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

Found 17,128 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

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VAERS ID: 1736840 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-22
Onset:2021-09-23
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 17B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardioversion, Circulatory collapse, Death, Dyspnoea, Echocardiogram, Endotracheal intubation, Resuscitation, SARS-CoV-2 test positive, Syncope, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (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 (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Hypoglycaemia (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Post-mortem COVID-19 PCR pos.
CDC Split Type:

Write-up: Patient brought to ED by EMS after being found unresponsive. Patient reportedly was eating food, began to have trouble breathign, collapsed, and became unresponsive. Patient received 1 defibrillation prior to arrival for V-fib per EMS. King airway placed with bag-valve-mask and CPR in place upon arrival. Patient intubated upon arrival in ED. Received multiple medications including epinephrine, calcium, sodicum bicarbonate, magnesium, amiodarone. No return of spontaneous circulation Bedside u/s showed no cardiac activity. TIme of death 1712hrs on 9/23/2021. Post-mortem PCR COVID-19 test was postiive.


VAERS ID: 1736876 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-29
Onset:2021-09-13
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Fatigue, Intensive care, Myalgia, Nausea, Parosmia, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive, Taste disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 10
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: AMLODIPINE, ATENOLOL, AZITHROMYCIN, ESCITALOPRAM, HCTZ, LISINOPRIL, PIOGLITAZONE, TAMSULOSIN, ZOPIDEM
Current Illness:
Preexisting Conditions: HYPERTENSION, GOUT, T2NIDDM
Allergies:
Diagnostic Lab Data: POSITIVE COVID-19 PCR TEST ON 09/20/2021
CDC Split Type:

Write-up: ONSET 09/13/2021 WITH SOB, MYALGIA, RHINORRHEA, OLFACTORY/TASTE DISORDER, FATIGUE, COUGH, FEVER 102.6, NAUSEA RESULTING IN ICU HOSPITALIZATION AND DEATH


VAERS ID: 1736905 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-09
Onset:2021-08-27
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, 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), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300mg; aspirin 81mg; Cardura 4mg; ibuprofen 200mg; zyrtec 10mg
Current Illness:
Preexisting Conditions: Hypertension; Obstructive Sleep Apnea; Gout; BPH; Morbid obesity
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID infection admitted with acute hypoxic respiratory failure secondary to SARS-CoV-2


VAERS ID: 1736918 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-25
Onset:2021-08-29
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 29
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: DM
Preexisting Conditions: DM
Allergies: NKDA
Diagnostic Lab Data: troponin on admit 0.34 (09/04/2021)
CDC Split Type:

Write-up: Shortness of breath


VAERS ID: 1737002 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-31
Onset:2021-08-10
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-27
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: 2021-08-14
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown conditions or risk factors
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is fully vaccinated, then later hospitalized and died four days later due to Covid related causes. Patient was resident of long-term care facility


VAERS ID: 1737038 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Coronary artery disease, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: Hypoxia on 9/24, but patient did have coronary artery disease with chest pain starting 8/6/21.


VAERS ID: 1737051 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-24
Onset:2021-08-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure chronic, Cardiac failure congestive, Chronic obstructive pulmonary disease, Condition aggravated, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Memantine, Trelegy, Buspirone, Warfarin, Atorvastatin, Albuterol, metoprolol, furosemide, donepezil
Current Illness: CHF, COPD, Dementia
Preexisting Conditions: Pulmonary artery HTN, GERD, Depression, HTN, Type 2 diabetes
Allergies: None
Diagnostic Lab Data: ER visit 8/26 or 8/27 leading up to death
CDC Split Type:

Write-up: Acute exacerbation of end stage CHF and Endstage COPD


VAERS ID: 1737079 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-19
Onset:2021-08-19
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aneurysm, Death, Fall, Headache, Malaise
SMQs:, Accidents and injuries (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 37
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Rushed to emergency hospital 9/25/2021 then air lifted to another HCF
CDC Split Type:

Write-up: Severe headache within 4 hours of shot and after 4 days of feeling very unwell Pt stood up and fell over instantly of and aneurysm and died .I lost my partner of 23 years due to vaccination


VAERS ID: 1737140 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-01-19
Onset:2021-08-28
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 29 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: MS, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed, hospitalized and expired from COVID-19


VAERS ID: 1737142 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-04-30
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardioversion, Death, Dyspnoea, Endotracheal intubation, Intensive care, Pyrexia, SARS-CoV-2 test positive, Supraventricular tachycardia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), 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: 2021-05-11
   Days after onset: 11
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: 04/30/21 SARS-CoV-2 (COVID-19) by NAA - DETECTED
CDC Split Type:

Write-up: Pt. presented to EC on 04/30/21 c/o SOB for several weeks, progressing, and subjective fever; PMHx significant for COPD, IDDM2; admitted to acute care but subsequently transfered to ICU, intubated on 05/09; developed SVT that had to be cardioverted x1; compassionately extubated and expired 05/11/21.


VAERS ID: 1737143 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-11
Onset:2021-09-14
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8721 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown


VAERS ID: 1737160 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-23
Onset:2021-09-21
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   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: Morbid obesity, CKD stage 3, Hx CVA, Lupus, CHF
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed, hospitalized and expired from COVID


VAERS ID: 1737167 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-11
Onset:2021-08-19
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EM9810 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Bronchiectasis, COVID-19, Cough, Death, Pulmonary embolism, 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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease
Allergies:
Diagnostic Lab Data: 08/19/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/19/2021: Cough. Hospitalized 8/19/2021 for unknown duration. Death 8/26/2021. Vital records COD = ACUTE HYPOXIC RESPIRATORY FAILURE, COVID-19. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: BRONCHIECHIECTASIS PULMONARY EMBOLUS; Place of death: HOSPITAL;


VAERS ID: 1737223 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-05
Onset:2021-08-09
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Dizziness, Dyspnoea, Hypercoagulation, Obesity, Obstructive shock, Protein deficiency, Pulmonary embolism, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Proteinuria (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: 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: Chronic lung disease, Diabetes, Cardiovascular disease
Allergies:
Diagnostic Lab Data: 08/09/2021 PCR+ Medical Laboratories; 08/24/2021 PCR+ Medical Center.
CDC Split Type:

Write-up: Breakthrough COVID-19 with symptom onset 8/24/2021: Shortness of breath/difficulty breathing. Hospitalization 8/24/2021. Death 8/24/2021. From Vital Records COD = OBSTRUCTIVE SHOCK, SADDLE PULMONARY EMBOLUS, HYPERCOAGULABLE STATE, COVID 19. Per vital records, Codes include: Not yet coded ; Other Significant Conditions include: MORBID OBESITY PROTEIN DEFICIENCY. Place of death: HOSPITAL-INPATIENT, MEDICAL CENTER; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: PEER COUNSELOR, SERVICE. Dizziness. Pt c/o dizziness while at work. Pt COVID+ 8/9/21 and fully vaccinated. Pt VSS, GCS 15. Ambulatory on arrival. Denies N/V/fever


VAERS ID: 1737230 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Missouri  
Vaccinated:2020-12-30
Onset:2021-06-02
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Autopsy, Chest X-ray, Hernia, Laboratory test, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Labetalol arorvastin
Current Illness: None
Preexisting Conditions: None
Allergies: Nka
Diagnostic Lab Data: Labs, chest xray
CDC Split Type:

Write-up: On 06/02/2021 my father started having extreme abdominal pain. He visited er and was sent home with a surgeon follow up in one week. They said he had a hernia However no hernia was noted on autopsy report. He died suddenly on the morning of 6/9/2021 just before surgeon appointment


VAERS ID: 1737285 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-08-21
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, HTN, CVA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT DEVELOPED COVID19 INFECTION FOLLOWED BY SUBSEQUENT HOSPITALIZATION AND DEATH


VAERS ID: 1737314 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-27
Onset:2021-01-30
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood pressure decreased, Blood test abnormal, Malaise
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   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: My mom had COVID-19 in December 2020 and was determined to be "out of danger" on 12/16. She had had a dry cough on 12/3, and a PCR test returned positive on that day. I believe she had loss of taste a day or two before 12/3. My mom was put on oxygen support during her COVID-19 illness. This was very unusual for my mom to require oxygen.
Preexisting Conditions: My mother had many long-standing health conditions, however none of them were related to respiratory issues or required her to be on oxygen.
Allergies:
Diagnostic Lab Data: See #18.
CDC Split Type:

Write-up: On Jan. 30, 2021, my mom''s blood pressure dropped, she was placed on oxygen support, and a blood panel indicated elevated risk of blood clotting. This was shortly after receiving a dose of Moderna COVID vaccine on or about Jan. 27. These symptoms seemed very similar to what she had experienced in December when she contracted COVID.


VAERS ID: 1737322 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-09-26
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. developed COVID-19 virus and passed away on 9/26/21


VAERS ID: 1737341 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-09-10
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 16
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: Coronary artery disease with stent, pacemaker, GERD, dyslipidemia, Hypertension, Non-insulin dependent diabetes mellitus, chronic kidney disease stage IIIB
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated on 3/16/21 and 4/14/21 with moderna covid vaccines. Admitted to hospital with COVID pneumonia requiring nasal cannula oxygen initially. Oxygen requirements increased and patient later required high flow oxygen. Patient was admitted on 9/10/21 and expired on 9/26/21


VAERS ID: 1737367 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-08-28
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown- Medical Records unavailable
Current Illness: Unknown- Medical Records unavailable
Preexisting Conditions: Unknown- Medical Records unavailable
Allergies: Unknown- Medical Records unavailable
Diagnostic Lab Data: 8/28/21 PCR positive NP Swab
CDC Split Type:

Write-up: On 8/28/21 after patient had been fully vaccinated, Patient became COVID positive. On 8/30/21, her respiratory status declined and she was admitted to Hospital. On 9/18/21 while still admitted as inpatient, she declined and required mechanical ventilation and ICU care. On 9/22/21 case died.


VAERS ID: 1737481 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-08-31
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Death, Dyspnoea, General physical health deterioration, Lung consolidation, Pneumonia, Pneumothorax, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: presented to ED with c/o worsening SOB x 3days, respiratory distress, collapse of left lower lobe secondary to consolidation versus atelectasis; earlier was diagnosed with bilateral pneumonia; has taken her antibiotics; was diagnosed with COVID a few days after pneumonia diagnosis; pt''s condition deteriorated and patient died in the hospital


VAERS ID: 1737526 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-09-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: General physical health deterioration, Hypotension, Hypoxia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Voltaren Gel 1 % (Diclofenac Sodium)Apply 1 application transdermally two times a day, Acetaminophen Liquid 160 MG/5ML give 30 ml by mouth three times a day, Refresh Optive Advanced Solution 0.5-1-0.5 % (Carboxymeth-Glycerin-Polysorb)Instil
Current Illness: Resident had been admitted to hospice in April 2021 d/t terminal diagnosis of Alzheimer''s dementia. He continued to have issues with dysphagia and needed a mechanically altered diet. He had increase difficulty was speech and making needs known. He was w/c bound and required total assistance.
Preexisting Conditions: Hypertensive heart and chronic kidney disease with heart failure, Diabetes Mellitus, Parkinson''s Disease, Alzheimer''s dementia, anemia, BPH, TIA
Allergies: TB Skin test
Diagnostic Lab Data: None due to end of life wishes.
CDC Split Type:

Write-up: Resident was administered 3rd dose d/t immunocompromising condition. He was on hospice at the time of vaccination living in a nursing home. He was observed to have a blood pressure lower than normal on 9/21/21 and hypoxia and tachycardia. The resident received morphine. He continued to decline and was provided comfort/end of life care.


VAERS ID: 1737583 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Diarrhoea, Fatigue, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: IHSS
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vomiting, diarrhea, fatigue, DEATH


VAERS ID: 1737614 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-01-31
Onset:2021-02-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Intensive care
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 32
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Estrogen and Blood pressure
Current Illness: Bronchitis
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: Do not have any records of testing
CDC Split Type:

Write-up: First dose January 10, 2021. Second dose January 31,2021. Awakened early February 1 and admitted to ICU where she remained until death March 5, 2021


VAERS ID: 1738037 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-24
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, COVID-19, Cough, Death, Extra dose administered, Interchange of vaccine products, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test positive, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad), 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify Atorvastatin Banophen Gabapentin Hydrochlorothiazide Trulicity Ibuprofen Lantus Lisinopril Sertraline Metformin Pregabaln Trazodone
Current Illness: 57 yo female with DM, HTN, hyperlipidemia, and a recent illness of covid 19 diagnosed 9/13/21 three days after a Pfizer booster on 9/10/21 (although patient had Johnson and Johnson 3/12/21), congestion, sore throat, cough initially. On (day 8) noted that had some GI upset with emesis which continued throughout the week with some possible coffee grounds emesis. Patient went to take a shower and was found unresponsive 10 minutes later and died
Preexisting Conditions: DM2, Renal insufficiency, HTN, hyperlipidemia, remote methamphetamine abuse
Allergies: NKDA
Diagnostic Lab Data: 9/13/21 COVID positive test
CDC Split Type:

Write-up: Death on 9/24/21. Pfizer administered on 9/10/21. Jand J on 3/12/2021


VAERS ID: 1738061 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-08-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Death, Dyspnoea, Headache, Intensive care, Laboratory test, Malaise, Myalgia, Nausea, Oropharyngeal pain, Oxygen saturation decreased, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 21
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: Metformin, Hydrochlorothiazide, Prednisone, Aleve, Cetirizine, Tizanidine
Current Illness: Rheumatoid Arthritis
Preexisting Conditions: Asthma, Obesity, Hypertension
Allergies: Tobacco
Diagnostic Lab Data: Multiple (Check with medical facility).
CDC Split Type:

Write-up: Developed COVID Symptoms within <24 hours of receiving vaccine (Sore throat, mild fever, headache the morning after the vaccine). Patient had minimal to no contact with any other people prior to vaccination, and had not been around any individuals exposed to COVID in the past 2 weeks. Symptoms included fever, headache, nausea, joint & muscle pain, difficulty breathing, low oxygen stats, and vomiting. Patient was taken to medical facility on September 6th, was admitted to the hospital, and later transferred to the MICU. Patient pronounced dead September 18, 2021.


VAERS ID: 1738259 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Disorientation, Fall, Feeling of despair, Immunodeficiency, Incoherent
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad), Dehydration (broad)

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: Not Known
Current Illness: Not known
Preexisting Conditions: Not known
Allergies: Morphine
Diagnostic Lab Data: Not sure. The hospital wouldn''t share that information
CDC Split Type:

Write-up: Patient came in to receive his 3rd dose of Pfizer Covid-19 vaccine. He said he qualified as immunocompromised. The pharmacist on duty stated that he appeared to be in good health as far as she could tell. Team member claimed he was disoriented upon checking out for his purchase, they helped him to his car. He crumpled to the ground and team members helped him sit up in his car and waited with him for EMS. After a few minutes we were told that he became incoherent and this continued when EMS arrived. EMS medic came to the pharmacy around 12:30pm to let the pharmacist know the patient was despondent. Upon later information from the family, the patient had passed away at the hospital due to a brain bleed.


VAERS ID: 1738486 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-17
Onset:2021-08-12
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, amlodipine, insulin, vitamin D, Advair, levothyroxine, lisinopril, melatonin, metoprolol, omeprazole
Current Illness:
Preexisting Conditions: Diabetes, hypertension, hyperlipidemia, hypothyroidism, chronic kidney disease
Allergies: Keflex, atorvastatin, niacin, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced breakthrough COVID infection despite getting vaccine. She passed away on 9/14/21.


VAERS ID: 1738603 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-17
Onset:2021-09-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   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: Ill and weak for at least a month that pushed off 2nd dose
Preexisting Conditions: Immunocompromised
Allergies: Patient and son verified that patient had no allergies, nor any history of allergic reactions or anaphylaxis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administration was uneventful. Patient and son confirmed that patient was cleared for vaccine and that she was well during and after the observation period. No signs of distress and no abnormality of breathing.


VAERS ID: 1739176 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-09-10
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death


VAERS ID: 1739931 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-08-01
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, COVID-19, Death, Diarrhoea, Pulmonary embolism, SARS-CoV-2 test, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DEXAMETHASONE; ATIVAN; SEROQUEL; PRILOSEC [OMEPRAZOLE]; ZOLOFT; MINIPRESS; PROLIA; POTASSIUM CHLORIDE; VITAMIN D [ERGOCALCIFEROL]; CALCIUM; MAGNESIUM; LOXITANE [LOXAPINE SUCCINATE]
Current Illness: 21-hydroxylase deficiency; Congenital adrenal hyperplasia; CVA; Diverticulosis; Gastritis; Gastroduodenitis; Gastrointestinal arteriovenous malformation; GI bleed; Hyperlipidemia; Ischemic cerebral infarction; Lung nodule; Melena; Meningioma
Preexisting Conditions: Comments: The patient had no current illness other than clinical diagnoses.
Allergies:
Diagnostic Lab Data: Test Date: 202108; Test Name: Autopsy; Result Unstructured Data: Pulmonary embolism cause of death; Test Date: 20210803; Test Name: SARS-CoV-2 test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210907659

Write-up: DEATH; PULMONARY EMBOLISM; COVID-19; SARS-COV-2 TEST POSITIVE; VOMITING; DIARRHOEA; AUTOPSY; This spontaneous report received from a health care professional via a Regulatory Authority Vaccine Adverse Event Reporting System (VAERS) (VAERS ID 1624304) concerned a 51 year old female patient of unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: congenital adrenal hyperplasia, 21-hydroxylase deficiency, CVA (Cerebrovascular accident), white matter periventricular infarction, meningioma, lung nodule, hyperlipidemia, gastritis, gastroduodenitis, GI (Gastrointestinal) AVM (Arteriovenous malformation), GI bleed, melena, and diverticulosis, and the patient had no other current illness. The patient experienced drug allergy when treated with acetylsalicylic acid (Aspirin), codeine, escitalopram, etodolac (Lodine), olanzapine (Zyprexa), Olanzapine and risperidone for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: unknown, expiry: Unknown) dose was not reported, 1 total administered on 02-AUG-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. Concomitant medications included calcium, denosumab (Prolia), dexamethasone, ergocalciferol (Vitamin D), lorazepam (Ativan), loxapine succinate (Loxitane), magnesium, omeprazole (Prilosec), potassium chloride, prazosin hydrochloride (Minipress), quetiapine fumarate (Seroquel) and sertraline hydrochloride (Zoloft) used for unknown indication. On 03-AUG-2021, the patient experienced diarrhoea, vomiting (till 09-AUG-2021 and tested positive for COVID-19 (Coronavirus) via SARS-CoV-2 test. On the same day the patient experienced pulmonary embolism. On 09-AUG-2021, the patient was found dead at her residence. On an unspecified date in AUG-2021 an autopsy was performed, and pulmonary embolism was found to be the cause of death. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of death, pulmonary embolism, autopsy, covid-19, diarrhoea, vomiting and SARS-CoV-2 test positive was fatal. This report was serious (Death). This report was associated with product quality complaint: 90000192669. The suspected product quality complaint has been confirmed to be undetermined. The reported allegation could not be confirmed. A manufacturing related root cause could not be identified based on the PQC evaluation/investigation performed. Additional information was received from Central Complaint Vigilance on 23-SEP-2021. The following information was updated and incorporated into the case narrative: Product complaint investigation result was updated. Upon review, the following information was amended: labeling for the events vomiting and diarrhea was updated from labeled to unlabeled.; Sender''s Comments: V3: The follow up information in this version updates: Product complaint investigation result, Labelling of events vomiting and diarrhea updated. This updated information does not alter the causality of previously reported events. 20210907659-Covid-19 vaccine ad26.cov2.S- Pulmonary embolism, Death, Autopsy, Covid-19, Diarrhoea, Vomiting, SARS-CoV-2 test positive. 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: PULMONARY EMBOLISM


VAERS ID: 1739934 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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: 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: Frailty
Preexisting Conditions: Medical History/Concurrent Conditions: Vaccination adverse reaction (The patient always reacted badly to annual vaccinations.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210940998

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; DEATH; This spontaneous report received from a consumer (patient''s friend) via a company representative and via social media concerned a female patient of unspecified age, race and ethnic origin The patient''s height, and weight were not reported. The patient always reacted badly to annual vaccinations. It was reported that the patient was fragile. 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, 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 the patient was unknowingly incubating covid-19 (start date unspecified) at the time of vaccination (suspected covid-19 infection, and suspected clinical vaccination failure), and was hospitalized (date unspecified) for its treatment. On an unspecified date, the patient was sent home. On an unspecified date, the patient died at home from an unknown cause. It was unknown if an autopsy was performed. As per reporter, ''''The only person that I know who died in proximity to the vax was a friend who was fragile, always reacted badly to annual vaxes, took the J and J while unknowingly incubating the covid infection, went to the hospital for treatment only to be sent home where she died.'''' The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of death was reported as fatal, and the outcome of suspected covid-19 infection and suspected clinical vaccination failure was not reported at the time of death. This report was serious (Death, Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender''s Comments: V0: 20210940998-Covid-19 vaccine ad26.cov2.s-Death, 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). 20210940998-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: 1740065 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Multiple heart attack patients (4 to 5); 2 people died; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (2 people died) and MYOCARDIAL INFARCTION (Multiple heart attack patients (4 to 5)) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (2 people died) (seriousness criteria death and medically significant) and MYOCARDIAL INFARCTION (Multiple heart attack patients (4 to 5)) (seriousness criteria hospitalization and medically significant). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, MYOCARDIAL INFARCTION (Multiple heart attack patients (4 to 5)) outcome was unknown. Concomitant medications were not reported. Multiple people had heart attacks after vaccine. Two people died after getting the COVID-19 vaccine. Treatment information was not provided. Company Comment: This case concerns a patient of unknown gender and age, with no relevant medical history, who experienced the unexpected events of myocardial infarction and death. Cause of death was unknown. The events occurred after a dose of mRNA-1273. Very limited information regarding this case and this event has been provided. The benefit-risk relationship of mRNA-1273 is not affected by this report. This case was linked to MOD-2021-323668, MOD21-144997 (Patient Link).; Sender''s Comments: This case concerns a patient of unknown gender and age, with no relevant medical history, who experienced the unexpected events of myocardial infarction and death. Cause of death was unknown. The events occurred after a dose of mRNA-1273. Very limited information regarding this case and this event has been provided. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1740088 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-07-30
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Cerebrovascular accident, Death, Inappropriate schedule of product administration, Pneumonia aspiration, Sepsis, Urinary tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypertension (narrow), Medication errors (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 42
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: Test Name: elevated blood pressure; Result Unstructured Data: elevated blood pressure
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: stroke; UTI; sepsis; aspiration pneumonia; first dose on 17Jun2021 (048A21A) Second dose was administered on 27Jul2021; Death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death), CEREBROVASCULAR ACCIDENT (stroke), URINARY TRACT INFECTION (UTI), SEPSIS (sepsis), PNEUMONIA ASPIRATION (aspiration pneumonia) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose on 17Jun2021 (048A21A) Second dose was administered on 27Jul2021) in an 88-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 009C21A and 048A21A) for COVID-19 vaccination. No Medical History information was reported. On 17-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Jul-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Jul-2021, the patient experienced CEREBROVASCULAR ACCIDENT (stroke) (seriousness criteria death, hospitalization and medically significant). On an unknown date, the patient experienced URINARY TRACT INFECTION (UTI) (seriousness criteria hospitalization and medically significant), SEPSIS (sepsis) (seriousness criteria hospitalization and medically significant), PNEUMONIA ASPIRATION (aspiration pneumonia) (seriousness criteria hospitalization and medically significant) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose on 17Jun2021 (048A21A) Second dose was administered on 27Jul2021) (seriousness criterion medically significant). The patient died on 10-Sep-2021. The reported cause of death was Stroke. It is unknown if an autopsy was performed. At the time of death, URINARY TRACT INFECTION (UTI), SEPSIS (sepsis), PNEUMONIA ASPIRATION (aspiration pneumonia) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (first dose on 17Jun2021 (048A21A) Second dose was administered on 27Jul2021) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Blood pressure increased: elevated blood pressure (High) elevated blood pressure. No concomitant medications information was reported. No treatment medications were provided. This is a case of Inappropriate schedule of vaccine administered concerning an 88-year-old female patient with no reported medical history who experienced the fatal unexpected events of cerebrovascular accident, urinary tract infection, sepsis and aspiration pneumonia. The events of urinary tract infection, sepsis and aspiration pneumonia occurred on an unspecified date after CVA occurred 3 day after the second dose and the subject expired 1 month 4 days after the second dose of mRNA-1273 The rechallenge was not applicable as events occurred after second dose with a fatal outcome. Causality assessment for the event was not provided by the reporter. However, the subject is of an advanced age and UTI is of an infective origin which can lead to sepsis and thus assessment with product used is determined as unlikely. The benefit-risk relationship of mRNA-1273is not affected by this report; Sender''s Comments: This is a case of Inappropriate schedule of vaccine administered concerning an 88-year-old female patient with no reported medical history who experienced the fatal unexpected events of cerebrovascular accident, urinary tract infection, sepsis and aspiration pneumonia. The events of urinary tract infection, sepsis and aspiration pneumonia occurred on an unspecified date after CVA occurred 3 day after the second dose and the subject expired 1 month 4 days after the second dose of mRNA-1273 The rechallenge was not applicable as events occurred after second dose with a fatal outcome. Causality assessment for the event was not provided by the reporter. However, the subject is of an advanced age and UTI is of an infective origin which can lead to sepsis and thus assessment with product used is determined as unlikely. The benefit-risk relationship of mRNA-1273is not affected by this report; Reported Cause(s) of Death: stroke


VAERS ID: 1740112 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Illness
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: USMODERNATX, INC.MOD20213

Write-up: Patient dies of covid-19 related illness weeks afetr receiving second covid vaccine; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (Patient dies of covid-19 related illness weeks afetr receiving second covid vaccine) in a 36-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced ILLNESS (Pateint dies of covid-19 related illness weeks afetr receiving second covid vaccine) (seriousness criterion death). The reported cause of death was covid related illness. It is unknown if an autopsy was performed. No concomitant medications were provided. No treatment information was provided. This case concerns a 36-year-old patient of an unknown gender with no reported medical history of who experienced the unexpected fatal event of covid 19 related illness. The event occurred after an unspecified time after administration of the second dose of mRNA-1273. The rechallenge was not applicable as this event occurred after the second dose with a reported fatal outcome. Causality assessment for the event was not reported. However, covid 19 is considered as not applicable due biologically implausible based on known etiology. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 36-year-old patient of an unknown gender with no reported medical history of who experienced the unexpected fatal event of covid 19 related illness. The event occurred after an unspecified time after administration of the second dose of mRNA-1273. The rechallenge was not applicable as this event occurred after the second dose with a reported fatal outcome. Causality assessment for the event was not reported. However, covid 19 is considered as not applicable due biologically implausible based on known etiology. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: covid related illness


VAERS ID: 1740221 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
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 INC202101238100

Write-up: The PCP had a cousin that died from the covid vaccine; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received bnt162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The reporter''s new PCP recommended that she not take the COVID vaccine. The PCP had a cousin that died from the COVID vaccine. They had done all of the autopsy and everything and he had just died, so the doctor had kind of advised caller not to do it. The patient died on an unspecified date. The cause of death was not reported. The lot number for the vaccine BNT162B2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: died from the covid vaccine


VAERS ID: 1740232 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 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 INC202101252349

Write-up: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine; This is a spontaneous report from a contactable consumer via a Pfizer-sponsored program COVAX Support. This consumer reported similar events for four patients. This is one of four reports. A patient of unspecified age and gender received BNT162B2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The reporter stated that he has been doing some research on the amount of people who have died from taking the COVID-19 vaccine and what adverse events they have had after receiving the vaccine. He stated that he has personally gone to 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine but stated he didn''t know whether they were Moderna or Pfizer or (Company name withheld) and he doesn''t know one person who has died from the actual virus. He just wanted information. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for BNT162b2 was not provided and will be requested during follow up.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101252919 same reporter/drug/AE, different patient;US-PFIZER INC-202101252918 same reporter/drug/AE, different patient;US-PFIZER INC-202101252916 same reporter/drug/AE, different patient;US-PFIZER INC-202101252917 same reporter/drug/AE, different patient; Reported Cause(s) of Death: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine


VAERS ID: 1740523 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Vaccination failure, Vaccine breakthrough infection
SMQs:, Lack of efficacy/effect (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: Chronic renal failure; Dyslipidemia; Hypertension; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210949213

Write-up: DEATH; BREAKTHROUGH INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a physician via a company representative concerned a male of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. The patient''s past medical history included: hypertension, dyslipidemia, type 2 diabetes, and Chronic renal failure (CKD). The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose, 1 total administered on unspecified therapy start date for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced breakthrough infection with Covid-19 vaccine ad26.cov2.s(suspected clinical vaccine failure), and died. 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 outcome of breakthrough infection and suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: 20210949213-covid-19 vaccine ad26.cov2.s-Suspected Clinical Vaccination Failure. This event(s) is considered not related. The event(s) has an 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 20210949213-covid-19 vaccine ad26.cov2.s-Death, breakthrough infection. This event(s) is considered unassessable. The event(s) has an 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: 1740529 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210951234

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer (patient''s niece) concerned a male of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown and expiry: unknown) dose, therapy start date were not reported, 1 total for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On JUL-2021 (two months prior), the patient experienced blood clots and died. It was unspecified 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: V0.20210951234-Covid-19 vaccine ad26.cov2.s -Blood clot. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOTS


VAERS ID: 1740571 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Intracranial aneurysm
SMQs:, Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: USMODERNATX, INC.MOD20213

Write-up: brain aneurism; This spontaneous case was reported by an other health care professional and describes the occurrence of INTRACRANIAL ANEURYSM (brain aneurism) in an adult female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced INTRACRANIAL ANEURYSM (brain aneurism) (seriousness criteria death and medically significant). The reported cause of death was brain aneurism. 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 concomitant medication details were provided. It was reported that the person around it''s 30''s died from a brain aneurism right after receiving the Moderna Vaccine. No treatment information was mentioned. This case concerns female patient of unknown age with no relevant medical history reported, who experienced the unexpected event of intracranial aneurysm. The event occurred on an unknown number of days after the first dose of mRNA-1273 and had a fatal outcome on an unknown date. No autopsy report was provided. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Sender''s Comments: This case concerns female patient of unknown age with no relevant medical history reported, who experienced the unexpected event of intracranial aneurysm. The event occurred on an unknown number of days after the first dose of mRNA-1273 and had a fatal outcome on an unknown date. No autopsy report was provided. The rechallenge was not applicable, as the event happened after the first dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Reported Cause(s) of Death: brain aneurism


VAERS ID: 1740603 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2021-02-05
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (The patient was allergic to Bactrim, because hand was turning red and developed a rash on the face, back and itching hands.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Oxygen level; Result Unstructured Data: low
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Developed pneumonia after the vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Developed pneumonia after the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026B21A and 042L20A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (The patient was allergic to Bactrim, because hand was turning red and developed a rash on the face, back and itching hands.). On 05-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Mar-2021, received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PNEUMONIA (Developed pneumonia after the vaccine) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized for 8 days due to PNEUMONIA. The patient was treated with ZOLEDRONIC ACID (RECLAST) for Adverse event, at an unspecified dose and frequency. The reported cause of death was Pneumonia. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Oxygen saturation: low (Low) low. No concomitant medications were reported. Company Comment: This case concerns a patient with of unknown age and gender, as well as unknown medical history, who experienced the unexpected event of pneumonia that ended with fatal outcome. The temporal relationship remained unknown having in mind that the date of vaccination and date of the event were not provided. If was unknown if the autopsy was performed. The rechallenge was not applicable, as the event ended with fatal outcome. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report. This case was linked to MOD-2021-325775, MOD-2021-325636 (Patient Link).; Sender''s Comments: This case concerns a patient with of unknown age and gender, as well as unknown medical history, who experienced the unexpected event of pneumonia that ended with fatal outcome. The temporal relationship remained unknown having in mind that the date of vaccination and date of the event were not provided. If was unknown if the autopsy was performed. The rechallenge was not applicable, as the event ended with fatal outcome. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: Pneumonia


VAERS ID: 1740833 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-02
Onset:2021-09-25
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 08B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 1
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: Covid-19 after complete vaccination. Patient expired on 9/26/2021


VAERS ID: 1740836 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-04-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 6206 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8733 / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Asthenia, Confusional state, Feeding disorder, Gait inability, Laboratory test, Loss of personal independence in daily activities, Malaise, Malnutrition, Mobility decreased, Pain, Pruritus, Renal impairment, Speech disorder, Staphylococcus test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-23
   Days after onset: 40
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: rheumatoid arthritis, diabetes in remission
Preexisting Conditions: rheumatoid arthritis
Allergies: penicillin
Diagnostic Lab Data: The hospital conducted many tests and diagnosed her with MRSA 2times and then reported that both of the tests were contaminated and that she didn''t have MRSA. Hospital said that she wasn''t getting enough nutrition for her kidneys to function properly. She was too sick to eat and became too fragile to have a feeding tube.
CDC Split Type:

Write-up: my mother complained of pains all over her body the night of first shot. She continued to have pain. My mother also became very confused after 1st shot and would speak inappropriately and repeat herself often. She stayed in bed all day and had no energy to to do regular routine. She was very itchy and vomited after 2nd dose. the day after second dose she was unable to ambulate and continued throwing up. When I called ambulance she could not even answer basic questions like how old she was.


VAERS ID: 1740865 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-21
Onset:2021-09-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Malaise, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   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: losartan 50 mg 1 daily, eliquis 5mg 1 twice a day levothyroxine 125mcg 1 once a day, liothronine sod 5mcg 2 tab once a day
Current Illness:
Preexisting Conditions: hypothyroidism, sick sinus syndrome
Allergies: none
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: felt sick tired and no appetite, and headache the day after the vaccine the next day felt ok no complaints still no real appetite the third day had coffee got up to do dishes and apparently just dropped where she stood and died.


VAERS ID: 1741038 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-09-25
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPIRED; BREAKTHROUGH CASE OF COVID-19


VAERS ID: 1741067 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-09-23
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Confirmed PCR positive
CDC Split Type:

Write-up: Pt died after contracting COVID-19 in Sep 2021. Pt developed COVID pneumonia


VAERS ID: 1741085 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-06
Onset:2021-09-20
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   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: Unknown
Current Illness: Ulcerative colitis, Cellulitis of RLE CKD, Polycystic Kidney disease, Osteoarthritis, Hyperlipidemia, Post kidney transplant, Long term use of immunosuppressive drug, would of lower extremity, ESRD on dialysis, CVA, Immunosuppressed status,
Preexisting Conditions: Ulcerative colitis, Cellulitis of RLE CKD, Polycystic Kidney disease, Osteoarthritis, Hyperlipidemia, Post kidney transplant, Long term use of immunosuppressive drug, would of lower extremity, ESRD on dialysis, CVA, Immunosuppressed status,
Allergies: NKA
Diagnostic Lab Data: 9/21/2021 SARS CoV RAP RNA (RT RNA) positive 9/23/2021 SARS CoV RNA (RT RNA) positive 9/23/2021 SARS CoV PAN (RT RNA) positive
CDC Split Type:

Write-up: Developed Acute Respiratory Failure leading to intubation and death.


VAERS ID: 1741118 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-01
Onset:2021-09-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Anticoagulant therapy, COVID-19, Cryotherapy, Deep vein thrombosis, Echocardiogram abnormal, Ejection fraction decreased, Exposure to SARS-CoV-2, General physical health deterioration, Hypoxia, Left ventricular dysfunction, Leg amputation, Peripheral ischaemia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted on 9/7/2021 with COVID-19 and sever hypoxia. Known COVID contact several days prior. Treated with remdesivir, dexamethasone, ceftriaxone, and azithromycin. Also started on barictnib on 9/9 but stopped due to ARF. Echocardiogram showed EF of 25-50% with moderately severe LV function. Started on heparin and continued throughout hospital stay. DVT in right lower leg. Seen by infectious disease and continued on cefepime and levofloxacin for 14 days. Underwent cryo-amputation of right ischemic lower extremity and then BKA by vascular surgery. Prognosis poor and not improving. Family elected comfort care.


VAERS ID: 1741146 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-22
Onset:2021-09-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported by individual - Parents told EMS and Death Investigator that he had been "sick a few weeks ago". He was last tested for COVID-19 for his job on 8-16-21 and was negative. It was a PCR test.
Preexisting Conditions: None reported
Allergies: NKA
Diagnostic Lab Data: No medical or lab tests were done by the Death Investigator. An autopsy was ordered and the body was sent to the State Medical Examiner for an autopsy.
CDC Split Type:

Write-up: Parents reported to Death Investigator that patient complained of body aches, severe headache, and pain in his lower extremities on the evening of 9/22/21 (thee date he received the vaccine). He was taking Tylenol for his symptoms per his parents. On Thursday, 09/23/21, he continued with the above symptoms and felt worse per parents. Mother asked him if he needed to go to the doctor and he said no. On Friday, 09/24/21, he felt better than the day before but still had symptoms. Parents last talked with him around 2230 Friday night. They went to wake him up at 1100 on Saturday, 09/25/21 and found him deceased in the bed. EMS was called and he was transported to Hospital Emergency Department DOA.


VAERS ID: 1741219 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-18
Onset:2021-09-15
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Atrial fibrillation, Bradycardia, COVID-19, Chronic kidney disease, Condition aggravated, Death, Dyspnoea, Electroencephalogram normal, Endotracheal intubation, Fibrin D dimer increased, Hyperkalaemia, Magnetic resonance imaging abnormal, Malnutrition, Metabolic encephalopathy, Microangiopathy, SARS-CoV-2 test positive, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (broad), Arrhythmia related investigations, signs and symptoms (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), Noninfectious encephalopathy/delirium (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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 (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI: chronic microangiopathic disease but no evidence of anoxic injury EEG: no seizure activity
CDC Split Type:

Write-up: Pt wife tested positive for COVID-19. Pt tested positive 9/15/21. Presented to ED 9/17/21 with SOB. Intubated upon arrival. Terminal extubation on 9/22/21. Deceased 9/23/21. Discharge Dx: Sepsis d/t COVID-19. Acute hypoxemic resp failure, Moderate ARDS, Acute metabolic encephalopathy, Elevated d-dimer, Afib, Bradycardia, CKD Stage 3a, moderate protein calorie malnutrition, hyperkalemia. HO smoking, afib, hyperlipidemia


VAERS ID: 1741248 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-07-13
Onset:2021-09-28
   Days after vaccination:77
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dhiarrea


VAERS ID: 1741267 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-26
Onset:2021-09-25
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / UNK - / IM

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

Life Threatening? No
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Bacterial Epiglottitis
Preexisting Conditions: Obesity
Allergies: Unknown
Diagnostic Lab Data: Autopsy 9/27/2021
CDC Split Type:

Write-up: Patient died and preliminary autopsy revealed Massive pulmonary embolism


VAERS ID: 1741301 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-30
Onset:2021-09-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alprazolam, atorvastatin, olmesartan, clonidine, I-CAPS oral multivitamin, metroprolol tartrate, amlodipine, calcium-vitamin D, ferrous sulfate, torsemide, meloxicam, hydrocodone-acetaminophen, potassium chloride, lansoprazole, escitalopram
Current Illness: None
Preexisting Conditions: Anxiety Diarrhea associated with pseudomembranous colitis GERD Heart murmur History of knee problem Hypertension Iron deficiency anemia Morbid obesity Primary osteoarthritis of right foot Vision problem History of MRSA infection
Allergies: propoxyphene - drowsiness
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received first dose of COVID-19 vaccine on 8/30/2021. Patient was then hospitalized on 9/7/2021 with COVID-19 symptoms. Patient was a no code/no intubation at admission. Patient ultimately progressed to high flow oxygen and was made compassionate care and passed away on 9/19/2021.


VAERS ID: 1741327 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-26
Onset:2021-09-12
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray abnormal, Confusional state, Death, Dyspnoea, Echocardiogram abnormal, Ejection fraction, Fall, Heart rate decreased, Humerus fracture, Hypoxia, Lung infiltration, N-terminal prohormone brain natriuretic peptide increased, SARS-CoV-2 test positive, Troponin T increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 90-year-old male history of AFib, on anticoagulation with Eliquis, HTN, dementia, DM type 2, BPH presents with increasing shortness of breath. Previously lived in an assisted living facility, was admitted on 08/23 with confusion and generalized weakness, decreased heart rate. He was treated with IVF hydration, empiric antibiotics with ceftriaxone azithromycin, 2D echocardiogram was performed that demonstrated a preserved EF, he was transferred to a local SNF. He fell upon arrival to the sniff within 24 hours, with a subsequent left proximal humerus fracture, and is pending outpatient orthopedic evaluation. Unfortunately patient tested positive for COVID-19 on 08/31. He is fully vaccinated since January ''21. Felt in ED profoundly hypoxic, proBNP elevated $g39k, troponin T 262, CXR with bilateral multifocal infiltrates. Initiated on treatment with dexamethasone, Remdesivir, IV diuresis, and supplemental O2. Patient was seen by Cardiology and Pulmonary during hospitalization. They recommended continuing present management as above and reiterated patient has very poor overall prognosis given his multiple comorbidities and frail state. Unfortunately, despite aggressive treatment, at 3:55 a.m. On 09/12/2021, patient passed away. His family was notified of death by nursing staff.


VAERS ID: 1741335 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-27
Onset:2021-09-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3014SBA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   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:

Write-up: Patient suffered from cardiac arrest and past away due to underlying medical conditions on 9-28-2021.


VAERS ID: 1741359 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-09-26
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, COVID-19, Chest tube insertion, Death, Dyspnoea, Fatigue, General physical health deterioration, Intensive care, Mechanical ventilation, Oxygen saturation decreased, Pneumothorax spontaneous, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 57 y.o. male with a history of testing testing diabetes, bronchitis, hypertension and recent COVID-19 infection presenting with worsening shortness of breath and fever at 102. Initially treated outpatient with antibiotics steroids without improvement. Patient presented today with decreased oxygen saturations at 84% on 4L. Reports dyspnea. Reports fatigue. Reports fever. Denies nausea vomiting diarrhea. Reports recently tested positive COVID-19 on August 31st. Patient admitted to hospitalist service. History was obtained from patient who seemed an accurate and reliable historian. Significant other was present. From Pulmonary/Critical Care Consult: Patient is a 57 y.o. male who initially presented to the emergency department on 9/13/2021 with worsening respiratory status. Pt provides some information, majority of info provided by significant other that is at the bedside. Pt was diagnosed with 8/31 with COVID 19 in the emergency department. He was sent home with home oxygen and managed by his fiance. His status waxed and waned. He presented back to the ED on 9/13 with increased dyspnea, increased fatigue, decreased oxygen saturation, and fever. Pt was then admitted to the pulmonary floor to the hospitalist services. He remained on the pulmonary floor. He did require more supplemental oxygen and was eventually receiving maximum amounts of oxygen via heated high flow NC with a nonrebreather on top. He was also started on IV dexamethasone on admission. Decision was made to transfer the patient to the ICU for AVAPS. Pt arrived to the ICU. He was placed on NIV. He did become anxious with application, so he was started on precedex. Pt is alert and oriented. His fiance is at bedside. Hospital Course: Patient was transferred to the ICU on 9/19/2021 due to worsening respiratory status and was transition to noninvasive ventilatory support. He required a dexmedetomidine infusion for anxiety. He further decompensated on 9/23/2021 and required intubation. He suffered a spontaneous left pneumothorax and a chest tube was placed. He required paralytic infusion as well. He was initiated on broad-spectrum antibiotics while in the ICU for a possible secondary bacterial infection. Unfortunately, the patient continued to decompensate despite maximal mechanical support. On the evening of 9/26/2021, the patient''s family mid determination to transition to comfort measures and terminal extubation. Patient did succumb to his critical illness on the evening of 9/26/2021 at 1910 hr, may he rest in peace. Disposition: Deceased; time of death 1910 hr, 9/26/2021


VAERS ID: 1741384 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-09-27
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, COVID-19, Cerebrovascular accident, Confusional state, Contusion, Death, Dysarthria, Face injury, Fall, Feeling cold, Gait disturbance, Lacunar infarction, Magnetic resonance imaging head abnormal, NIH stroke scale abnormal, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (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, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 84 y.o. female with dementia who resides in an assisted living facility. She usually ambulates with a walker per her son. She fell OOB almost 2 weeks ago and hit her right cheek - has a bruise there but seemed fine afterwards. Her son reports she had some slurred speech on Sunday but by Monday it had resolved. Caretaker had reported she seemed to be dragging one leg when she walked earlier this weak. Today she was sent to ER for some confusion - her NIH stroke scale was 11 but some of the score was felt to be due to confusion with understanding directions. An MRI shows acute stroke to the Left Posterior Parietal area and also small Left Lacunar infact adjacent to the left lateral ventricle. She does not appear to be on any antiplatelet drugs or statins per her med list. Her son reports she had trouble moving her left leg in the ER and trouble with speech. she is able to follow simple commands for me. There is no facial droop. She does have expressive aphasia but pulls the covers up over herself and says "cold". She easily lifts both legs off the bed for me on command and has good hand grips. Hospital Course: Patient was admitted with expressive aphasia - Neurology was consulted - family requested hospice care as patient had little hope of improvement. She tested + for Covid but was not requiring any oxygen. She was made hospice care only on the Covid unit and died on 9/27/2021 at 10:01 AM


VAERS ID: 1741405 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-28
Onset:2021-09-28
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL12830N / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Agitation, COVID-19, Chest X-ray normal, Computerised tomogram thorax normal, Death, Dyspnoea, Fall
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brief History: Patient is an 84-year-old male. He is a resident of assisted living. He was diagnosed with COVID at least 3 or 4 days prior to admission.. He fell at assisted living. He was brought to the emergency department and subsequently admitted. He does have advanced COPD. Hospital Course: Patient was admitted and even though he was diagnosed with COVID his CT chest and CXR did not show any signs of this. So he was not treated with remdesivir - However, he was started on steroids, antibiotics, nebulizer treatments - typical COPD treatment. He continued to have high oxygen requirements, using significant accessory muscles to breath and agitation.He did require both morphine and ativan for this. Mutliple converstaions with family lead to family coming and determining comfort care. On 9/28/21 we withdrawaled care. Her son and daughter were both at bedside. He passed peacefully the early morning of 9/28/21 with family at his bedisde.


VAERS ID: 1741622 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-01-29
Onset:2021-09-13
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer Covid vaccine on 1/8/2021 and 1/29/2021 and was admitted to the hospital for 12 days for COVID symptoms.


VAERS ID: 1741639 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-02
Onset:2021-09-07
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 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: 2021-09-24
   Days after onset: 17
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 vaccine. Last dose on 3/2/2021. Case tested positive for COVID on 9/7/21. Was admitted to hospital on 9/21/2021 and expired on 9/24/2021 while still hospitalized.


VAERS ID: 1741669 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-03-24
Onset:2021-08-16
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood creatinine increased, Blood test abnormal, Blood urea increased, Cardioversion, Chills, Complication associated with device, Computerised tomogram, Condition aggravated, Contrast media reaction, Death, Dyspnoea, Feeding disorder, Fluid intake reduced, Full blood count, Infection, Magnetic resonance imaging head, Metabolic function test, Pain, Pain in jaw, Positive airway pressure therapy, Pyrexia, Renal disorder, Renal failure, Renal function test abnormal, Scan with contrast, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Osteonecrosis (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor, Diltiazem, Doxycycline, Flonase, Losartan, Metformin, Mutlaq, Novolin 70/30, Prilosec, Proair HFA, Flomax, Aranesp, Magnesium, MultiVitamin One-a-day Men''s 50+
Current Illness: None
Preexisting Conditions: Afib, anemia, HBP, HCL, Diabetes type 2
Allergies: Codeine, Lisinopril, Levofloxacin
Diagnostic Lab Data: (8/16/2021)Blood Test, CBC, Metabolic panel, X-Ray (8/19/2021) Blood work(8/20/2021) CT Scan, MRI (Head) Blood tests.(8/21/2021) Blood test.
CDC Split Type: vsafe

Write-up: On the 16th of Aug., went to ER for fever, chills, and jaw pain. Was given antibiotics but was back on 17th by request because blood test reveled a blood infection. Early on the 18 Afib, Metoprolol given for it. By midday discharged and was upset at care that was given. On the 19th Admitted to Hospital, because racked with pain and felt like he couldn''t breathe. Drew blood for new tests. Couldn''t drink or eat, issues with taking blood(iv lines infiltrated and kept popping out). On the 20th, contrast media given, one was a drink and one was injected for CT scan. Rapid fluids given, and had a bad response with it, Rapid afib(tried convert to sinus rhythm twice and failed), kidney issues. PCU on 21th Kidney started to fail, BiPap, elevated creatinine, BUN elevated. On 8/22 blood test showed kidney failure imminent was then advised a kidney transplant would be needed, patient declined, discharged about 12:30PM MT and patient died under Hospice care by 6:00PM MT


VAERS ID: 1741688 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-22
Onset:2021-09-21
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 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: 2021-09-26
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Pfizer Vaccine. Last dose given on 1/22/2021. Tested positive for COVID on 9/21/2021. Case expired at Hospital East while in the ED on 9/26/2021.


VAERS ID: 1741705 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-10
Onset:2021-08-18
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / 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: 2021-09-24
   Days after onset: 37
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 one dose of Janseen vaccine on 3/10/2021. Tested positive for COVID on 8/18/2021. Case was admitted to hospital on 8/22/2021 and expired on 9/24/2021 while still hospitalized.


VAERS ID: 1741776 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-11
Onset:2021-03-08
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EM9809 / 2 AR / 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: 2021-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatal myocardial infarction


VAERS ID: 1741874 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-23
Onset:2021-09-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain, Blood glucose increased, Cardio-respiratory arrest, Coma scale, Confusional state, Death, Disorientation, Dyspnoea, Hyperglycaemia, Nausea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81mg (delay release, 1 tab daily), Atorvastatin 80mg (1 tab daily), Cetirizine 10mg (1 tab daily), Flonase (2 sprays daily), Losartan 50mg (1 tab daily)
Current Illness: None
Preexisting Conditions: HTN, High Cholesterol, History of Stroke
Allergies: None
Diagnostic Lab Data: Intervention given at local Hospital
CDC Split Type:

Write-up: [Directed to enter VAERS report due to close proximity of vaccine administration] Member received first dose of Pfizer COVID-19 vaccine on 23 September 2021. On 24 September 2021, member complained to co-workers of abdominal pain with nausea/vomiting, treating symptomatically over the weekend. On 26 September 2021, member''s co-worker contacted him and member was coherent and alert, On 27 September 2021, after member did not respond to co-workers'' attempts to contact him, co-workers and first responders went to member''s residence, where member was found somewhat disoriented. Member was subsequently transferred to local Hospital ED (arrived at approximately 09:15), where member was found to have confusion and hyperglycemia (GCS of 14 and blood sugar reading, measuring as ''high".). During treatment and monitoring process, member was found to have labored breathing (at approximately 11:00) and a CODE was called at 11:05. Member subsequently expired at 11:30.


VAERS ID: 1742182 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-01
Onset:2021-03-24
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Death, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever. Died 3 weeks later from spontaneous brain bleed


VAERS ID: 1742990 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-01
Onset:2021-06-11
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Illness, Laboratory test, Neoplasm malignant, Scan abnormal, Thrombosis
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), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 59
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: Many tests and scans to detect and monitor blood clots, strokes, cancer, etc.
CDC Split Type:

Write-up: Illness, Blood clots, Strokes, Cancer Diagnosis, Death


VAERS ID: 1743470 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210950539

Write-up: COVID; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer concerned a patient of unspecified age, sex, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN and expiry: UNKNOWN) dose, start therapy date were not reported, 1 total administered 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 experienced covid (COVID-19) and suspected clinical vaccination failure. On an unspecified date, the patient died from covid (COVID-19). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This report was associated with product quality complaint number. This case, from the same reporter is linked to 20210950686, 20210950658 and 20210950479.; Sender''s Comments: V0: 20210950539-Covid-19 vaccine ad26.cov2.s - Covid. 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). V0: 20210950539-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: COVID


VAERS ID: 1743472 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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: USJNJFOC20210950678

Write-up: DEATH; This spontaneous report received from a consumer via a company representative through social media concerned a 33 year old patient of unspecified sex, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: unknown and expiry date: unknown) dose, start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On an unspecified date, 12 hours following vaccination, the patient died from an unknown cause. It was unknown if an autopsy was performed. As per the reporter, ''''33-year-old dies 12 hours after JJ vaccination.'''' The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was fatal. This report was serious (Death). .; Sender''s Comments: V0: 20210950678-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: 1743473 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210950686

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer concerned a patient of unspecified age, sex, race and ethnic origin. 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, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced suspected covid-19 infection and suspected clinical vaccination failure. On an unspecified date, the patient died from suspected covid-19 infection. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to 20210950539, 20210950479 and 20210950658.; Sender''s Comments: V0: 20210950686- 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). 20210950686-covid-19 vaccine ad26.cov2.s- suspected clinical vaccination failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: SUSPECTED COVID-19 INFECTION


VAERS ID: 1743482 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210952702

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer via a company representative concerned an 84 year old male. 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: 202A21A, and expiry: 21-SEP-2021) dose was not reported, 1 total, administered on 07-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On an unspecified date, the patient experienced covid-19 (suspected covid-19 infection and suspected clinical vaccination failure). On an unspecified date in 2021, the patient died from covid-19. It was unspecified, if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of suspected covid-19 infection on 2021, 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: 90000194804.; Sender''s Comments: V0:20210952702-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). 20210952702-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: COVID-19


VAERS ID: 1743791 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101252855

Write-up: One of my family members had no medical history she took the vaccine now she''s dead.; This is a spontaneous report from a contactable consumer or other non hcp. A female patient of an unspecified age received BNT162B2 (COMIRNATY, Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified as dose number unknown, single for COVID-19 immunisation. The patient medical history was reported as none. The concomitant medications were not reported. The reporter stated that so many side effects had not been listed on the Pfizer website. Many people experience death, stroke and other problems. Reporter stated that one of the reporter''s family members had no medical history she took the vaccine now she''s dead on an unspecified date. Reporter stated to have seen so many people dying after receiving the vaccine. People who had no medical history get sick after the vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Follow-up attempts are completed. No further information is expected. Batch/lot number not available for BNT162B2.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101253587 same reporter/product, different patient / event.; Reported Cause(s) of Death: One of my family members had no medical history she took the vaccine now she''s dead.


VAERS ID: 1743793 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101252916

Write-up: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine; This is a spontaneous report from a contactable consumer via Pfizer-sponsored program. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection; 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 were not reported. Reporter stated that he had personally gone to 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine, but states he doesn''t know whether they are moderna or Pfizer or Johnson and Johnson and he doesn''t know one person who has died from the actual virus. He just wanted information. The patient died on an unspecified date. Autopsy performed was unknown and cause of death was not reported. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine


VAERS ID: 1743794 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101252917

Write-up: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine; This is a spontaneous report from a Pfizer-sponsored program via a contactable consumer or other non-healthcare professional. This case split for third patient. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for covid-19 immunisation.The patient medical history and concomitant medications were not reported. On an unspecified date, the patient had gone to 4 funerals of people who have died 3 to four days after getting the covid-19 vaccine. The reporter wanted to know now that the Pfizer COVID-19 vaccine was fully approved and enquired if he took the vaccine and had adverse side effects from it who was going to pay for his bills. The reporter stated that he had been doing some research on the amount of people who have died from taking the COVID-19 vaccine and what adverse events they have had after receiving the vaccine. He stated that he had personally gone to 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine, but stated he doesn''t know whether they are moderna or Pfizer or Johnson and Johnson and he doesn''t know one person who has died from the actual virus. He just wanted information. The patient died on an unspecified date. 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: Unknown cause of death


VAERS ID: 1743798 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101252918

Write-up: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine; This is a spontaneous report from a contactable consumer via a Pfizer-sponsored program. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot number: not reported, Expiry date: not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. Caller stated that he was been doing some research on the amount of people who have died from taking the COVID-19 vaccine and what adverse events they have had after receiving the vaccine. He stated that he had personally gone to 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine, but stated he did not knew whether they were moderna or Pfizer or Johnson and Johnson and he did not knew one person who had died from the actual virus. He just wanted information. Caller wanted to know that the Pfizer COVID-19 vaccine was fully approved if he took the vaccine and had adverse side effects from it who was going to pay for his bills. The patient died on an unspecified date. It was not reported if an autopsy was performed and cause of death was not reported. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: 4 funerals of people who have died 3 to four days after getting the COVID-19 vaccine


VAERS ID: 1743803 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101253281

Write-up: the patient died after getting the Pfizer BioNtech Covid vaccine; This is a spontaneous report from a Pfizer Sponsored Program. A non-contactable consumer reporting same event under the same suspect product for 6 patients. This is one of 6 reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and the patient''s concomitant medications were not reported. The patient died on an unspecified date. 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101275697 same reporter, same vaccine, same adverse event, different patient;US-PFIZER INC-202101276043 same reporter, same vaccine, same adverse event, different patient; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1743832 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101275697

Write-up: the patient died after getting the Pfizer BioNtech Covid vaccine; This is a spontaneous report from a Pfizer Program. A non-contactable consumer reporting same event under the same suspect product for 6 patients. This is one of 6 reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and the patient''s concomitant medications were not reported. The patient died on an unspecified date. 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101253281 same reporter/SD/AE, different patient; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1743833 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101276040

Write-up: the patient died after getting the Pfizer BioNtech Covid vaccine; This is a spontaneous report from a Pfizer Sponsored Program. A non-contactable consumer reporting same event under the same suspect product for 6 patients. This is one of 6 reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and the patient''s concomitant medications were not reported. The patient died on an unspecified date. 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101253281 same reporter,same vaccine, same adverse event, different patient; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1743834 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101276041

Write-up: the patient died after getting the Pfizer BioNtech Covid vaccine; This is a spontaneous report from a Pfizer Sponsored Program. A non-contactable consumer reporting same event under the same suspect product for 6 patients. This is one of 6 reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and the patient''s concomitant medications were not reported. The patient died on an unspecified date. 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101253281 same reporter,same vaccine, same adverse event, different patient; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1743835 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101276042

Write-up: 6 kids in her neighborhood have died after getting the Pfizer BioNtech Covid vaccine; This is a spontaneous report from a Pfizer Sponsored Program. A non-contactable consumer reporting same event under the same suspect product for 6 patients. This is one of 6 reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and the patient''s concomitant medications were not reported. The patient died on an unspecified date. 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101253281 same reporter,same vaccine, same adverse event, different patient; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1743836 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-29
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 INC202101276043

Write-up: 6 kids in her neighborhood have died after getting the Pfizer BioNtech Covid vaccine; This is a spontaneous report from a Pfizer Sponsored Program. A non-contactable consumer reporting same event under the same suspect product for 6 patients. This is one of 6 reports. A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and the patient''s concomitant medications were not reported. The patient died on an unspecified date. 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.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101253281 same reporter/SD/AE, different patient;US-PFIZER INC-202101253281 same reporter,same vaccine, same adverse event, different patient; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1744331 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-29
Onset:2021-04-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0421321A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Death, Decreased appetite, Dizziness, Dyspnoea, Fatigue, Headache, Laboratory test, Nausea, Pericardial effusion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 69
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone 200 MG Tablet, Atorvastatin 20 MG Tablet, Furosemide 40 MG Tablet, Gabapentin 300 MG Capsule, Glipizide 10 MG Tablet, Magnesium Oxide 400 MG, Metolazone, 2.5 M Tablet, Metoprolol Succinate 100 MG, Nexium 40 MG Capsule, SitaGlipti
Current Illness:
Preexisting Conditions: Congestive Heart Failure, Hypertension, Coronary Artery Disease and Atrial Fibrillation
Allergies: Latex
Diagnostic Lab Data: Too many test and laboratory results to list as my father had extensive list of health issues.
CDC Split Type:

Write-up: Fatigue, Dizzy, Nausea, Loss of taste, Loss of smell (lasted about a week, then disappeared) Fatigue, Dizzy, Nausea, Loss of taste, Loss of smell, trouble breathing, headaches, loss of appetite(05/09/2021, went to hospital twice, was discharged too early the first time; 11 May 2021; returned to the hospital 21 May 2021 due to shortness of breath, fatigue, dizzy, nausea, loss of appetite, which the trouble breathing and shortness of breath was due to fluid build-up around the heart and his lungs). Admitted approximately late afternoon 21 May 2021 and did not get discharged, died on 9 June 2021 in the Hospice house.


VAERS ID: 1744381 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-05
Onset:2021-09-09
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 UN / SYR

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

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

Write-up: Hospitalization and death on 9/9/2021 cause of death is under review


VAERS ID: 1744398 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-09-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / SYR

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

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

Write-up: The patient is deceased six days after Pfizer vaccination (first dose)


VAERS ID: 1744606 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-11
Onset:2021-09-28
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 0
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: Pt died after contracting COVID in September 2021


VAERS ID: 1744645 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-19
Onset:2021-08-19
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   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: unknown


VAERS ID: 1744676 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-02-18
Onset:2021-02-24
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Arthralgia, Asthenia, Blood pressure decreased, Computerised tomogram abnormal, Death, Dyspnoea, Feeling abnormal, Flank pain, Gait inability, Intensive care, Internal haemorrhage, Mechanical ventilation, Nausea, Pneumonia, Pneumonitis, Positive airway pressure therapy, Pulmonary oedema, Respiratory disorder, Transfusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Arthritis (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: See continuation page o Jan 2018 Mom was diagnosed with stage 4 lung/brain/lymph node cancer o Feb 25th: Mom was brought to ER for a respiratory issue. Full set of tests were done, nothing was found and she was sent home. ER was happy she was going to see her primary the next day for follow up. o Feb 27th: Mom woke up feeling ok, by afternoon she was too weak to walk and brought back to the ER. Lungs shown with pneumonia and inflammation. Mom was admitted to ICU that evening. o Feb 28th: Mom seemed ok in ICU, but oxygen demands increased. o Mar 1st: Mom was placed on bi-pap o Mar 2nd: Mom was placed on vent o March 8th: Mom fought back and was able to come off vent o March 12th: Due to lack of rooms in ICU (from my understanding), Mom was moved to medical o March 13th: Mom expressed pain behind knee (maybe referred pain due to bleeding noted on the 14th) o March 14th: Mom had severe side pain, blood work indicated potential internal bleed. Hours later a CT scan was done and confirmed bleeding. Plan was to give her plasma and maybe other drugs to hopefully stop the bleed (that doesn''t make complete sense to me, but I''m not a doctor). Mom said she "Felt like she was dying". The nurse said that given Mom''s condition, it would be best that someone spend the night with her. I relieved my sister around 8:30 that night. Mom was receiving plasma and whole blood. I asked the nurse if her blood pressure and pulse were monitored at the nurses station, she said no but she would come in every hour to check (note additional checks were done every 15 minutes when a blood transfusion was started). Mom''s door was closed due to 4 other psych patients on the floor making a lot of noise, so I was the only one to hear alarms. Mom was too weak and couldn''t press the nurse button when her side pain increased after 10 pm. I pushed the button for her, a couple minutes later a nurse came on the intercom wondering what Mom needed, and what felt like 10 minutes later a nurse arrived. Around 11:15 pain meds were administered but didn''t have any impact initially. I questioned whether Mom should be in the ICU given the internal bleed, pain, and number of units of blood/plasma she was receiving (in my mind she was critical enough not to be on a medical floor where there is a high patient to nurse count and no continuous monitoring of vitals). o March 15th The on call doctor came in around 12:30 am, I think, after pain meds started to settle Mom. His first words, which I felt were said in a stern way, were "I hear you want your Mom moved to ICU". I expressed my concerns and that I was just trying to do what was best for Mom. His voice softened and he said there is nothing more that ICU can do. My impression was that he stated they would give more blood and if vitals drop, then move her to ICU. Nurse came back in after the doctor left (note I felt the nurse did a great job that night) and said the doctor wanted her to discuss with me re-evaluating whether Mom should be a full code... It is very confusing since I felt the doctor was saying she was stable enough to stay on the medical floor, but then have the full code reconsidered at 1:00 in the morning by family... I was in full tears after she left, didn''t sleep, and said a few rosaries. At 3:30 am Mom was moved to ICU. By 6 or 7 am Mom had received 5 units of blood and 5 units of plasmas, which I believe is as much as the body can hold... Around 7:15 am there was a clear indication on the monitor that Mom''s blood pressure was dropping linearly over last hour. Her breathing over night was 18 and normal, but increased to over 20 was very labored. Her heart rate went from 90s to 114. I walked over to ICU nurse with tears and there is a scary trend happening, do I need to call family in. She stated that "Mom is in the right place and no need to call family". But took no action to correct decline. Her only action was to get zophrane (or similar drug) since Mom was nauseous. It wasn''t until after the doctor came in after 8:15 am that the decision was made to transport. At that point family was allowed to come in 1 by 1. It was also the same time that the snow storm started and Mom had to go by ambulance, which by time coordinating wass complete didn''t happen until 11 am. Mom was given blood pressure medication which helped initially, but by time Mom reached it we were told her blood pressure was 37/19. It feels if action was taken over night, Mom could have been flown and the blood pressure might not have dropped that far. Mom''s procedure was successful to stop bleeding. o March 16th: We were told that given the amount of fluid Mom''s lungs were starting to fill with fluid again and given low blood pressure on arrival, her kidneys were shutting down. o March 17th: Mom was placed on hospice o March 18th: Mom was brought home o March 26th: Mom went peacefully to heaven


VAERS ID: 1744956 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-01-27
Onset:2021-09-28
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid death


VAERS ID: 1744983 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-09-16
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Headache, Mental status changes, Myalgia, Oedema, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Resident of long term care facility. Tested positive for COVID-19 on 9/16/2021 with headache and muscle ache. Retested 9/25/2021 with hospital admission (PCR +) with reported edema and altered mental health status. Patient history of chronic liver disease and cancer. Died 9/25/2021.


VAERS ID: 1745008 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-08-06
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anemia, afib, COPD, DM, hypercholesterolemia, measles, mumps, pancreatitis, sleep apnea, shingles, cancer.
Allergies: NKA
Diagnostic Lab Data: Labs, covid test, cxr.
CDC Split Type:

Write-up: Pt came to ER c/o SOB, onset 4 weeks prior.


VAERS ID: 1745080 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-12
Onset:2021-09-13
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID test 9/14/21
CDC Split Type:

Write-up: Patient hospitalized 9/13/21, diagnosed with COVID19 9/14/21, deceased 9/25/21


VAERS ID: 1745088 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-08-03
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea, General physical health deterioration, Malaise, Nausea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 15
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: 08/03/2021 pt had at-home COVID-19 test, results positive; presented to ED on 8/12/2021 with SOB, cough, nausea, malaise, weakness; condition worsened; pt was a DNR; admitted to hospice on 08/18/2021 where he passed away


VAERS ID: 1745112 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-24
Onset:2021-09-03
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase increased, Anion gap normal, Anti factor Xa assay normal, Anticoagulant therapy, Aspartate aminotransferase increased, Asthenia, Atrioventricular block complete, Basophil count, Bilirubin conjugated increased, Blood alkaline phosphatase normal, Blood bicarbonate decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride normal, Blood creatine increased, Blood gases abnormal, Blood glucose normal, Blood magnesium normal, Blood pH decreased, Blood phosphorus normal, Blood potassium normal, Blood pressure abnormal, Blood pressure systolic decreased, Blood sodium decreased, Blood urea increased, Body temperature decreased, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Carbon dioxide normal, Cardiac arrest, Cardiac failure, Cardiac resynchronisation therapy, Cardiac vein dissection, Chest X-ray abnormal, Condition aggravated, Cough, Death, Delirium, Diarrhoea, Dyspnoea, Endotracheal intubation, Eosinophil count, Fibrin D dimer increased, General physical health deterioration, Glomerular filtration rate, Haematocrit decreased, Haemoglobin decreased, Haemoptysis, Hypotension, Hypoxia, Hypoxic-ischaemic encephalopathy, Immature granulocyte count, Implantable defibrillator insertion, Intensive care, International normalised ratio normal, Ischaemic cardiomyopathy, Laboratory test abnormal, Lymphocyte count decreased, Mean cell volume normal, Mental status changes, Metabolic acidosis, Metabolic encephalopathy, Monocyte count, Neutrophil count increased, Neutrophil percentage increased, Oxygen saturation decreased, PCO2, PO2 decreased, Platelet count decreased, Prothrombin time prolonged, Pulseless electrical activity, Red blood cell count decreased, Red blood cell nucleated morphology present, Red cell distribution width increased, Respiratory failure, Resuscitation, Sputum abnormal, Troponin I increased, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan (COZAAR) 25 mg Oral Tab Take 1 tablet by mouth daily ? Furosemide (LASIX) 20 mg Oral Tab Take one-half tablet by mouth daily in the morning. May increase to 1 tablet for sudden weight gain and more shortness of breath ? Tamsulosin
Current Illness: None known
Preexisting Conditions: PMH of CHF (EF 20%), hypertension, anemia, seizures, renal calculus s/p ureteral stents placement and removal
Allergies: NKA
Diagnostic Lab Data: Results for patient as of 9/29/2021 10:27 9/9/2021 07:00 NA: 138 K: 4.5 CL: 99 (L) CO2: 23 (L) BUN: 82 (H) CREAT: 2.72 (H) ANION GAP4 SERPL: 16 CA: 7.8 (L) MG: 2.0 PHOS: 4.8 (H) GLUC: 136 ALT: 115 (H) AST: 108 (H) ALKP: 62 TBILI: 1.5 (H) BILID: 0.6 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 9.7 (H) WBC: 13.7 (H) RBC''S: 3.51 (L) HGB: 10.2 (L) HCT: 31.7 (L) MCV: 90 RDW, RBC: 17.2 (H) PLT: 139 (L) IMMAT GRANULO % AUTO: 1 NRBC: 1 (H) NEUTROPHILS % AUTO: 89 (H) ANC: 12.2 (H) LYMPHS % AUTO: 4 (L) MONOS % AUTO: 5 EOS % AUTO: 0 BASO''S % AUTO: 0 D-DIMER: 0.56 (H) 9/9/2021 09:43 ANTI XA, HEP UNFR: 1.06 (AA) 9/9/2021 23:34 XR CHEST: Rpt 9/10/2021 07:05 NA: 136 K: 4.4 CL: 99 (L) CO2: 25 BUN: 96 (H) CREAT: 2.70 (H) ANION GAP4 SERPL: 12 GLUC: 158 ALT: 120 (H) AST: 77 (H) ALKP: 66 TBILI: 1.1 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE WBC: 8.9 RBC''S: 3.41 (L) HGB: 9.9 (L) HCT: 30.8 (L) MCV: 90 RDW, RBC: 16.6 (H) PLT: 124 (L) IMMAT GRANULO % AUTO: 0 NRBC: 1 (H) NEUTROPHILS % AUTO: 90 (H) ANC: 7.9 LYMPHS % AUTO: 4 (L) MONOS % AUTO: 6 EOS % AUTO: 0 BASO''S % AUTO: 0 9/11/2021 00:15 ANTI XA, HEP UNFR: <0.10 9/11/2021 07:21 NA: 132 (L) K: 4.7 CL: 96 (L) CO2: 24 BUN: 102 (H) CREAT: 2.79 (H) ANION GAP4 SERPL: 12 MG: 2.3 GLUC: 159 ALT: 76 (H) AST: 34 ALKP: 80 TBILI: 1.1 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 6.1 (H) WBC: 13.3 (H) RBC''S: 3.69 (L) HGB: 10.9 (L) HCT: 33.0 (L) MCV: 89 RDW, RBC: 16.8 (H) PLT: 101 (L) NRBC: 2 (H) PT: 19.6 (H) INR: 1.7 D-DIMER: $g4.00 (H) ANTI XA, HEP UNFR: 1.24 (AA) 9/11/2021 07:21 WBC: 12.8 (H) RBC''S: 3.62 (L) HGB: 10.4 (L) HCT: 33.3 (L) MCV: 92 RDW, RBC: 16.8 (H) PLT: 107 (L) IMMAT GRANULO % AUTO: 1 NRBC: 2 (H) NEUTROPHILS % AUTO: 92 (H) ANC: 11.8 (H) LYMPHS % AUTO: 3 (L) MONOS % AUTO: 4 (L) EOS % AUTO: 0 BASO''S % AUTO: 0 9/12/2021 07:04 NA: 132 (L) K: 5.0 CL: 97 (L) CO2: 22 (L) BUN: 111 (H) CREAT: 2.84 (H) ANION GAP4 SERPL: 13 MG: 2.3 GLUC: 175 (H) BNP: 3,468 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE 9/12/2021 09:58 XR CHEST: Rpt 9/12/2021 14:53 NA: 129 (L) K: 5.3 CL: 96 (L) CO2: 21 (L) BUN: 115 (H) CREAT: 2.99 (H) ANION GAP4 SERPL: 12 GLUC: 195 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE 9/13/2021 05:09 TEMP: 96.5 (L) INSPIRED O2: 37 PH CORR VEN BLD: 7.31 (L) PCO2 CORR VEN BLD: 44 PO2 ADJUST TO PT''S TEMP, BLD-V: 36 PH VBLD: 7.30 (L) PVCO2: 47 PO2-V: 39 HCO3-V: 20.3 (L) BE-V: -3.4 (L) SO2, BLDV: 55.3 9/13/2021 07:10 NA: 131 (L) K: 5.1 CL: 96 (L) CO2: 15 (L) BUN: 115 (H) CREAT: 3.12 (H) ANION GAP4 SERPL: 20 (H) MG: 2.7 (H) GLUC: 191 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 2.8 (H) 9/13/2021 07:25 TROPONIN I: 0.12 (H) BNP: 1,926 (H) WBC: 20.8 (H) RBC''S: 4.02 (L) HGB: 11.8 (L) HCT: 38.5 (L) MCV: 96 RDW, RBC: 18.2 (H) PLT: 113 (L) IMMAT GRANULO % AUTO: 1 NRBC: 3 (H) NEUTROPHILS % AUTO: 90 (H) ANC: 18.8 (H) LYMPHS % AUTO: 3 (L) MONOS % AUTO: 5 EOS % AUTO: 0 BASO''S % AUTO: 0 D-DIMER: $g4.00 (H) 9/13/2021 08:15 XR CHEST: Rpt 9/13/2021 08:40 TEMP: 98.6 INSPIRED O2: 100 PH CORR ART BLD: 7.11 (AA) PCO2 CORR ART BLD: 34 (L) PO2 ADJUST TO PT''S TEMP, BLD-A: 95 PH ABLD: 7.11 (AA) PACO2: 34 (L) PO2-A: 95 HCO3 BLD: 11.1 (L) BE BLD: -17.2 (L) SO2, CALCULATED, ARTERIAL: 91.9 (L) 9/13/2021 10:30 TEMP: 98.6 INSPIRED O2: 100 PH CORR ART BLD: 7.13 (AA) PCO2 CORR ART BLD: 51 (H) PO2 ADJUST TO PT''S TEMP, BLD-A: 80 PH ABLD: 7.13 (AA) PACO2: 51 (H) PO2-A: 80 HCO3 BLD: 14.8 (L) BE BLD: -11.2 (L) SO2, CALCULATED, ARTERIAL: 88.4 (L)
CDC Split Type:

Write-up: Reason for Hospital Admission (Admitting Diagnosis): Heart Block/COVID Pneumonia Hospital Course and Significant Findings: 75 Y male with hx of HFrEF (EF: 20%), HTN, anemia, seizures (not on antiepileptics), hx of renal calculus s/p ureteral stents and subsequent removal who presented with shortness of breath, weakness and diarrhea and was found to have AKI, 3rd degree AV block which was diagnosed on 9/5/2021 and COVID diagnosed on 9/3/2021. Dual chamber ICD placed on 9/9 by Dr. (couldn''t get coronary sinus lead in so only RV pacing now). Reattempt LV lead placement is scheduled on 10/18 with Dr. . Stopped heparin gtt and start BID Eliquis (2.5mg BID - discussed dosing with pharmacy) Weight up (standing weight 201lbs today and recorded 188lbs on 9/6), BNP is up, oxygen requirement up today. CXR looked a little better (intermpretation complicated by recent COVID diagnosis). BP is soft (SBP low 90s). Cr and BUN up. D/w Cardiology who recommended start hydralazine, start dopamine gtt, resume Lasix, and consider repeat echo giving finding of dissection of coronary sinus on recent pacemaker placement. With regard to COVID, symptom onset 9/3/2021. COVID positive on 9/3/2021. He remained afebrile. He completed 5 day course of remdesivir and was continued on daily decadron. He was not requiring much oxygen, about 2 to 4LMP via NC and appears well without tachypnea. He had a mild dry cough. He is speaking in complete sentences without cough or tachypnea during my exam. - No hypoxia on 9/11, even with activity, but on 9/12 was a bit hypoxic so was on supplemental oxygen. NONTRAUMATIC AKI on CKD. BUN and Cr increasing. BP was low and CXR looked better but other findings concerning for increasing heart failure. See above for recommendations from cardiology. AMS / Delirium. Due to metabolic and hypoxemic encephalopathy. Fluctuated and occurred the first couple of days during the night. Overnight in the early hours of 9/13, his respiratory status deteriorated. He required increasing oxygen, was seen by cross cover. He started coughing up bloody frothy sputum. Required high flow oxygen. Unfortunately he went into PEA arrest in the morning on 9/13. Required CPR, was resuscitated, intubated and transferred to the ICU. Bedside echo showed diminished EF, no pericardial effusion or tamponade. Per ICU note, "Significant metabolic acidemia an refractory PEA despite initial ROSC and complete resuscitation. Finally, patient was prounced dead at 11am on 9/13." Cause of death: Hypoxic respiratory failure from COVID pneumonia and ischemic cardiomyopathy. Primary Procedures: Procedure(s): CARDIAC AICD TOTAL SYSTEM IMPLANTATION, BIVENTRICULAR CHAMBER


VAERS ID: 1745114 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-28
Onset:2021-08-24
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 test 8/24/21
CDC Split Type:

Write-up: Patient admitted to hospital and tested for COVID 8/24/21. Discharged 8/28/21. Deceased 9/7/21


VAERS ID: 1745116 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-07-12
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Headache, Hypoxia, Mechanical ventilation, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: 2021-07-23
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive for COVID-19 at dr''s office approximately 1 week before being seen in the ED; presents to ED with SOB and is hypoxic, with runny nose, sore throat, headache, and cough; hx of COPD, placed on a ventilator; condition worsened; pt passed away in hospital


VAERS ID: 1745141 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-08-17
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, Chest X-ray abnormal, Cough, Death, Dyspnoea, Influenza like illness, Lung infiltration, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   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: presented to ED with SOB; c/o cough, flu like sx, SOB, weakness, head congestion and runny nose x 2-3 wks; started using wife''s O2 at home due to SOB; chest xray showed bilateral infiltrates; positive COVID test; acute respiratory failure due to COVID; pt passed away in the hospital


VAERS ID: 1745214 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-21
Onset:2021-09-07
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Laboratory test, 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: 2021-09-15
   Days after onset: 8
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: Covid Test 9/7/21, RPP 9/8/21
CDC Split Type:

Write-up: Patient admitted to hospital via ED 9/7/21. COVID test positive 9/7/21. Deceased 9/15/21


VAERS ID: 1745215 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-08-27
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with SOB, c/o fever, SOB, nausea, decreased appetite x 1 wk; hx of DMT2; tested positive for COVID-19; acute respiratory failure and pneumonia due to COVID; refuses to be intubated; will use BIPAP; pt''s condition worsened where he passed away in the hospital


VAERS ID: 1745226 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-17
Onset:2021-09-27
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died at home under hospice care. Hospice notes submitted into database.


VAERS ID: 1745253 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-09-07
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   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: Chronic Lung Disease, Chronic Renal Disease, Hypertension, Autoimmune Condition, Obese
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospice patient. Died due to COVID-19. Was fully vaccinated.


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