21); COVID-19 positive; Fully Vaccinated Discharge Provider Primary Care Physician at Discharge Admission Date: 9/2/2021 Date of Death: 9/17/21 Time of Death: 3:30 PM Preliminary Cause of Death: Bacteremia Discharge Disposition: death DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hyponatremia Loss of vision AKI (acute kidney injury) HOSPITAL COURSE: Patient is a 70 y.o. male with a pertinent past medical history for chronic diastolic heart failure, cirrhosis, non-insulin-dependent type 2 diabetes, who presented to the ED primarily with generalized weakness and left vision sided loss. The patient''s wife is at bedside and provides aspects of history. 8/19 he started having some confusion and generalized weakness and went to the ED due to wife concern for hepatic encephalopathy, however ammonia normal. He went back to the ED 8/25 and was found to be COVID positive but did not have any symptoms, he received monoclonal antibodies the next day. He presented to the ED again 8/31 for right knee pain and swelling and thought that he may have twisted his knee, he has had a prior arthroplasty there. Radiograph was negative for fracture or other acute abnormality at that time. He then returned with left eye vision loss that started 5-6 days prior to admission that he had never mentioned until day of admission. He was noted to have hyponatremia and mild AKI both of which corrected while hospitalized. CT orbits negative for globe issue. Ophthalmology evaluated him and stated this was Iritis and started patient on prednisolone and atropine drops (the atropine caused left eye pupillary dilation). He was evaluated by ortho and had his right knee tapped which returned septic and grew MSSA. On Ancef with plan to continue 6 weeks course. His hospitalization was complicated by his lethargy and confusion likely related to pain medications and liver function. He had a stroke rap called which did not show concern for a stroke. He was found to have MSSA bacteremia as well and was seen by ID. TTE negative for vegetations. Unfortunately patient developed worsening LFTs and bilirubin. Gastroenterology was consulted. It is noted that patient had cirrhosis have baseline etiology unclear. Hepatitis-C and hepatitis-B workup were negative. Imaging did not show thrombus. Acute liver failure was initially attributed to recent anesthesia exposure and Ancef use as well as Tylenol. These medications were discontinued but LFTs continue to trend up. There was also concern for Bilateral endogenous endophthalmitis. IV Ancef was discontinued and patient was started on IV vancomycin and linezolid. Unfortunately this led to acute kidney injury with high vancomycin trough level. Given that his LFTs have continued to worsen despite stopping ancef, id felt the Ancef is less likely to be the cause of Abnormal LFTs, hence; he was placed back on Ancef and Vanco was discontinued. Unfortunately patient continued to decline and have further elevation in bilirubin levels. Ultimately after consultation with various consultants it was felt that the liver failure was more attributable to sepsis. Renal function also continued to decline with subsequent noted hyperkalemia. Given patient''s overall decline and lack of options for possible medical intervention to reverse liver failure (patient deemed not to be a transplant candidate per Gastroenterology in setting of bacteremia) patient and family ultimately decided to pursue comfort care and patient was transitioned to inpatient comfort care on 09/16. Palliative Care was consulted and assisted with medication. Patient was placed on a fentanyl drip. Physician was called that patient passed away at 3:30 p.m. 09/17/2021. Patient officially pronounced on 15:50 on 09/17/2021. Family present in room.


VAERS ID: 1726435 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-01
Onset:2021-09-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Bradycardia, COVID-19 pneumonia, Cardiac arrest, Diabetes mellitus inadequate control, Endotracheal intubation, Hypotension, Hypoxia, Mechanical ventilation, Oxygen saturation decreased, PO2 decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (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), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, diabetes
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initially diagnosed with COVID-19 pneumonia. He required intubation shortly after arrival to the ED. He required significantly elevated ventilatory support since the beginning. He has required high ventilatory settings since the beginning of his ventilation course. Throughout his course he was treated aggressively with COVID-19 treatments, his baracitinib was stopped due to concern for concomitant bacterial infection. He remained on steroids and was increased to higher doses of steroids due to continued lack of improvement. He was started on therapeutic anticoagulation due to high concern for PE. He was never stable enough for CT scan unfortunately. He had difficult to control blood sugars during his course and was at one point in time on an insulin infusion. On the morning of 9/22/21 he had worsening of his oxygenation into the low 80s with a po2 of 51. Despite no changes to his ventilator and attempts to diurese he continued to decline. His sats dropped to the 70s and his po2 dropped to 41. He continued to decline throughout the morning with persistent hypoxemia and worsening hypotension despite pressor support and early afternoon and became bradycardic and subsequently asystole.


VAERS ID: 1726482 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-17
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease, Chronic Renal disease, Chronic Liver disease, Former smoker, Unknown autoimmune condition
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and hospitalized and eventually died due to Covid related causes.


VAERS ID: 1726490 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-09-09
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID positive, admitted 9/9 for worsening hypoxia, deceased 9/10 while admitted. Fully vaccinated March 2021.


VAERS ID: 1726491 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-09-06
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Malaise
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? 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 the hospital with COVID symptoms and was treated with typical COVID medications. Patient expired while in the hospital.


VAERS ID: 1726514 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-09-14
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Malaise
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? Yes, 6 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 the hospital with COVID symptoms and was treated with typical COVID medications. Patient expired while in the hospital.


VAERS ID: 1726638 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-08-05
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Heart rate increased, Laboratory test abnormal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 26
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital for COVID-19 from 8/5/21 - 8/19/2021; discharged to nursing home where he began to have weakness and abnormal lab work with an increase in his heart rate; he was again transported to the hospital on 8/28/2021; hx of elevated liver enzymes and a known lung mass; COVID-19 pneumonia with acute hypoxemic respiratory failure


VAERS ID: 1726639 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-19
Onset:2021-08-18
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension Chronic cardiovascular disease Former smoker
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization due to shortness of breath and death


VAERS ID: 1726726 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-08-04
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Endotracheal intubation, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with productive cough, increasing SOB, fever, tested positive for COVID; HX of COPD, CHF, HTN,DM2, CKD II; intubated on 8/13, condition worsened where patient died in the hospital


VAERS ID: 1726730 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-02
Onset:2021-08-24
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Unknown autoimmune and psychological condition.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died due to Covid related causes. Patient was a resident at a Nursing and Rehabilitation facility


VAERS ID: 1726783 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-09
Onset:2021-09-02
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Death, Decreased appetite, Hypoxia, Musculoskeletal pain, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: seen in ED after a dr''s appointment for complaint of pain in L buttock area, COVID test done - positive; confusion, decreased appetite and drinking x 2days; mildly hypoxic; pt wanted to go home; dc''d to home with O2; pt died at home 5 days later


VAERS ID: 1726785 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-09-13
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Moderna COVID-19 vaccine on 2/13/21 & 3/11/21 Deceased- Positive COVID related death, 9/13/21


VAERS ID: 1726842 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-21
Onset:2021-09-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2859 / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pulse absent, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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: 2021-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, Tylenol, Albuterol, Aricept, Artificial Tears, Asprin, Atorvastatin, Biofreese, Biscadoyl, Carbidopa-Levodopa, Carveilol, Cepacol, Cetrizine, Coenzyme 10Q, Vit. B12, Cozaar, Daily multi vitamin, Colace, Lasix, Glucosamin- Chondroi
Current Illness:
Preexisting Conditions: Chronic CHF, Prakinsons, Alzheimers, Cognitive Communication Deficit, Muscle Weakness, Ceberal Infarct, Muscle Weakness, Type 2 Diabetes, A. Fib., Depressive Disorder, Hypertension, Dry Eye syndrome, Vit, B12 deficiency, back pain, constipation, mixed hyperlipidemia, bipolar disorder, primary insomonia, GERD, Artheroscelrosis,
Allergies: Cipro
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident found unresponsive without a pulse at approx. 0730am on 9/22/21, CPR initiated, spouse chose to discontinue CPR, resident expired.


VAERS ID: 1726857 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-08-29
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was hospitalized earlier with COVID-19, discharged to a nursing home where condition worsened and was brought back to hospital; presented with COVID-19 pneumonia; condition deteriorated and patient passed away in the hospital; hx of CHF, AFib, HTN


VAERS ID: 1726966 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-07-27
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Dyspnoea, Fall, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-06
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HX of multiple myeloma, BMH, CKD 3; presented to ED after a fall at home with SOB and weakness, positive for COVID; acute hypoxemic respiratory failure due to COVID pneumonia


VAERS ID: 1727109 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-15
Onset:2021-08-07
   Days after vaccination:114
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Acute respiratory failure, Anticoagulant therapy, Blood fibrinogen, Blood gases, Blood lactate dehydrogenase, Blood magnesium, Bradycardia, C-reactive protein, COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Death, Dyspnoea, Endotracheal intubation, Fibrin D dimer increased, Full blood count, Heart rate irregular, Hyperhidrosis, Liver function test, Metabolic function test, Pneumonia bacterial, Positive airway pressure therapy, Positive end-expiratory pressure, Prothrombin time, Resuscitation, Sepsis, Serum ferritin, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), 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 (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   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: hypertension medications
Current Illness: unknown
Preexisting Conditions: morbid obesity, HTN,
Allergies: No known drug allergies
Diagnostic Lab Data: CBC, CMP, PT, PTT, D DIMER, ABG''S, FIBRINOGEN, LFT, MAGNESIUM, LDH, FERRITIN, CRP. Labs concurrent with COVID pneumonia, sepsis, respiratory failure. CT, XRay chest done to assess lung status daily, continues to be concurrent with COVID pneumonia diminishing over stay.
CDC Split Type:

Write-up: obese 35yoM who presents with acute SOB which was found in the ED due to acute COVID 19. He is diaphoretic, and speaks in only short sentences, frequently expressing varying preference for BPAP or facemask. He received the Moderna vaccine series several months prior, and had been in his usual state of good health prior to the abrupt onset of symptoms. He takes medication for hypertension. DISCHARGE DIAGNOSIS: 1. Acute hypoxic respiratory failure secondary to COVID- 19 pneumonia 2. COVID- 19 pneumonia with super-imposed bacterial pneumonia 3. Sepsis secondary to above on pressor support 4. Obesity with body mass index 57 5. Elevated D-dimer He was started on NRB and BPAP, as well as all COVID therapies of steroids, anticoagulation, Colchicine, and Ivermectin. He was also started on broad spectrum antibiotics for possible super-imposed bacterial pneumonia. His oxygenation worsened and he was intubated on 8/8. His O2 levels remained difficult to control and the AM of 8/9 he was proned with increasing PEEP. His oxygenation improved and he appeared to be overall stabilizing by 8/10. The afternoon of 8/10, he was getting suctioned by RT and was noted to become bradycardic, however, this quickly resolved with Atropine and was attributed to increased vasovagal tone secondary to prone positioning and increased PEEP. He remained HD stable and his O2 remained 90s (Last recorded VS HR 61, RR 24, BP 111/67, and O2 99%). Unfortunately, at approximately 2117 the patient developed an irregular heart rate before going into ventricular tachycardia and then asystole. He was started on medical management as per guidelines and CPR was initiated as soon as possible under the direction of Dr. was never obtained and Dr called at 2150. The patient''s family was informed of his passing and all questions were answered. Cause of death appears to be cardiac arrest secondary to ventricular tachycardia secondary to hypoxic respiratory failure secondary to COVID- 19 pneumonia.


VAERS ID: 1727167 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-15
Onset:2021-08-09
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Acute kidney injury, Acute respiratory failure, Anuria, Back pain, Blood fibrinogen, Blood gases, Blood lactate dehydrogenase, Blood lactic acid, Blood magnesium, C-reactive protein, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Chest pain, Chest tube insertion, Computerised tomogram, Cough, Death, Dyspnoea, Fatigue, Fibrin D dimer, Full blood count, Inflammatory marker increased, Intensive care, Metabolic function test, Multiple organ dysfunction syndrome, Oxygen saturation decreased, Pneumonia bacterial, Pneumothorax, Prothrombin time, Renal failure, Respiratory failure, Sepsis, Septic shock, Unresponsive to stimuli, Withdrawal of life support
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), 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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA, Sinemet, Celebrex, combigan, comtan, flexeril, duloxetine, finasteride, furosemide, gabapentin, hydrocodone, jardiance, k-dur, lansoprazole, lumigan, one-a-day 50 plus, probiotic, simvastatin, synthroid, testosterone enanthate, valsart
Current Illness: unknown
Preexisting Conditions: aortic valve replacement, rheumatoid arthritis, parkinson, CHF, DM II, hypertensive heart disease, hyperlipidemia, anxiety depression, hypothyroidism, fatty liver, chronic back pain, GERD, pernicious anemia, glaucoma, BPH with obstruction, Vitamin D deficiency, low testosterone
Allergies: PCN, Travaprost, metformin, victoza
Diagnostic Lab Data: ABG, CMP, CBC, PT, PTT, FIBRINOGIN, D-DIMER, LDH, CRP, CHEST XRAY, CT, MAGNESIUM, LACTIC ACID. Labs and radiological test confirmed COVID pneumonia, sepsis, respiratory failure.
CDC Split Type:

Write-up: Acute hypoxic respiratory failure secondary to COVID-19 pneumonia Left pneumothorax 2/2 COVID-19, s/p chest tube insertion Covid-19 pneumonia with superimposed Hospital acquired bacterial pneumonia Sepsis with septic shock and multiorgan failure requiring pressors 2/2 above Acute kidney injury with anuria secondary to above Hypertension Hyperlipidemia Coronary artery disease Aortic valve replacement Congestive heart failure with diastolic dysfunction Chronic back pain Rheumatoid arthritis Anemia Hypothyroidism Diabetes mellitus II 71 yo Male with a history of hypertension, hyperlipidemia, coronary artery disease, aortic valve replacement, congestive heart failure with diastolic dysfunction, prostate enlargement, rheumatoid arthritis, and anemia presenting for cough, mild shortness of breath, and back pain. He reports that he is vaccinated and got both Moderna vaccines several months ago. He reports about 2 days of worsening fatigue, back pain, cough, and mild shortness of breath. He came to the ED for the cough and was found to have borderline low O2. He reports mild chest pain with cough only. No fever, chills, nausea, vomiting, bowel changes. His son also has COVID as is currently admitted. Patient was vaccinated and inflammatory markers were elevated Overnight 8/11, his O2 worsened to 15L NC, however, he was able to be weaned back to 3L NC. He again worsened 8/14 with concerns for HAP vs aspiration PNA. He was started on empiric coverage but he continued to decompensate and it was decided to undergo RSI on 8/16. He was moved to the ICU and began to improve being able to tolerate wean down to 50% fiO2 but then on 8/19 he began to desaturate again. Stat XR noted L sided pneumothroax requiring chest tube insertion. Despite aggressive therapy he continued to decline going into renal and eventually multiorgan failure. Spouse was updated regularly during his admission of his progress and prognosis. On 8/23/21 family notified us to discontinue aggressive care, discontinue life support, and focus on comfort measures. Emergency services was called to the bedside as patient was found unresponsive. The patient was found to be in asystole. At 1223 the patient was pronounced deceased. Family was notified.


VAERS ID: 1727193 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-27
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chronic obstructive pulmonary disease, Cough, Death, Fall, Pneumonia, SARS-CoV-2 test negative, Sepsis
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was seen in the doctor''s office earlier in the week and diagnosed with pneumonia (COVID test was negative)before being seen in the ED on 8/27; presented to ED after falling 3x in past 24hrs; c/o weakness x 1 wk and cough, pt admitted; condition worsened; COPD exacerbation with sepsis due to COVID; pt passed away in the hospital


VAERS ID: 1727253 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Biktarvy, Albuterol, Advair, Lopressor, Sublocade - (last dose 7/30/21).
Current Illness: HIV and Opioid DO,Tricuspid Prosthetic valve endocarditis. His grandmother found him dead on 9/14 8 to 8:30 pm. She said it looked like he had vomited in the commode. She did not use Narcan on him and denied that she saw evidence of drug use. She called 911 and EMS /coroner did not think an autopsy was appropriate and said "he had heart disease ".
Preexisting Conditions: HIV, Hep C - status treatment, Prosthetic TV endocarditis, Treated with IV cefazolin and then linezolid, He received sublacade previously for his Opioid use DO, ( last dose of sublacade 7/30/21).
Allergies: NKDA
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: Patient''s grandmother found him dead in the bathroom 4 to 4:30 hours after his vaccine. She was not aware of him having complaints. He had vomited in the commode -that was the only comment that she had.


VAERS ID: 1727443 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-25
Onset:2021-07-07
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731, EW0167 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   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: ADHD medication
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on July 7, 2021 of a pulmonary embolism. The clots were in his lungs.


VAERS ID: 1727463 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-03-19
Onset:2021-09-02
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal operation, Abdominal pain, Ascites, Atelectasis, COVID-19, COVID-19 pneumonia, Cerebral atrophy, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram head abnormal, Death, Gastric ulcer perforation, Intensive care, Lung consolidation, Nausea, Pleural effusion, Pneumonia, Pseudomonas test positive, SARS-CoV-2 test positive, Sputum culture positive, Vomiting, Weaning failure
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal ulceration (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine-olmesartan (AZOR) 10-40 MG per tablet atorvaSTATin (LIPITOR) 10 mg tablet donepezil (ARICEPT) 10 mg tablet escitalopram (LEXAPRO) 10 mg tablet glipiZIDE (GLUCOTROL) 5 mg tablet letrozole (FEMARA) 2.5 MG tablet memantine (NAMENDA)
Current Illness: None
Preexisting Conditions: Essential hypertension Mixed hyperlipidemia Controlled type 2 diabetes mellitus without complication, without long-term current use of insulin Obesity (BMI 30-39.9) History of breast cancer Moderate recurrent major depression Dementia without behavioral disturbance
Allergies: NKDA
Diagnostic Lab Data: Covid test at admission (9/2): rapid and PCR positive Sputum culture positive (9/9/21) - pseudomonas and stenotrophomonas CT head: 1. No evidence for acute intracranial abnormality. 2. Atrophy and mild chronic microvascular white matter ischemic changes CT Abd/Pelvis: 1. Findings most consistent with perforated gastric ulcer with associated perigastric fluid and areas of free intraperitoneal air as well as mild ascites within the upper abdomen and pelvis 2. Atelectasis left lung base and consolidation and effusion right lung base 3. Mildly distended fluid-filled distal esophagus and stomach proximally Chest xray: 1. Interval worsening of multilobar opacifications with enlarging bilateral pleural effusions consistent with diagnosis of COVID-19 pneumonia. 2. Lines and tubes as above.
CDC Split Type:

Write-up: Patient was admitted to the hospital with abdominal pain,nausea, vomiting on 9/2/21. Diagnosed with COvid-19 and perforated gastric ulcer. Had open abdominal surgery and admitted to ICU post-operatively on the ventilator. She developed ventilator associated pneumonia and was not able to successfully wean from ventilator and POA moved to comfort measures only on 9/14/21. Patient died on comfort measures.


VAERS ID: 1727523 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-19
Onset:2021-09-13
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Anxiety, COVID-19, Chest X-ray normal, Chest discomfort, Chest pain, Chronic obstructive pulmonary disease, Chronic respiratory failure, Condition aggravated, Cough, Death, Diarrhoea, Dyspnoea, Hypercapnia, Hypoxia, SARS-CoV-2 test positive, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol, ferrous sulfate, finasteride, fluticasone-umedlidin-vilant; HYDROcodone-acetminophen; ipratropium-albuterol; levothyroxine; lorazepam; MVI; potassium chloride ER; pravastatin; predniSONE; prilosec OTC; promethazine
Current Illness: 8.17.21: ED - shortness of breath 8.20.21: ED to hospital admission - acute exacerbation of COPD; chronic respiratory failure; hypoxia; hypercapnia Anxiety 9.13.21: COVID-19 positive
Preexisting Conditions: History of peptic ulcer disease Osteoarthritis of hand Hemorrhoids Osteoarthritis of lumbar spine Emphysema/COPD (HCC) GERD (gastroesophageal reflux disease) DDD (degenerative disc disease), lumbar Diverticulosis of colon Lumbar spinal stenosis Benign prostatic hyperplasia with urinary obstruction RLS (restless legs syndrome) Chronic kidney disease (CKD), stage III (moderate) Hypothyroid Hyperlipidemia, unspecified Oxygen dependent Secondary pulmonary arterial hypertension (HCC) Osteoarthritis of left shoulder History of pneumothorax - right Chronic prescription opiate use Secondary spontaneous pneumothorax Depression, major, recurrent, moderate (HCC) Chronic pain syndrome Recurrent pneumothorax s/p EBV 9/2018 Chronic respiratory failure with hypoxia (HCC) COPD with acute exacerbation (HCC) GAD (generalized anxiety disorder) ACP (advance care planning) COVID-19 with multiple comorbidities Iron deficiency anemia Insomnia Protein-calorie malnutrition, severe (HCC)
Allergies: risperidone - nausea / vomiting
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.13.21); COVID-19 positive (9.13.21); Deceased (9.22.21); Fully Vaccinated Admission Date: 9/13/2021 Discharge Date: 09/22/2021 Discharge Diagnoses: Severe COPD COVID-19 positive GAD CKD3 DISCHARGE INSTRUCTIONS Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY Hospital Course: Patient is a 81 y.o. male with PMH of O2 dependent COPD, GAD, CKD3 who presented 9/13 with chest pain/pressure and SOB. He was discharged 8/23 after hospitalization for COPD exacerbation and had loose stools, SOB, and cough. He tested positive for COVID-19 and was on baseline O2. He was having trouble sleeping due to anxiety and SOB. He was treated with Decadron for COVID-19 which was transitioned to methylprednisolone when COPD seemed to be more of his underlying problem. Initial chest x-rays and CTA were unremarkable for underlying pneumonia or blood clot. Patient''s symptoms were difficult to assess as underlying anxiety, respiratory status, or both. Patient remained on home O2. He was treated with frequent nebulizer treatments, and PRN Ativan and hydroxyzine added for underlying anxiety. He was started on antibiotics for possible underlying bacterial pneumonia on 9/17 although clinical suspicion was low. The patient did not improve symptomatically and discussed goals of care with Dr. At that point, he transitioned to comfort care on 9/19. Comfort measures were initiated and patient passed overnight 9/21-9/22.


VAERS ID: 1728780 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-12
Onset:2021-08-02
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   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:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death due to COVID-19 pneumonia and acute hypoxic respiratory failure


VAERS ID: 1729444 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-12
Onset:2021-07-01
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Death, Dizziness, Dysstasia, Headache
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Survived lung cancer in 2001, stroke in 2016.
Preexisting Conditions: See above
Allergies: N/A
Diagnostic Lab Data: N/A - Patient told these were temporary and non-life threatening. Take Tylenol and relax
CDC Split Type:

Write-up: Patient began having severe headaches within 24 hours of second dose of Moderna vaccine. The following day patient became light headed and dizzy, unable to stand up straight with blinding headaches. Called the clinic where she received the vaccine and told to relax as these were temporary side effects and that is how she knows it''s working. Headaches did not subside, patient died 2 and a half months after second dose of Moderna vaccine that was administered at the Hospital/clinic


VAERS ID: 1730184 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: COVID-19
Preexisting Conditions: Comments: Patient had underlying health problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210943824

Write-up: DEATH; HAD COVID AND DIDN''T KNOW IT; This spontaneous report received from a consumer via a company representative via Social media concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: covid-19. Patient had underlying health problems. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, Expiry: Unknown) 1 total, dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. As stated by reporter, "My uncle had covid and didn''t know it. 3 days after his exposure he got the J&J shot. 7days after that he was dead. Both my uncle and father had underlying health problems. I was exposed to my uncle, aunt and father all at the same time when they had covid and didn''t know it". The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on 2021, and the outcome of had covid and didn''t know it was not reported. This report was serious (Death).; Sender''s Comments: V0: 20210943824 -covid-19 vaccine ad26.cov2.s- Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1730309 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-01-19
Onset:2021-01-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery disease
SMQs:, Other ischaemic heart disease (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: cause of death of unknown aetiology (her spelling) coronary artery disease; This spontaneous case was reported by a patient family member or friend and describes the occurrence of CORONARY ARTERY DISEASE (cause of death of unknown aetiology (her spelling) coronary artery disease) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 19-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Jan-2021, the patient experienced CORONARY ARTERY DISEASE (cause of death of unknown aetiology (her spelling) coronary artery disease) (seriousness criterion death). The patient died on 30-Jan-2021. The reported cause of death was unknown aetiology (her spelling) coronary artery disease. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No relevant concomitant and treatment medications were reported. Company comment- This case concerns a 77-year-old, male patient with no known medical history, who experienced the unexpected event of CORONARY ARTERY DISEASE. The event occurred approximately 11 days after the first dose of Spikevax and had a fatal outcome, with death occurring in this day. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case concerns a 77-year-old, male patient with no known medical history, who experienced the unexpected event of CORONARY ARTERY DISEASE. The event occurred approximately 11 days after the first dose of Spikevax and had a fatal outcome, with death occurring in this day. The rechallenge was not applicable, as the event happened after the first dose. The event was considered related to the product per the reporter''s assessment. The benefit-risk relationship of Spikevax is not affected by this report.; Reported Cause(s) of Death: unknown aetiology (her spelling) coronary artery disease


VAERS ID: 1730336 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-09
Onset:2021-09-05
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Application site vesicles, Intracardiac thrombus
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Clot in his Heart due to the Vaccine; A small Bubble in the Injection site; This spontaneous case was reported by a consumer and describes the occurrence of INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 092D21A and 059E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 09-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced APPLICATION SITE VESICLES (A small Bubble in the Injection site). On 06-Sep-2021, the patient experienced INTRACARDIAC THROMBUS (Clot in his Heart due to the Vaccine) (seriousness criteria death and medically significant). The patient died on 06-Sep-2021. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. At the time of death, APPLICATION SITE VESICLES (A small Bubble in the Injection site) outcome was unknown. Concomitant product use was not provided by the reporter. The patient died in his sleep after 24 hours of getting his second dose of the Moderna Covid-19 vaccine. The patient did not have any existing medical condition and the cause of death indicated on death certificate was a clot in his heart due to the vaccine. Patient only had a small bubble in the injection site. No treatment information was provided. Company comment: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Sender''s Comments: This fatal case concerns a 74-year-old male patient with no medical history reported, who experienced the serious unexpected event Intracardiac thrombosis .The event occurred approximately 28 days after the first dose and one day after the second and most recent dose of mRNA-1273 Moderna vaccine. The reported cause of death was clot in his heart due to the vaccine. It is unknown if an autopsy was performed. Further information has been requested. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: Clot in his Heart due to the Vaccine


VAERS ID: 1730909 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-11
Onset:2021-08-07
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none My friend was fully vaccinated got covid on ventilator 14 days then died - how can you say it is safe and effective if you can still get it and die? Stop this madness of this vaccine NOW!
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: My friend was fully vaccinated got covid on ventilator 14 days then died - how can you say it is safe and effective if you can still get it and die? Stop this madness of this vaccine NOW!


VAERS ID: 1731177 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-21
Onset:2021-09-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Agitation, Breath sounds absent, Death, Pulse absent, Pupil fixed, Skin discolouration, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   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: SEROquel Tablet 25 MG (QUEtiapine Fumarate) Give 1 tablet by mouth every 6 hours as needed for agitation until 10/07/2021 23:59 Pharmacy Active 9/23/2021 13:45 10/7/2021 9/23/2021 There is a black box warning associated with this order. Pl
Current Illness: PARKINSON''S DISEASE (G20) 9/7/21 Primary/Principal/Admission (67) Primary/Principal/Admission EPILEPSY, UNSPECIFIED, NOT INTRACTABLE, WITHOUT STATUS EPILEPTICUS (G40.909) 9/7/21 Secondary #1 Admitting Dx (69) ATRIOVENTRICULAR BLOCK, COMPLETE (I44.2) 9/7/21 Secondary #2 Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 9/7/21 Secondary #3 Admitting Dx (69) HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I12.9) 9/7/21 Secondary #4 Admitting Dx (69) UNSPECIFIED ATRIAL FIBRILLATION (I48.91) 9/7/21 Secondary #5 Admitting Dx (69) UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE (M19.90) 9/7/21 Secondary #6 Admitting Dx (69) OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED (N13.9) 9/7/21 Secondary #7 Admitting Dx (69) GOUT, UNSPECIFIED (M10.9) 9/7/21 Secondary #8 Admitting Dx (69) ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS (I25.10) 9/7/21 Secondary 9 Or More Admitting Dx (69) CONSTIPATION, UNSPECIFIED (K59.00) 9/7/21 Secondary 9 Or More Admitting Dx (69) HYPERLIPIDEMIA, UNSPECIFIED (E78.5) 9/7/21 Secondary 9 Or More Admitting Dx (69) HYPOTHYROIDISM, UNSPECIFIED (E03.9) 9/7/21 Secondary 9 Or More Admitting Dx (69) PERSONAL HISTORY OF URINARY (TRACT) INFECTIONS (Z87.440) 9/7/21 Secondary 9 Or More Admitting Dx (69) PRESENCE OF CARDIAC PACEMAKER (Z95.0) 9/7/21 Secondary 9 Or More Admitting Dx (69) URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) 9/7/21 Secondary 9 Or More Admitting Dx (69)
Preexisting Conditions: PARKINSON''S DISEASE (G20) 9/7/21 Primary/Principal/Admission (67) Primary/Principal/Admission EPILEPSY, UNSPECIFIED, NOT INTRACTABLE, WITHOUT STATUS EPILEPTICUS (G40.909) 9/7/21 Secondary #1 Admitting Dx (69) ATRIOVENTRICULAR BLOCK, COMPLETE (I44.2) 9/7/21 Secondary #2 Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 9/7/21 Secondary #3 Admitting Dx (69) HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I12.9) 9/7/21 Secondary #4 Admitting Dx (69) UNSPECIFIED ATRIAL FIBRILLATION (I48.91) 9/7/21 Secondary #5 Admitting Dx (69) UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE (M19.90) 9/7/21 Secondary #6 Admitting Dx (69) OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED (N13.9) 9/7/21 Secondary #7 Admitting Dx (69) GOUT, UNSPECIFIED (M10.9) 9/7/21 Secondary #8 Admitting Dx (69) ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS (I25.10) 9/7/21 Secondary 9 Or More Admitting Dx (69) CONSTIPATION, UNSPECIFIED (K59.00) 9/7/21 Secondary 9 Or More Admitting Dx (69) HYPERLIPIDEMIA, UNSPECIFIED (E78.5) 9/7/21 Secondary 9 Or More Admitting Dx (69) HYPOTHYROIDISM, UNSPECIFIED (E03.9) 9/7/21 Secondary 9 Or More Admitting Dx (69) PERSONAL HISTORY OF URINARY (TRACT) INFECTIONS (Z87.440) 9/7/21 Secondary 9 Or More Admitting Dx (69) PRESENCE OF CARDIAC PACEMAKER (Z95.0) 9/7/21 Secondary 9 Or More Admitting Dx (69) URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) 9/7/21 Secondary 9 Or More Admitting Dx (69)
Allergies: Amoxil, ACE Inhibitors
Diagnostic Lab Data: None- Resident is a patient with DX of End Stage Parkinson''s with life expectancy of less than 6 months.
CDC Split Type:

Write-up: 9/23/2021 2:30pm- Resident noted having agitation this shift taking his right arm and banging on the wall with his right arm noted 3 new discolorations to his right forearm and hand. Resident continued to bang on wall hospice notified visited resident to assess status change. Resident noted having agitation this shift taking his right arm and banging on the wall with his right arm noted 3 new discolorations to his right forearm and hand. Resident continued to bang on wall hospice notified visited resident to assess status change. New order for Seroquel 25mg in the am and 2 25mg tabs at bedtime with prn dose 25mg as needed for agitation q6h will evaluate need for prn medication on 10-7-21. Resident is resting comfortably in his bed at this time. 9/23/2021 9:30pm- Resident noted to be non responsive with no audible or visible signs of life. Unable to obtain BP. Unable to auscultate apical pulse or palpate any peripheral pulses. Respirations are nonexistent. Pupils non reactive to light, fixed and dilated. Hospice notified of findings. Family notified, son stated he did not set up funeral home arrangements and will be calling right away and would contact facility. Pronouncement of death made by Dr.


VAERS ID: 1731202 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-09-09
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Confusional state, Death, Decreased appetite, Fall, Fatigue, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt presented to hospital after a fall earlier today, c/o abdominal pain, confusion, fatigue and decreased appetite x 1 wk; tested positive for COVID; condition deteriorated where pt passed away in the hospital.


VAERS ID: 1731203 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-20
Onset:2021-05-14
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Electrocardiogram, Imaging procedure, Laboratory test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   Days after onset: 133
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, dexamethasone, lovenox, ferrous gluconate, Lasix, lisinopril, cellcept, prednisone, sodium bicarbonate, prograf
Current Illness: Previous kidney transplant
Preexisting Conditions: Hypertension, prostate problems, immunocompromised state, gout, anemia
Allergies: Erythromycin
Diagnostic Lab Data: multiple labs, ekg, imaging from 9-20 to 9-24-21.
CDC Split Type:

Write-up: Pt received Pfizer vaccination series at local pharmacy. Was hospitalized with COVID-19 diagnosis 9-20-21. Passed away 9-24-21.


VAERS ID: 1731205 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-09-10
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, dyslipidemia, seizure disorder, GERD, BPH, hypertension, chronic constipation and DVT
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital with covid pneumonia on 9/10/21. Patient was fully vaccinated with doses of Pfizer covid vaccine with first dose on 2/1/2021 and second dose on 2/23/21. Patient eventually required intubation and ultimately expired on 9/23/21.


VAERS ID: 1731226 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-09-09
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Nausea, Pyrexia, SARS-CoV-2 test positive, Sick relative, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt''s husband positive for COVID, pt presents to ED with c/o progressive weakness, N/V/D x 2 wks; fever, non-productive cough, SOB; positive COVID test; pt''s condition worsened where she died in the hospital


VAERS ID: 1731246 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-08
Onset:2021-07-19
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriosclerosis coronary artery, COVID-19, Cardiac failure, Cough, Death, Malaise, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 07/19/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with Symptom onset 7/19/21; c/o cough, congestion, malaise. Death 8/3/2021. From vital records: HEART FAILURE UNSPECIFIED, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, COVID-19. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed. place of death: NURSING HOME-LONG TERM CARE FACILITY,, PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: HOMEMAKER, OWN HOME


VAERS ID: 1731261 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-09-11
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   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:
Current Illness:
Preexisting Conditions: HTN, CHF, DM, HX OF BREAST CANCER, COPD, OBESITY
Allergies:
Diagnostic Lab Data: POSITIVE COVID19 ON 8/23/21
CDC Split Type:

Write-up: PRESENTED TO ED WITH DYSPNEA, TESTED COVID19 POSITIVE. DEVELOPED ACUTE RESP FAILURE AND DIED 9/11/21


VAERS ID: 1731266 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-08-08
Onset:2021-08-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 UN / SYR

Administered by: Pharmacy       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: 2021-08-01
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased. Heart attack. 24-48 hours after 2nd injection.


VAERS ID: 1731299 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-14
Onset:2021-09-20
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Electrocardiogram, Imaging procedure, Laboratory test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Anemia, immunocompromised state, gout, elevated prostate specific antigen, hyperlipidemia, history of kidney transplant, hyptertension
Allergies: Erythromycin
Diagnostic Lab Data: Labs, imaging, EKG 9-20 through 9-24.
CDC Split Type:

Write-up: Fully vaccinated individual, hospitalized on 9-20-21 for COVID. Passed away 9-24-21.


VAERS ID: 1731305 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-25
Onset:2021-09-08
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 4
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: Dysphagia, Anxiety Disorder, Alzheimer''s, Major Depressive Disorder, Malignant neoplasm of skin (Right upper limb, incl. shoulder)., chronic lung disease
Allergies:
Diagnostic Lab Data: 09/08/2021 Antigen+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 9/9/2021-9/12/2021. Death 9/12/2021. Death certificate not yet available


VAERS ID: 1731338 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-08-15
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Delirium, General physical health deterioration, Lethargy, Mental status changes, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT PRESENTED WITH ALTERED MENTAL STATUS, DELERIUM WHICH RESULTED IN LETHARGY; POSITIVE FOR COVID-19, HX OF CLL AND A FIB; PT''S CONDITION WORSENED WHERE SHE DIED IN THE HOSPITAL


VAERS ID: 1731354 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-26
Onset:2021-03-05
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Cardiac failure congestive, Death, Hypertension, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HYPERTENSION, CHRONIC KIDNEY DISEASE
Allergies:
Diagnostic Lab Data: 03/08/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 3/8/2021: abdominal pain. Hospitalized 3/5/2021 for unknown duration. Death 6/1/2021. From Vital Records COD = CHRONIC DIASTOLIC CONGESTIVE HEART FAILURE, HYPERTENSION. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: CHRONIC KIDNEY DISEASE PERIPHERAL VASCULAR DISEASE ADULT FAILURE TO THRIVE. place of death: NURSING HOME-LONG TERM CARE FACILITY, PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: OWNER OPERATOR, RETAIL


VAERS ID: 1731362 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-08-07
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Ageusia, Anosmia, COVID-19, COVID-19 pneumonia, Chills, Cough, Death, Diarrhoea, Dyspnoea, General physical health deterioration, Hypoxia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with hypoxia, cough, SOB, chills, loss of taste and smell, loose stools; hx of HTN; tested positive for COVID-19; acute chronic kidney disease; pt deteriorated during the hospital stay and eventually passed away in the hospital; COVID-19 pneumonia


VAERS ID: 1731372 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-19
Onset:2021-05-06
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Death, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-30
   Days after onset: 55
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: ALZHEIMER''S WITH DEMENTIA DISEASE, DIABETES MELLITUS TYPE 2
Allergies:
Diagnostic Lab Data: 05/06/2021 PCR+ COVID-19 test; 05/10/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Death 6/30/2021. From Vital Records COD = ACUTE CARDIOPULMONARY ARREST, ALZHEIMER''S WITH DEMENTIA DISEASE, DIABETES MELLITUS TYPE 2. Per vital records; Other Significant Conditions include: None listed. place of death: DECEDENT''S HOME; certified by: CERTIFYING PHYSICIAN; occ/ind: HOME ECONOMICS TEACHER, EDUCATION


VAERS ID: 1731400 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-08-23
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Chills, Decreased appetite, Diarrhoea, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: positive for COVID on 8/23; took monoclonal antibodies on 8/25 and dc''d to home; presented to ED 8/27 with SOB, chills, fever, poor appetite, diarrhea x5days, generalized weakness; acute respiratory failure


VAERS ID: 1731423 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-08-16
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Confusional state, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with c/o dyspnea, confusion, known bronchitis (on a Z pack), hypoxic; positive COVID -19 test; severe acute hypoxic respiratory failure; pt intubated; condition worsened where patient died in the hospital; hx of HTN, HL, NIDDM


VAERS ID: 1731435 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 213
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Pfizer. Tested positive for COVID 19 @ 9/15/2021. Admitted on 9/15/2021 and expired on 9/20/2021 while still hospitalized.


VAERS ID: 1731451 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-08-18
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Cough, Death, Dyspnoea, Hypoxia, Pneumothorax, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt tested positive for COVID on 8/18; presented to ED on 8/24 hypoxic with confusion, SOB, coughing; placed on BIPAP; pneumothorax occurred; condition worsened where patient died in hospital


VAERS ID: 1731465 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-08-21
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized for unknown reasons. Patient was fully vaccinated. Died due to COVID.


VAERS ID: 1731525 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-08-19
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / -

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

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

Write-up: hx of pituitary adenoma - post surgical resection back in April 2021; presented to ED with weakness and SOB, positive for COVID - 19; pt''s condition worsened where he passed away in the hospital; Acute hypoxemic respiratory failure secondary to COVID pneumonia


VAERS ID: 1731557 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-08-27
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, Hypoxia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hx of recent hospitalization for cellulitis, dc''d home with IV antibiotic therapy; tested positive for COVID while in the hospital; presented to ED with severe hypoxia; respiratory failure with intubation; AFib; COVID pneumonia; pt passed away in the hospital


VAERS ID: 1731564 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-06
Onset:2021-08-09
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, Dyspnoea, Nausea, Respiratory arrest, SARS-CoV-2 test positive, Vaccine breakthrough infection, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic kidney disease stage 4, immunosuppressive condition, diabetes, COPD, congestive heart failure, DVT, hypertension, hypercholesterolemia
Allergies:
Diagnostic Lab Data: 8/9/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom onset: sob/difficulty breathing, nausea or vomiting, generalized weakness. Hospitalized 8/9/2021 to 8/16/2021. Death 8/16/2021. COD respiratory arrest, COVID-19. Place of death: HOSPITAL. CERTIFIED BY PRONOUNCING AND CERTIFYING PHYSICIAN


VAERS ID: 1731598 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-08-24
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Mechanical ventilation, Obesity, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 3
Permanent Disability? No
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to ED with SOB x 1wk, worsening; morbidly obese; cough, hypoxic; hx of CHF, chronic A Fib, DM2; positive for COVID; intubated on mechanical ventilation; condition worsened, pt died in the hospital


VAERS ID: 1731635 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-02
Onset:2021-07-31
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Dyspnoea, Nausea, Pain, Pulmonary oedema, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, diabetes, fibromyalgia, chronic pain, glaucoma
Allergies:
Diagnostic Lab Data: 7/31/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 7/24/2021: weakness, cough, body aches, nausea, cough, congestion, anorexia, shortness of breath. Hospitalized 7/31/2021 for unknown duration. Death 8/27/2021. COD reported by ICP Acute respiratory failure with hypoxia, COVID-19 pneumonia, pulmonary edema, Acute kidney failure


VAERS ID: 1731647 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-09-17
Onset:2021-09-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Was being treated at a local hospital for COPD/Pneumonia. Hospital called and asked if we could come and give a COVID vaccine to patient since he had not left his house in a year. They felt Janssen would be best fit for him since transport
Current Illness: Was presently Hospitalized
Preexisting Conditions: COPD
Allergies: NKDA
Diagnostic Lab Data: RN at hospital would be able to help you and find more information for you.
CDC Split Type:

Write-up: Client was discharged from hospital on 09/20/2021 and was found deceased on 09/21/2021


VAERS ID: 1731676 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-09
Onset:2021-08-02
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 8/2/2021 Antigen+ COVID-19 test; 8/9/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalization, unknown date and duration. Death 8/11/2021. COD from vital records: hypoxemic respiratory failure, COVID-19 pneumonia. Place of death: HOSPITAL INPATIENT, PRONOUNCING AND CERTIFYING PHYSICIAN, occ/ind: UPHOLSTERER, UPHOLSTERY


VAERS ID: 1731686 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-06
Onset:2021-01-27
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, Mechanical ventilation, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 238
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 47 year old female with a multiple co morbidties including asthma, bipolar disorder, primary hypothyroidism, oxygen dependent possible chronic obstructive lung disease ( 3 liters nasal cannula), liver cirrhosis(Non alcoholic serohepatitis), depression, history of tobacco use, diabetes mellitus type 2, gastroesophageal reflux and obesity (BMI 60). Tested COVID positive 8/31. Patient required intubated. Patient completed 10 days of Decadron and 5 days of Remdesivir. Patient was not able to be weaned from the vent and was made comfort care 9/23 and expired shortly after.


VAERS ID: 1731745 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-19
Onset:2021-07-16
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Deep vein thrombosis, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-31
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: hospitalization
CDC Split Type:

Write-up: Was taken to pharmacy for Janssen Covid-19 shot, she passed away after hospitalization for bilateral blood clots in lungs and blood clout in leg. Date of death July 31, 2021. (Cause of death per death certificate: pulmonary thromboembolism and deep venous thrombosis.)


VAERS ID: 1731846 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-04-29
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Extubation, Intensive care, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 04/29/21 SARS-CoV-2 (COVID-19) by NAA - DETECTED
CDC Split Type:

Write-up: On 04/29/21 pt. presented to EC in respiratory distress via EMS; "Hx of CHF, NSCLC with mets to brain"; subsequently admitted to ICU; Palliative extubation was carried out on 05/05/21, which is when patient diet.


VAERS ID: 1731894 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-18
Onset:2021-04-09
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 OT / OT

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Intensive care, Shock, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (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), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 155
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 82 year old female with a PMH of CAD, HTN, HLD. Received Decadron,Remdesivir and Barcitinib. Ended up going to the ICU for shock and VT arrest.


VAERS ID: 1731925 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-28
Onset:2021-04-16
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 OT / OT

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Endotracheal intubation, Intensive care
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 148
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 63-year-old male with a past medical history of right lung transplant, hypertension, hyperlipidemia, type 2 diabetes, GERD. 8/30/2021 to 8/31/2021 patient was admitted for COVID-19 and that admission he received 2 doses of remdesivir and 2 doses of dexamethasone and he was discharged home 9/2/2021 he returned to the emergency department with complaint of generalized weakness. Still taking Decadron. 9/5/2021 Received Tocilizumab 9/6/2021 patient had increased work of breathing, a rapid response was called and he was transferred to the ICU and intubated. 9/11 Patient was made comfort care


VAERS ID: 1732122 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-26
Onset:2021-03-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6103 / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: Insulin Heart meds
Current Illness: congestive Heart falure
Preexisting Conditions: Diabetes , Congestive heart failure
Allergies: Quibron
Diagnostic Lab Data: Pronounced death in home the next morning
CDC Split Type:

Write-up: Death sometime the next A.M.


VAERS ID: 1732172 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-30
Onset:2021-08-29
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Acute respiratory failure, Ageusia, Blood bicarbonate increased, Blood chloride decreased, Blood creatinine increased, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Catheter placement, Chest X-ray abnormal, Condition aggravated, Continuous haemodiafiltration, Cough, Death, Dyspnoea, End stage renal disease, Endotracheal intubation, General physical health deterioration, Haemoglobin decreased, Hypervolaemia, Hypotension, Inflammatory marker test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Intensive care, Lung opacity, Mechanical ventilation, Platelet count normal, Pleural effusion, SARS-CoV-2 test positive, Shock, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (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 (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 650mg QID albuterol MDI 2 puffs QID prn SOB ascorbic acid 1000mg daily ASA 81mg daily atorvastatin 20mg daily cat''s claw daily folic acid/B complex daily guaifenesin as needed iron sucrose complex 50mg IVP weekly midodrine su
Current Illness: 8/18/21 Recurrent right pleural effusion
Preexisting Conditions: CHF ESRD on hemodialysis hyperlipidemia hypertension OSA Recurrent right pleural effusion
Allergies: ciprofloxacin hydralazine
Diagnostic Lab Data: 8/25/21 NP swab positive for SARS-CoV-2, negative for influenza A/B 8/28/21 Na 138, K+ 3.8, Cl 96, HCO3 34, BUN 20, Cr 4.0, WBC 4.26, Hgb11.4, Plt 164, CRP 57 CXR Mixed interstitial and airspace opacities, right greater than left primarily in the mid-to-lower lung zones and increased from 08/13/2021 chest radiograph. Moderate right pleural effusion, increased in volume
CDC Split Type:

Write-up: 8/25/21 Pt was seen by PCP office for cough and loss of taste. Was positive for SARS-CoV-2 8/29/21 He presented to the ED w/ worsening cough and SOB. RA pulse ox was 85%. He was admitted. Hospital course as below. Family did change his care to comfort care and the patient died on 9/4/21 Patient is a 66 year old male with a history of end-stage renal disease requiring hemodialysis, chronic systolic heart failure with LVEF 20%, chronic hypotension, anemia of chronic disease, secondary hyperparathyroidism, DVT who was admitted on August 28 for acute hypoxemic respiratory failure, Covid pneumonia, and fluid volume overload. Nephrology was consulted with management of hemodialysis while hospitalized. Infectious disease was consulted. He was started on IV steroids, IV remdesivir, and daily inflammatory markers. The patient experienced worsening hypoxemia and respiratory failure requiring high flow nasal cannula. He required escalating requirements on high flow nasal cannula and was transferred to the intensive care unit on 9/2/2021. Critical care was consulted for management. Palliative care was consulted for goals of care discussion with no changes in plan of care. On 9/3/2021, the patient deteriorated requiring endotracheal intubation and mechanical ventilation. He was placed in the prone position due to hypoxemia. He developed severe acidosis. Temporary HD catheter was placed. This evening, he had continued acidosis with increasing vasopressor requirements. The case was discussed with nephrology and he was started on CVVHD. There were complications with initiation of CVVHD as multiple filters clotted off after initiation. The patient developed progressive hypotension and shock requiring max dosing of norepinephrine, phenylephrine, vasopressin, epinephrine. He received a total of 6 A of sodium bicarb. The patient''s deteriorating condition was discussed with his daughters. He was transitioned to a DNR CCA. The patient expired cessation of vital signs on 9/4/2021 at 1:10am. Discharge Diagnoses: Acute hypoxemic respiratory failure Covid pneumonia ESRD HD dependent Shock Systolic heart failure with LVEF 20% OSA on CPAP


VAERS ID: 1732186 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-01
Onset:2021-09-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Cardioversion, Death, Malaise, Myocardial infarction, Nausea, Respiratory arrest, Resuscitation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   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: xyzal
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Paramedics stated he died of heart attack.
CDC Split Type:

Write-up: Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom. That continued off and on all night. Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak. H e went back to bed. We checked on him around lunch time lying on his bed with his phone in his hand. He appeared to be trying to text. I checked on him a few minutes later and he had not moved. I checked and saw he wasn''t breathing. At that time he had a heart beat. We called 911 and I started CPR and continued for approx 25 until paramedics arrived. They bagged him and used defibrillator but could not bring him back.


VAERS ID: 1732348 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-25
Onset:2021-09-16
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 2
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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown


VAERS ID: 1732399 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-21
Onset:2021-09-23
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 7+ RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   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: Unknown
Current Illness: Yes
Preexisting Conditions: Yes Facility reported Urine retention Foley catheter, Acute Kidney Injury, Bowel obstruction and DNR
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse effect during the 15 minutes after administration of vaccine patient expired on 9/23/21 reported by facility


VAERS ID: 1732415 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Diaphragmatic spasm, Dyspnoea, Malaise
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-11
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Digitalis, nitro-patch, blood thinners, hydromorphone, medication for nausea
Current Illness: None
Preexisting Conditions: heart weakness, tumors in his bladder, prostate cancer
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: increased feeling of unwellness and weakness, gasping like chest or stomach spasms


VAERS ID: 1732810 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 124
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: heart disease.
Allergies: nuts
Diagnostic Lab Data: Medical staff was not interested in discussing side effects.
CDC Split Type:

Write-up: breathing, chest pain, and severe pain within joints.


VAERS ID: 1733185 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: amLODIPine 10 mg oral tablet, 10 mg= 1 tabs, Oral, QDAY atorvastatin 40 mg oral tablet, 40 mg= 1 tabs, Oral, QPM, 3 refills buPROPion 300 mg/24 hours (XL) oral tablet, extended release, 300 mg= 1 tabs, Oral, QAM calcium (as carbonate)-vi
Current Illness: Anemia CHF Colon polyp Depression Diabetes type 2 with nephropathy Diabetic foot GERD Hyperlipidaemia Hypertension Morbid obesity Renal insufficiency Creat 4.09 S/P colostomy Nephrotic syndrome Toe amputation status
Preexisting Conditions: Diabetes with sequela including CKD 4, nephrotic syndrome, osteomyelitis and amputation
Allergies: Pip/tazo
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Death


VAERS ID: 1733803 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210937311

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received via a company representative concerned multiple patients. No past medical history or concurrent conditions were reported. Initial information was processed along with the additional information received on 21-SEP-2021. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported,1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. The reporter claimed that out of those who were vaccinated and hospitalized (date and duration unspecified), had received the JnJ (Johnson and Johnson) vaccine. On an unspecified date, 2 deaths were reported who had received the JnJ vaccine and the context did imply death not due to the vaccine but due to the covid virus itself (suspected covid-19 infection and suspected clinical vaccination failure). It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died from suspected covid-19 infection. The outcome of the suspected clinical vaccination failure was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged). This report was associated with product quality complaint number 90000194196.; Sender''s Comments: V0: 20210937311-Covid-19 vaccine ad26.cov2.s-Suspected Covid 19 infection. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210937311-Covid-19 vaccine ad26.cov2.s-Suspected Clinical Vaccination Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: SUSPECTED COVID-19 INFECTION


VAERS ID: 1733808 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-08-14
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210814; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210941196

Write-up: DEATH; SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a consumer concerned a male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, 1 total, administered on 30-JUN-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. It was reported that "My sister''s husband waited a while to get vaccinated. She and I both had a very high regard for this virus very early on. His job was giving J&J and he got it there on June 30th. He tested positive on August 14th and passed on August 24th. His doc told us J&J not great w/Delta" Laboratory data included: COVID-19 virus test (NR: not provided) Positive. On 24-AUG-2021, the patient died from unknown cause of death. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was dead on 24-AUG-2021, had not recovered from suspected covid-19 infection, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This report was associated with product quality complaint: 90000194157.; Sender''s Comments: V0-20210941196-COVID-19 VACCINE AD26.COV2.S-Death. This event(s) is considered un-assessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s). 20210941196-COVID-19 VACCINE AD26.COV2.S-Suspected Clinical Vaccination Failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1733812 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210943888

Write-up: DEATH; This spontaneous report received from a pharmacist through reports (from other doctors and nurses) concerned 6 or 7 patients. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown expiry: unknown) dose, start therapy date were not reported, frequency time 1 total was administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. The reporter stated that, on an unspecified date 6 or 7 patients died due to unknown cause of death after receiving the Janssen covid-19 vaccine around the time of the food and drug administration (FDA) pause of vaccine. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20210943888-covid-19 vaccine ad26.cov2.s-death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1733856 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210947994

Write-up: DIED; This solicited report received from a patient via JS2021-30756: COVID 19 Consumer. The patient''s weight, height, and medical history were not reported. The patient initiated treatment with covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown expiry: unknown) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The reporter provided no causality assessment. Company causality between covid-19 vaccine ad26.cov2.s, and died was not related. This report was serious (Death). This case, from the same reporter is linked to 20210941085 and 20210941906.; Sender''s Comments: V0: 20210947994-COVID-19 VACCINE AD26.COV2.S -Died. This event(s) is considered not related. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1734141 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-19
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiomegaly
SMQs:, Cardiac failure (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101177018

Write-up: killed this young man/he died of an enlarged heart (500+ grams); The initial case was missing the following minimum criteria: unidentified reporter. Upon receipt of follow-up information on 20Sep2021, this case now contains all required information to be valid. This is a spontaneous report from Pfizer sponsored Program, via contactable consumers. A 16-year-old male patient received BNT162B2 via an unspecified route of administration on 19Apr2021 (Lot Number: ER8731; Expiration Date: Jul2021) (at 16-year-old) as dose 1, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died in 24Apr2021. His father claimed he took the Pfizer vaccine five days before (24Apr2021) he died and that he died of an enlarged heart (500+grams) from Apr2021. It''s not reported if autopsy performed. Follow-up attempts are completed. No further information is expected. ; Reported Cause(s) of Death: died of an enlarged heart


VAERS ID: 1734211 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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 INC202101234857

Write-up: had a stroke and passes away; This is a spontaneous report from a contactable consumer. A 37-year-old patient of an unspecified gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date (at unknown age) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Caller is inquiring about the Pfizer COVID-19 vaccine. He wants to know if the booster shot is required in the US for the general population or only for immunocompromised patients? The 37-year-old had a stroke and passes away." The virus is not messing around". Caller was not able to confirm if reported cases were vaccinated or not. Caller stated "Pfizer is better than Moderna. They have done more research." Caller also pleased about the results on the use of the Pfizer COVID-19 vaccine in a younger population. The patient died on an unspecified date. It was unknown if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: had a stroke and passes away


VAERS ID: 1734215 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101236254

Write-up: heart attacks; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient experienced heart attacks on an unspecified date. The outcome of the event was fatal. The patient died on an unspecified date. Autopsy was done. The lot number for the vaccine [BNT162B2] was not provided and will be requested during follow up.; Reported Cause(s) of Death: heart attacks


VAERS ID: 1734218 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101238417

Write-up: Heart attack; This is a spontaneous report from a contactable consumer. A 56-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. This consumer reported information on additional patient. Caller reported that person in her county just had someone die from heart attack right while they had The Vaccine in the office-he was 56 and healthy. Caller mentioned they''ve had people who had autopsies who were administered the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. This is serious report for results in death. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: Heart attack


VAERS ID: 1734237 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-22
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101253272

Write-up: One family member who is dying today after being taken off the ventilator. The dying family member was vaccinated with the Pfizer vaccine; This is a spontaneous report from a Pfizer sponsored program CEP 159558.. A non-contactable consumer reported that a patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date as single dose for covid-19 immunisation. Medical history and concomitant medications were not reported. Reporter was concerned about taking the vaccine, she has a few family members who took the vaccine and got sick afterwards and has one family member who is dying today after being taken off the ventilator. The dying family member was vaccinated with the Pfizer vaccine. Read beginning of ISI. Reporter disconnected, had to take a call from family member about dying family member. Will fax AE to report family members sick and family member dying after vaccine. Event onset date was 22Sep2021. It was not reported if Autopsy Done. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: One family member who is dying today after being taken off the ventilator. The dying family member was vaccinated with the Pfizer vaccine


VAERS ID: 1734462 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-21
Onset:2021-09-25
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cough, Death, Dyspnoea, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: emphysema
Allergies: Tetanus Toxoids - Nausea & Vomiting - reported 6/4/18
Diagnostic Lab Data:
CDC Split Type:

Write-up: on Day 8 post vaccination, who presents to ED complaining of worsening shortness of breath for the past 4 days associated with cough and fever. Tested positive for COVID 8/29/21. Pneumonia, ARF, Septic Shock, AKF, Received CRRT from effects of Baricitinib, . Coded resulting in Death 9/25/21.


VAERS ID: 1734587 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-08-24
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

Administered by: Pharmacy       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: 2021-08-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: diabetes, heart disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart attack, death


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