National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

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



Case Details

This is page 77 out of 172

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172   next


VAERS ID: 1767953 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-13
Onset:2021-08-20
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breath sounds abnormal, COVID-19, Cough, Crepitations, Death, Dry mouth, Dyspnoea, Hyperresponsive to stimuli, Hypoxia, Mobility decreased, Oxygen saturation, Pain, Pyrexia, Respiratory distress, SARS-CoV-2 test positive, Thirst, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease, Sleep apnea, lymphedema, obesity
Allergies:
Diagnostic Lab Data: 08/20/2021 PCR+ COVID-19 test at University Medical Center
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/20/2021: Fever, Aches, Shortness of breath/difficulty breathing, Cough. Hospitalized 8/20/2021-8/27/2021. From HCW: Respiratory Distress. Per pt, he got "stuck in bed, couldn''t sit up for 3 hours". Pt found semi-responsive by EMS, initially satting 40s RA, mid-80s NRB, heard wet lung sounds. No known Covid exposure, recently vaccinated. Hx sleep apnea, lymphedema. No other aggravating or alleviating factors. Symptoms are described as mild to moderate in intensity, severity, quality, and character. Nurse''s notes have been requested, obtained, and reviewed. I agree with their assessment. The patient presents with shortness of breath with hypoxia. The patient is a very morbidly obese male with a history of sleep apnea and significant lymphedema to the left lower extremity. The patient denies using Lasix. The patient does seem to have a dry oral mucosa and feels thirsty. Patient denies any history of congestive heart failure. The patient was found semi responsive by EMS with an O2 saturation in the 40s but increased to the upper 80s on 100% non-rebreather mask. Death 8/27/2021. From Vital Records: place of death: HOSPITAL-INPATIENT, MEMORIAL MEDICAL CENTER; certified, PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: DIRECTOR, SCHOOL BOARD DIRECTOR . Per vital records, COD ICD Codes include: U071, A419, J80, J969, N288 ; Other Significant Conditions include: None listed


VAERS ID: 1767972 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-10
Onset:2021-08-23
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/23/2021 Antigen+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/23/2021: Runny Nose/Congestion, Cough. Hospitalized on unknown date for unknown duration. Death 8/29/2021. From Vital Records COD = ACUTE RESPIRATORY ARREST, COVID 19 PNEUMONITIS. per vital records (09/08/2021) other significant conditions: (none listed). place of death: HOSPITAL-INPATIENT PRONOUNCING AND CERTIFYING PHYSICIAN;


VAERS ID: 1767987 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-31
Onset:2021-08-22
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Death, Dyspnoea, 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), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 16
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: 08/22/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/22/2021: Shortness of breath/difficulty breathing. Hospitalized 8/25/2021-9/7/2021. Death 9/7/2021. Acute respiratory failure due to Covid-19


VAERS ID: 1768064 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-13
Onset:2021-08-23
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: comorbidities are hypertension and diabetes
Allergies:
Diagnostic Lab Data: 08/23/2021 PCR+ COVID-19 test at Hospital; 08/23/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 8/23/2021. Death 8/26/2021.


VAERS ID: 1768095 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-05-07
Onset:2021-05-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Sepsis, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
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: UNK
Current Illness: UNK
Preexisting Conditions: Stage 3 kidney disease, AFIB, pacemaker, VIT D deficiency , hypothyroid, hypertension
Allergies: UNK
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received death certificate that documented possible contributing factor to death as side effect from COVID vaccine. Immediate cause was documented as Ventricular Arrhythmia , probable sepsis.


VAERS ID: 1768110 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-19
Onset:2021-09-03
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Dyspnoea, Headache, Mechanical ventilation, Nausea, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Diabetes, Severe Obesity, COPD, Obstructive Sleep Apnea, Hypertension, and Chronic Diastolic Congestive Heart Failure
Allergies: unknown
Diagnostic Lab Data: Tested positive for COVID on 9-3-2021
CDC Split Type:

Write-up: Developed COVID and had to be put on a ventilator. Symptoms were: runny nose, headache, shortness of breath, nausea, vomiting, diarrhea, and congestion.


VAERS ID: 1768151 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-10-05
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Chest pain, Dyspnoea, Electrocardiogram abnormal, Resuscitation, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: end-stage renal disease, Hypertension, CAD with pacemaker
Allergies: Codeine, Penecillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with COVID on 9/22 and treated OP with antibiotics and monoclonal antibody infusion. Admitted to hospital on 10/5 with increasing chest pain and shortness of breath. Abnormal EKG. Cardiology and Nephrology followed patient. COVID + on admission. Had cardiac arrest with 5 rounds of chest compressions and multiple meds. Family contacted and requested DNR so ACLS was terminated.


VAERS ID: 1768160 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-10
Onset:2021-08-06
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Pain, Respiratory tract congestion, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic lung disease, Diabetes, Cardiovascular disease, Renal disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aches, Runny Nose/Congestion, Cough Death due to COVID-19 complications


VAERS ID: 1768179 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-13
Onset:2021-08-17
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 26L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Renal disease
Allergies:
Diagnostic Lab Data: 08/17/2021 PCR+ COVID-19 test; 08/24/2021 PCR+ COVID-19 test; 09/14/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/24/2021: Shortness of breath/difficulty breathing. Hospitalized 8/27/2021 for unknown duration. Death 9/19/2021. From Vital Records = COVID-19. Per vital records, Not yet coded ; Other Significant Conditions include: None listed. lace of death: HOSPITAL-INPATIENT, certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: MECHANIC, SALES


VAERS ID: 1768207 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-19
Onset:2021-10-05
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, COVID-19 pneumonia, Cardioversion, Ejection fraction decreased, Electrocardiogram ST segment elevation, Endotracheal intubation, Haemofiltration, Hepatic failure, Hypoxia, Mechanical ventilation, Oxygen saturation decreased, Pneumothorax, Pulse absent, Respiratory failure, Resuscitation, Seizure like phenomena, Shock, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Myocardial infarction (narrow), 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), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, hypertension, leukemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach. Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips. STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care.


VAERS ID: 1768218 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-08
Onset:2021-08-24
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Congestive cardiomyopathy, Death, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiomyopathy (narrow), 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: 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:
Allergies:
Diagnostic Lab Data: 08/24/2021 PCR+ COVID-19 test at Addington Place of Dublin; 08/24/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized unknown date and duration. Death 8/31/2021. From Vital Records COD = COVID 19 PNEUMONITIS, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, DILATED CARDIOMYOPATHY. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed. place of death: HOSPITAL-INPATIENT, HOSPITAL; certified, PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: CASHIER, CIVIL SERVICE


VAERS ID: 1768219 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-08-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MOD 040C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Cardioversion, Death, Endotracheal intubation, Feeling abnormal, Pulseless electrical activity, Resuscitation, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN, AMLODIPINE, MONTELUKAST
Current Illness: NONE
Preexisting Conditions: ESSENTIAL (PRIMARY) HYPERTENSION
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose #2 on Sunday 8/1/2021, decedent expressed no medical complaints at that time. However, on 8/2/2021, decedent told his wife that he "wasn''t feeling good" but went to work as a landscaper anyway. On 8/2/2021 at the end of the work day, the decedent had a witnessed collapse and CPR was initiated by bystanders. Paramedics found decedent to be in vfib and defibrillated and subsequently intubated. Epi given every four minutes, Amiodarone between epi. Decedent was found to be in asystole and back to vfib and shocked again. Second dose of Amiodarone was given and Narcan and decedent went into PEA. When bicarbonate was given, decedent back into vfib, shocked and back into PEA until pronounced at 1805 hours.


VAERS ID: 1768225 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-12
Onset:2021-08-08
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cough, Death, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 22
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: Fever, Aches, Shortness of breath/difficulty breathing, Cough Cause of death: ACUTE HYPOXIC RESPIRATORY FAILURE, COVID PNEUMONIA


VAERS ID: 1768227 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-08-09
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chills, Death, Diarrhoea, Dyspnoea, Fatigue, Hypoxia, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 6
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: presented to ED with SOB (increasing over last 3 days), diarrhea x 5 days, fever, chills, and fatigue; COVID test positive; PMH: sickle cell disease; diagnosed with pneumonia due to COVID, sepsis, hypoxia; started on oxygen, steroids and antibiotics; pt''s condition worsened and he passed away in the hospital


VAERS ID: 1768241 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-30
Onset:2021-10-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Injection site erythema, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN 50 MG 1 DAILY, BRILINTA 90MG 1 TWICE DAILY, NITROGLYCERIN 0.4 SUBLINGUAL AS DIRECTED, ISOSORBIDE MONO 30 MG ER 1 IN MORNING, PRALUENT 75MG/MG 75 MG EVERY OTHER WEEK, METOPROLOL TAR 25 MG 1 TWICE DAILY. OTC USE UNKNOWN.
Current Illness: Had undergone a procedure to place stents on 09/27/2021.
Preexisting Conditions: Hyperlipidemia, CAD.
Allergies: STATINS.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s caregiver called us on 10/7/2021 to inform us that patient passed away at 1 am on 10/03/2021 from a heart attack. He had mild redness at the site of injection. No flu like symptoms or fever after receiving the shot.


VAERS ID: 1768253 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-10-06
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain compression, COVID-19, Cerebellar stroke, Hydrocephalus, Intensive care, Medical device removal, Neurological symptom, Oedema, SARS-CoV-2 test positive, Therapy cessation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, hypertension, esophageal cancer s/p resection and ventriculostomy placement
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only.


VAERS ID: 1768259 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-12
Onset:2021-08-24
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Endotracheal intubation, Intensive care, Mental status changes, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Angioedema (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/24/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom onset date: altered mental status. Hospitalized 8/24/2021-8/25/2021. Death 8/25/2021. Per medical records, patient presented to ER with altered mental status. Patient was emergently intubated and was admitted to ICU. Patient''s previous medical history and symptoms were unable to be obtained due to patient''s clinical condition. Per patient''s husband, she was recently released from hospital and had recently had COVID-19. Patient expired on 08/25/2021. Vital records data not available yet.


VAERS ID: 1768273 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-01
Onset:2021-08-09
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, Cough, Dyspnoea, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-11
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic lung disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath/difficulty breathing, Nausea/Vomiting, Loss of smell or taste, Cough


VAERS ID: 1768324 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-09
Onset:2021-08-10
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 UN / SYR

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

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

Write-up: ACUTE HYPOXIC RESPIRATORY FAILURE IN SETTING OF COVID-19 PNEUMONIA


VAERS ID: 1768337 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-11
Onset:2021-05-03
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 AR / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 80
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Deep leg thrombosis, asthma
Allergies: No
Diagnostic Lab Data: Hospital has them
CDC Split Type:

Write-up: My mom received her first dose feb 11, 2021 and second dose of the pfizer covid vaccine on Mar 4, 2021. She experienced two brain bleeds, one after the first shot and the second brain bleed after the second dose. Both brain bleeds were detected by hospital''s CAT scan. The emergency room neurosurgeon indicated that he saw evidence of the old brain bleed that happened several months back and this new one that brought her into the emergency room on july 17, 2021. My mom died of this brain bleed on july 22, 2021


VAERS ID: 1768407 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-02-20
Onset:2021-08-03
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Condition aggravated, Death, Dyspnoea exertional, Endotracheal intubation, Enterococcal infection, Exposure to SARS-CoV-2, Fungal disease carrier, Hypoxia, Intensive care, Lung assist device therapy, Lung transplant rejection, Pneumonia pneumococcal, Respiratory depression, SARS-CoV-2 test positive, Sepsis, Traumatic lung injury, Urinary tract infection
SMQs:, Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 42 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: mycophenolae, amlodipine, MVI, pepcid, iron, flonase, mag ox, reglan, prednisone, sertraline, simethicone, sodium bicarb, bactrim tacrolimus
Current Illness: unknown.
Preexisting Conditions: COPD, GERD, seasonal allergies, weight loss, anxiety, renal insufficiency, osteopenia, b/l lung transplant.
Allergies: Benadrul, mold, peanut, apricot, red dye
Diagnostic Lab Data: 8/1/21 - COVID+ PCR
CDC Split Type:

Write-up: 63 y.o. female patient with PMHx of COPD s/p bilateral lung transplant (CMV D+/R+, EBV D+/R+, Toxo D-/R-) from an increased risk donor on 6/14/18 who was HCV NAT+/Ab+ as well as HBcAb+ and history of acute transplant rejection who presented to ED for dyspnea on exertion for two days. She was found to have had exposure to close contact with Covid 19 infection. She was previously vaccinated for COVID; admitted 8/1/2021 with confirmed COVID-19. Respiratory status has been worsening, requiring higher oxygen suppor, thus she was transferred to the MICU. At a local hospital, she was started on HFNC and then intubated for increasing/worsening hypoxia. ICU course complicated by need for ECMO cannulation with ARDS, sepsis from E.faecalis UTI and strep pneumoniae PNA ISO aspergillus colonization, and acute bilateral lung transplant rejection. Overall burden of lung injury felt to be not survivable, so her family made the decision for CMO on 9/12/21. VV ECMO support discontinued at 12:35 PM on 9/12/2021 and time of death was 1:05 PM on 9/12/2021.


VAERS ID: 1768415 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-17
Onset:2021-08-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Extra dose administered, Laboratory test, Multiple organ dysfunction syndrome, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 21
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: Allopurinol 300 mg; Lipitor 20mg; Protonix 40mg; Hydroxyurea
Current Illness: CMML (Chronic myelomonocytic) Leukemia
Preexisting Conditions: CMML (Chronic myelomonocytic) Leukemia
Allergies: He had an allergy to sulfur
Diagnostic Lab Data: See above
CDC Split Type: vsafe

Write-up: He had due to chemo hospital stay had 9 months of extremely low white blood cell count that didn''t move at all. 1/07/21 on a Thursday he had his first COVID vaccine, his has labs drawn done every Friday and when he went to the Doc. On 1/8 the white blood cell count had moved up just a little. And it was still moving up just a little and had his 2nd dose on Friday 2/4/21. And from then on every week when he went in for bloodwork it would go up just a little more. It continued to go up slowly and when he had his 3rd vaccine Aug 7th after the shot while in the hospital his white blood cell count went up 40k (he hit 340K) in a 12 hour period. We got to the emergency room they took lab work and by 8pm the next day it went up by 40K. They were pulling white blood cells out and he was making more that they could pull out. On 9/10 we lost him, the white blood cells attached his organs and made them all start shutting down. On Aug 12th before his vaccine his white blood cell count was 104K. By 9/6 he was over 300K. So his wbc tripled from his 2nd shot to his 3rd shot.


VAERS ID: 1768471 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-01-07
Onset:2021-01-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Death, Extra dose administered, White blood cell count increased, White blood cell disorder
SMQs:, Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 237
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: He was taking Allopurinol 300 mg, Lipitor 20mg, Protonix 40mg, Hydroxyurea
Current Illness: CMML (Chronic myelomonocytic) Leukemia
Preexisting Conditions: CMML (Chronic myelomonocytic) Leukemia
Allergies: He had an allergy to sulfur
Diagnostic Lab Data: weekly blood work draws on fridays
CDC Split Type: vsafe

Write-up: after shot on thursday, on friday his white blood cell count moved up just a little when he did his routine weekly blood work on fridays. the wbc count went up dispite the fact that he had been doing weekly xarixo shots (white blood cell boosting shots) from may 2020 - jan 2021 and the wbc did not move even after this time. and for the first time it went up after his 1st covid shot. WBC count slowly started going up and never stopped and continued to go up and when he got his 3rd shot in august it went up an accelerated rate in the 3 weeks and then he died. I noticed before his aug shot, he was at 700 at his wbc count and was at 100k on his august shot and 3 wks later at nearly 400K after that shot.


VAERS ID: 1768495 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-10-05
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - Acute intracranial hemorrhage


VAERS ID: 1768504 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-09-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK - / -

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

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

Write-up: death I61.9 - Cerebral parenchymal hemorrhage (CMS/HCC)


VAERS ID: 1768512 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-09-27
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Pneumonia, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Pneumonia I26.99 - Pulmonary embolism U07.1 - COVID-19


VAERS ID: 1768518 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-09-13
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death U07.1 - COVID-19 J96.01 - Acute respiratory failure with hypoxia J12.82 - Pneumonia due to coronavirus disease 2019 N17.9 - Acute kidney failure, unspecified


VAERS ID: 1768522 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-25
Onset:2021-08-17
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HYPOXIC RESPIRATORY FAILURE COVID-19, SEPSIS COVID-19, PNEUMONIA COVID-19


VAERS ID: 1768531 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-09-08
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute respiratory failure with hypoxia Pneumonia due to COVID-19 virus


VAERS ID: 1768541 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-09-27
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, COVID-19 pneumonia, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1768546 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-09-21
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death U07.1 - COVID-19 J96.01 - Acute respiratory failure with hypoxia J12.82 - Pneumonia due to coronavirus disease 2019 N17.9 - Acute kidney failure, unspecified


VAERS ID: 1768554 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-10-02
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hyponatraemia
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death E87.1 - Hyponatremia


VAERS ID: 1768564 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-10-02
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 002B21A / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 046B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Death, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J96.90 - Respiratory failure J96.01 - Acute respiratory failure with hypoxia


VAERS ID: 1768570 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-09-24
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 24M20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I63.9 - Acute CVA (cerebrovascular accident)


VAERS ID: 1768576 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-10-02
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hyponatraemia
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death E87.1 - Hyponatremia


VAERS ID: 1768580 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-04
Onset:2021-09-25
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - AKI (acute kidney injury)


VAERS ID: 1768588 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-10-01
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - AKI (acute kidney injury) (CMS/HCC) J96.01 - Acute respiratory failure with hypoxia (CMS/HCC)


VAERS ID: 1768591 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-09-28
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O-012L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O-031M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death G45.9 - TIA (transient ischemic attack)


VAERS ID: 1768599 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-09-18
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Death, Pneumonia
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Pneumonia, unspecified organism J96.01 - Acute respiratory failure with hypoxia


VAERS ID: 1768610 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-20
Onset:2021-09-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cough, Fatigue
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Coughing and fatigue


VAERS ID: 1768611 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-09-07
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J96.01 - Acute respiratory failure with hypoxia


VAERS ID: 1768620 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-09-30
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute kidney injury


VAERS ID: 1768627 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-10
Onset:2021-09-18
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death, Gastrointestinal haemorrhage, Pneumonia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (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), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - Pneumonia, unspecified organism - Acute kidney failure, unspecified - Gastrointestinal hemorrhage, unspecified gastrointestinal hemorrhage type


VAERS ID: 1768639 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-05
Onset:2021-09-29
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW069 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Bradycardia, COVID-19, Cardiac arrest, Chills, Cough, Death, Decreased appetite, Diarrhoea, Dizziness, Dyspnoea exertional, Oliguria, Resuscitation, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 4
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: ALbuterol MDI prn, Amlodipine 10 mg QD, Aspirin 81 mg QD, Benzonatate 100 mg TID prn, Carvedilol 50 mg BID, Famotidine 20 mg BID, Ferrous sulfate 325 mg QD, Fluticsone Nasal QD, Furosemide 40 mg BID, Insulin NPH 38 units BID, Lisinopril 20
Current Illness:
Preexisting Conditions: Anemia, BMI 32.69, Charcot arthritis feet/neurpoathy, CHF, CKD stage 3, DM Type 2, Gastroparesis, Hepatitis C infectio history of pancreaitits, Hypertension, Hyperlipidemia, Osteoarthritis, Proteinuria due to type 2 diabetes mellitus (HCC), Seasonal allergies, Testicular cancer (HCC) (1993), and Type 2 diabetes with nephropathy (HCC) (1/31/2015).
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Home test positive on 9/29/2021 per patient report. On 10/1/2021 Positive COVID-19 test using PCR of equivalent technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/14/2021 and 5/5/2021. Presented to ED on 10/1/2021 with reports of loss of taste, dyspnea on exertion, and diarrhea consists of watery stools 3 times a days for the past 2-3 days. Patient reports drinking 5 of 8oz water bottles every day but is having very minimal urine production. He reports associated lightheadedness, chills, non-productive cough, and decreased appetite. He was treated with Remdesivir, Tocilizumab, Decadron and supportive care. On 10/3/21 patient had a syncopal episode and became bradycardic. He went into cardiac arrest. CPR was initiated. Patient eventually expired.


VAERS ID: 1768718 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-25
Onset:2021-08-23
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   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: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization and Death


VAERS ID: 1768827 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Washington  
Vaccinated:2021-04-01
Onset:2021-06-16
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Mechanical ventilation, Myocardial infarction, Pulmonary oedema, Stent placement, Thrombosis
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-15
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Heart problems
Allergies: None
Diagnostic Lab Data: Hospital
CDC Split Type:

Write-up: He had a heart attack two months after receiving the shot. They had to put a stent in. He had blood clots they didn''t know where they were coming from. One month later, July 12, he had another heart attack that killed him. They put him on a ventilator and after they removed that he was doing fine. Then they put him on rendezevere. It filled his lungs with fluid and he was gone in 12 hours. They murdered him.


VAERS ID: 1768835 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-16
Onset:2021-08-23
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Multiple organ dysfunction syndrome, Subdural haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Accidents and injuries (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MULTI SYSTEMS FAILURE, TRAUMATIC SUBDURAL HEMATOMA Death on 9/6/2021


VAERS ID: 1768856 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-04
Onset:2021-07-22
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 48
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 35 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: NON HODGKINS LYMPHOMA; LAST TREATMENT 7/2021
Allergies: UNKNOWN
Diagnostic Lab Data: POSITIVE FOR COVID 19 ON 8/1/2021
CDC Split Type:

Write-up: PATIENT DIED FROM COVID 19 AFTER BEING FULLY VACCINATED


VAERS ID: 1768909 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-23
Onset:2021-09-08
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Angiogram cerebral abnormal, Anosmia, Anticoagulant therapy, Blood culture, Blood pressure decreased, COVID-19, Cardio-respiratory arrest, Cerebral endovascular aneurysm repair, Cerebral vasoconstriction, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Cough, Death, Deep vein thrombosis, Endotracheal intubation, General physical health deterioration, Hypophagia, Inappropriate schedule of product administration, Intracranial aneurysm, Intraventricular haemorrhage, Laboratory test, Lethargy, Mechanical ventilation, Mental status changes, Oropharyngeal pain, Pneumonia, Positive airway pressure therapy, Pulse absent, Respiratory tract congestion, Resuscitation, SARS-CoV-2 test positive, Sputum culture, Subarachnoid haemorrhage, Tachycardia, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azelastine Nasal BID, Benzonatate 100 mg TID prn, Carvedilol 12.5 mg BID, Fluticasone Nasal QD, Glucosamine+Chondroitin QD, Hydroxyurea 500 mg BID, Losartan 100 mg QD, Sertraline 50 mg QD, Lisinopril 30 mg QD.
Current Illness:
Preexisting Conditions: Anxiety, Colon polyp, Dysrhythmia, essential thrmobocytosis, hyperlipidemia, hypertension, osteoarthritis, Polycythemia vera, H/O colon cancer.
Allergies: Milk
Diagnostic Lab Data: Positive COVID-19 test on 9/3/2021, 9/4/2021, and 9/28/2021
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/23/2021 and 2/23/2021. Patient presented to physician office on 9/3/2021 after developing COVID symptoms of cough, sore throat, congestion, loss of taste and smell 4-5 days prior, as well as reports that daughter had recently tested COVID positive. Patient received Casirivimab and Imdevimab on 9/6/2021. On 9/28/2021 patient presented to the ED for altered mental status. She was found to have a subarachnoid hemorrhage and was admitted with consultation to the Stroke team. She was intubated on 9/30/2021. BCx2, Pneumonia Panel, Sputum culture without any organism found. She underwent diagnostic cerebral angiogram and subsequent coiling of the anterior communicating artery aneurysm on 9/30/20201. On 10/01/2021 she was awake and following commands. After completing a spontaneous breathing trial she was successfully extubated. She was initially communicating, following commands, and A&O x 3. Over the night of 10/02/2021 she had increasing O2 demands and was placed on HFNC. She was tachycardic on 10/03/2021, she was more lethargic and would not swallow sips of water. A sepsis work up was initiated along with DVT studies do to history of Essential Thrombocytosis. She was found to have DVTs in BL upper extremities and R lower extremity. She required BIPAP to maintain ventilation. She was sent for CT/CTA of head which noted slightly increased intravenricular hemorrhage and vasospasm of the right ACA, left ACA, and left MCA. CT Chest was consistent with multifocal pneumonia. She was increased to subcutaneous heparin TID with ASA 81 mg. On 10/4/2021 she continued to regress. The morning of 10/05/2021 she would respond only to pain stimulus. She was evaluated again with CT with worsening vasospasm. Patient was intubated, after which her BP dropped Two attempts were made with push dose Phenylephrine to increase BP with out success. Her pulse was lost and compressions were started. Code Blue was called. Family was informed of the changes to her status and they decided to stop chest compressions and let her pass peacefully.


VAERS ID: 1768915 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-13
Onset:2021-09-12
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Dyspnoea, Endotracheal intubation, Lung opacity, Mechanical ventilation, Paralysis, Prone position, Respiratory failure, SARS-CoV-2 test positive, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 40 mg nightly, bupropion 150 mg daily, lexapro, 20 mg daily, levothyroxine 75 mcg daily, losartan 100 mg daily, pantoprazole 40 mg daily, risperidone 1 mg
Current Illness:
Preexisting Conditions: Hypothyroidism, hyperlipidemia, diabetes, hypertension, bipolar disorder, gastroesophageal reflux disease, depression allergic rhinitis
Allergies: Penicillin, lactose
Diagnostic Lab Data: COVID test positive on 9/12/2021; CXR: Bilateral lower lobe opacities and consolidation on 9/12/2021
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/23/2021 and 2/13/2021. Patient presented to the emergency department with complaints of shortness of breath and admitted for COVID pneumonia. Patient progressed to respiratory failure requiring intubation on 9/16/2021. Despite lung protective mechanical ventilation, paralysis, proning, inhaled pulmonary vasodilators, steroids, broad spectrum antibiotics, and remdesivir, her respiratory failure progressively worsened. On 9/25/2021 patient developed acute renal failure with worsening shock. Family elected to pursue comfort care at that time. Patient was extubated on 9/25/2021, and expired at 2107 on 9/25/2021.


VAERS ID: 1768972 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-27
Onset:2021-09-10
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Computerised tomogram abdomen abnormal, Confusional state, Death, Depressed level of consciousness, Disturbance in attention, Dyspnoea, General physical health deterioration, Pneumonia, Pneumonitis, Pyrexia, SARS-CoV-2 test positive, Urine analysis, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Buspirone 5 mg BID, Calcium Citrate +Vit D; BID, Cholecalciferol 50 mcg QD, Duloxetine 60 mg QD, Esomeprazole 40 mg QD, Furosemide 20 mg QD, Lasmiditan 50 mcg QD, Mycophenolate 500 mg BID, Nitrofurantoin 50 mg QD, Prednis
Current Illness:
Preexisting Conditions: Renal transplant, Liver transplant, Degenerative joint disease, Depression, Anxiety, GERD, Chronic Immunosuppression, Chronic pain syndrome, Benign neoplasm of colon, S/P insertion of spinal cord stimulator, Osteoporosis, S/P kyphoplasty, panlobular emphysema, H/O myocardial infarction, Nicotine dependence, Combined systolic/diastolic CHF, CAD, Migraine, Essential hypertension, H/O cerebral infarction due to embolism of right cerebellar artery, Unintentional weight loss, polyneuropathy, hyperlipidemia, hypothyroidism.
Allergies: Topiramate, Nortriptyline, NSAID, Hydromorphone, Phenytoin
Diagnostic Lab Data: Positive COVID-19 test on 9/16/2021 using an unspecified platfrom using PCR or equivalent technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/31/2021 and 4/27/2021. Presented to ED on 9/10/2021 with complaint of confusion, as per family this happens when patient has urinary tract infection. Patient stated that she took a home urinary tract infection test kit which resulted positive. She was evaluated for urinary tract infection, but urinalysis was unremarkable. Chest x-ray was normal, but she underwent CT of the abdomen and pelvis which did show findings in the lung bases consistent with pneumonia versus pneumonitis. She was prescribed doxycycline, but stopped taking it after 2 days due to nausea. Subsequently changed to levofloxacin on 9/14/2021 during follow-up clinic visit. On 9/16/2021 patient presented to ED with shortness of breath, labored breathing, fever and chills. Placed on 6L O2 NC. Despite aggressive treatment, she has deteriorated and is no longer alert but is obtunded. Family has decided to transition to comfort care. Patient expired 9/25/2021.


VAERS ID: 1768982 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-23
Onset:2021-09-15
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Acute respiratory failure, COVID-19, Death, Decreased appetite, Depressed level of consciousness, Diarrhoea, Dyspnoea, Fatigue, Hypoxia, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen prn, Amlodipine 5 mg QD, Carvedilol 12.5 mg BID, Levothyroxine 37.5 mcg QD, Lisinopril 10 mg QD, Rivastigmine 4.6 mg/24hr Patch QD.
Current Illness:
Preexisting Conditions: Hypertension, Left bundle branch block, Hypothyroidism, Dementia, Atrial Fibrillation, Benign neoplasm of kidney, Nodular lymphoma, Angiomyolipoma, Follicular lymphoma, 1st degreee AV block, Bigeminy, SIADH,
Allergies: Penicillin
Diagnostic Lab Data: Positive COVID-19 test on 9/18/2021 using the Roche LIAT SARS assay platform using PCR or equivalent technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/5/2021 and 3/23/2021. Presented to ED on 9/18/2021 with reports decreased appetite over the last 3 days, diarrhea and abdominal pain 2 days duration, shortness of breath, and fatigue. She was found to have pneumonia secondary to COVID-19. She was hypoxic and admitted to the hospital. She was started on dexamethasone and determined to not be a candidate for remdesivir. She rapidly decompensated and required high-flow nasal cannula. By September 24th she had become relatively obtunded and stop taking all oral medications. On maximum high-flow she was only maintaining O2 saturations in the 86-89% range. Palliative Care evaluated the patient on that evening and on the morning of the 26th she was transitioned to comfort care. On September 26 at 3:16 a.m. the patient passed away.


VAERS ID: 1769000 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-09-17
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, Encephalopathy, Fall, Femoral neck fracture, Hallucination, Hypervolaemia, Imaging procedure abnormal, Inappropriate schedule of product administration, Mental status changes, Oxygen saturation decreased, Pyrexia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 500 mg Q6H PRN, Atorvastatin 10 mg QD, Calcium carbonate 500 mg QD, Caclium-Vitamin D 250 mg/2.5 mcg BID, Cyanocobalamin 100 mcg QD, Levothyroxine 112 mcg QD, Melatonin 3 mg QHS, Pantoprazole 40 mg QD.
Current Illness:
Preexisting Conditions: Ataxia, BPH, Dementia, Hyperlipidemia, H/O poliomyelitis, hypocalcemia, hypothyroidism.
Allergies: Alfuzosin
Diagnostic Lab Data: 9/22/2021 Positive COVID-19 test using the Roche LIAT SARS assay platform using PCR or equivalent technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/27/2021 and 2/26/2021. He tested positive for COVID on 9/20/21 after cough, fever, sob developed on 9/17. He was brought to the ED by spouse on 9/22 for a mechanical fall and worsening altered mentation with hallucinations. In the ED imaging shows worsening fluid overload, COVID PNA and left femoral neck fracture. COVID treatment was initiated (Remdesivir and Dexamethasone) and it was the plan for him to go to the OR. However, he continued to decompensate and O2 demand continued to increase - he was transitioned to high flow nasal cannula. He remained encephalopathic, agitated, and in respiratory distress. Family requested comfort care in the hospital. He was admitted for EOL cares on GIP service and ultimately expired on 10/3/2021.


VAERS ID: 1769002 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-09-10
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Decreased appetite, Dyspnoea, Hypoxia, Inappropriate schedule of product administration, Nausea, Productive cough, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Medication errors (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 23
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: Alendronate 70 mg QWeek, Atorvastatin 40 mg QD, Calcium carbonate 500 mg BID, Vitamin D3 600 units BID, Clopidogrel 75 mg QD, Diclofenac gel QID, Eliquis 5 mg BID, Fosinopril 10 mg QD, Metoprolol 150 mg QD, Fish Oil QD, Pantoprazole 40 mg Q
Current Illness:
Preexisting Conditions: Anemia, BPH, Cardiac pacemaker, Carotid artery stenosis, chronic pain, CAD, Hypertension, H/O focal seizure, arthritis, GERD, H/O colon polyps, H/O GI Bleed, H/O nephrolithiasis, H/O rickets, H/O TIA, H/O Vertebral compression fraction, Hyperlipidemia, Lesion of bladder, Paroxysmal atrial fibrillation, peripheral vascular disease.
Allergies: NKDA
Diagnostic Lab Data: Positive COVID-19 test on 9/24/2021 using the Cepheid GeneXpert platform using PCR or equivalent Nucleic Acid Amplification(NAA)technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/9/2021 and 4/6/2021. Presented to the ED on 9/24/2021 reports that over the past 2 weeks, he has had a productive cough, nausea, loss of appetite, and progressivley worsening SOB leading to EMS call. Pt tested positive for COVID, on arrival. He was satting 92% on 10L NRB; hypoxia progressed and pt was transition to HFNC 50/50. He was admitted and ended up requiring max HF settings, developing respiratory failure. Decision made to transfer to comfort care, patient expired on 10/3/2021


VAERS ID: 1769006 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-22
Onset:2021-09-18
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Death, Hypoxia, Interstitial lung disease, Lung opacity, Pyrexia
SMQs:, Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-29
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Memantine 5 mg BID, Tylenol #3 1 tab q6-8h PRN, albuterol 1-2 puffs q4-6h PRN, aspirin 81 mg daily, atorvastatin 40 mg daily, carbidopa-levodopa 25-100 mg TID, vitamin D3 50 mcg daily, clindamycin 300 mg TID, dicyclomine 20 mg q6-8h PRN, fl
Current Illness:
Preexisting Conditions: Parkinson''s disease, alzheimer''s dementia, diabetes
Allergies: Bactrim
Diagnostic Lab Data: 9/18/2021 CXR: Interstitial opacities in the bilateral midlung and left lower lobe
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/14/2021 and 2/22/2021. Presented to the emergency department on 9/18/2021 for worsening hypoxia and fever. Recently diagnosed with COVID pneumonia and treated at a different facility. Upon arrival to ED, on 9/18/2021, patient was placed on oxygen 5L nasal cannula (increased from home requirements of 2L). Throughout hospitalization, respiratory status continued to decline and patient received: remdesivir, dexamethasone, baricitinib, and antibiotics. Patient expired on 9/29/2021 at 1412.


VAERS ID: 1769008 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-09-01
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Cyanosis, Death, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Hypopnoea, Hypoxia, Mechanical ventilation, Nausea, Pain, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 29
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: Albuterol MDI PRN, Aspirin 81 mg QD, Atorvastatin 80 mg QD, Clopidogrel 75 mg QD, Lotrisone Cream BID, Empagliflozin 10 mg QD, Ferrous Sulfate 325 mg TID, Furosemide 40 mg QD, Hydrocodone+APAP PRN, Insulin glargine 20 units QAM 30 units QPM
Current Illness:
Preexisting Conditions: A-fib, Arthritis, Asthma, CAD, CHF, COPD, Depression, Diabetes mellitus, Foot Ulcer, Hyperlipidemia, Hypertension, Sleep apnea, Squamous cell carcinoma, H/O stroke, H/O TIA
Allergies: NKDA
Diagnostic Lab Data: Positive COVID test on 9/11/2021 SARS assay platform using PCR or equivalent Nucleic Acid Amplification(NAA)technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 2/27/2021 and 3/27/2021. Presented to ED on 9/11/2021 after patients son found him shallow breathing this morning and appears cyanotic and pushed on his chest which prompt patient to take a deep breath subsequently his color returned. EMS upon arrival noted he was hypoxic, placed him on 15 L of non-rebreather. Patient states that he has symptom onset about 10 days ago. He felt very fatigued, no appetite, generalized body ache, fever, cough and shortness of breath. He also have nausea vomiting couple days ago this has improved. He has some diarrhea a few days ago this is resolved. He continued to require high-flow oxygen and subsequently requiring mechanical ventilation on 9/20/21. He completed the 5 day course of remdesivir. Patient also treated with IV antibiotic therapy. Patient required vasopressor support. Determination made to initiate comfort care. The patient expired on 9/30/2021.


VAERS ID: 1769012 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-26
Onset:2021-09-08
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, Hypotension, Hypoxia, Lung opacity, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium 500 mg, vitamin D3 2000 units daily, gabapentin 100 mg TID, lisinopril 20 mg daily, multivitamin daily, omeprazole 20 mg daily, tramadol BID PRN
Current Illness:
Preexisting Conditions: arthritis, lumbar radiculopathy
Allergies: No known allergies
Diagnostic Lab Data: 9/7/2021: COVID positive; 9/7/2021: chest x-ray revealed Diffuse bilateral geographic groundglass opacity throughout both lung fields.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/5/2021 and 3/26/2021. Patient presented to emergency department with hypoxia and hypotension. Patient required supplemental oxygen upon arrival. Patient was transferred to a Med Cntr for admission. Patient''s respiratory status continued to decline throughout hospitalization. Patient received: azithromycin, ascorbic acid, cefepime, ceftriaxone, dexamethasone, remdesivir, vancomycin, and zinc. Patient was transitioned to comfort care and expired 9/26/2021 at 2043.


VAERS ID: 1769028 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-25
Onset:2021-10-05
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 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: 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: Client had 1 dose of covid 19 vaccine, client died-due to complications of covid-19


VAERS ID: 1769037 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-26
Onset:2021-09-27
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 6
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: Allopurinol 200 mg daily, aspirin 81 mg daily, bumex 1 mg BID, calcitriol 0.25 mcg daily, coreg 6.25 mg BID, cholecalciferol 400 units daily, vitamin B12 400 mg, finasteride 5 mg daily, tamsulosin 0.4 mg nightly.
Current Illness:
Preexisting Conditions: Benign prostatic hyperplasia, chronic kidney disease stage IV, hypertension, congestive heart failure, COPD
Allergies: No known allergies
Diagnostic Lab Data: 9/27/2021: COVID positive; 9/27/2021: Chest x-ray revealed patchy airspace opacity in the left lower lobe as well as the periphery of the right lower lobe
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 12/31/2021 and 1/31/2021. Patient recently diagnosed with COVID on 9/20/2021 and hospitalized at a different facility from 9/20/2021 to 9/22/2021. Patient presented to emergency department for shortness of breath and required oxygen supplementation 4-5L nasal cannula. Patient received cholecalciferol, ceftriaxone, and dexamethasone. Patients respiratory status continued to deteriorate and patient declined intubation. Patient expired 10/3/2021 at 0917.


VAERS ID: 1769681 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-09-30
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Condition aggravated, Death, Hyperglycaemia, Hyponatraemia, Hypoxia, Intensive care, Oxygen saturation decreased, Pneumonia bacterial, Superinfection, Type 2 diabetes mellitus
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (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), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 4
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: amLODIPine (NORVASC) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG chewable tablet busPIRone (BUSPAR) 5 MG tablet Cholecalciferol (VITAMIN D3) 1000 UNITS TABS Cyanocobalamin (VITAMIN B 12) 500 MCG TABS escitalopram (LEXA
Current Illness: NA
Preexisting Conditions: Diabetes mellitus type 2, uncontrolled Depression Vitamin D deficiency Osteoporosis, unspecified OA (osteoarthritis) Hypothyroid Varicose veins of lower extremities Fatigue Anxiety OSA on CPAP Periodic limb movements of sleep Diabetic neuropathy Coronary artery disease of native artery of native heart with stable angina pectoris Anemia Essential hypertension Sleep disturbance Gout of left foot, unspecified cause, unspecified chronicity Asthma Thoracogenic scoliosis of thoracic region Chronic kidney disease, stage 4 (severe) Class 2 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 39.0 to 39.9 in adult Renal oncocytoma of left kidney Lower extremity edema Diabetic ulcer of toe of left foot associated with type 2 diabetes mellitus, with fat layer exposed PAD (peripheral artery disease) Rash COVID-19
Allergies: Brilinta [Ticagrelor] Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased (10.4.21); Hospitalized (9.30.21); COVID-19 positive (9.30.21); fully vaccinated Discharge Provider: MD Primary Care Physician at Discharge: None Physician, MD None Admission Date: 9/30/2021 Date of Death: 10/4/21 Time of Death: 12:50 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19 PRESENTING PROBLEM: Hyponatremia [E87.1] Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin [E11.65] COVID-19 [U07.1] Acute respiratory failure due to COVID-19 [U07.1, J96.00] Acute hypoxemic respiratory failure [J96.01] HOSPITAL COURSE: Patient admitted for acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient was fully vaccinated, however she did not respond well to maximum medical therapy including iV decadron, IV remdesivir, and broad spectrum antibiotics to cover superimposed bacterial pneumonia. She was transferred to the ICU on maximum HFNC. She continued to have low oxygen levels. Patient decompensated and after long discussion with the family, resulted in transition to comfort care. She expired comfortably surrounded by family at 1250 on 10/4/21.


VAERS ID: 1770385 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211008694

Write-up: DEATH; This spontaneous report received from a consumer who reported hearing a news report concerned a patient of unspecified age, sex, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: unknown, expiry: unknown) frequency time-1 total, dose, start therapy date and therapy end date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient experienced death "who recently received the jnj vaccine". On an unspecified date, the patient died from an 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. This report was serious (Death). This case, from the same reporter is linked to 20211008681.; Sender''s Comments: V0: 20211008694-COVID-19 VACCINE AD26.COV2.S- Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1770392 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Pneumonia, Pulmonary embolism, Suspected COVID-19, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211009924

Write-up: PULMONARY EMBOLISM; ACUTE RESPIRATORY FAILURE; PNEUMONIA; SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a parent concerned a male of unspecified age of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: Unknown) dose was not reported, 1 total, administered on JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date in JUN-2021 (in third week of the month), patient received the vaccine because patient was doing shows on ship in the second week of July and had to be vaccinated to do the cruise. On 10-SEP-2021, the patient passed away from a pulmonary embolism and lack of oxygen as per parent but patient''s neurologist could not understand why patient died because the rest of organs were functioning well. On 10-SEP-2021, the patient died from pulmonary embolism, acute respiratory failure, pneumonia, and covid-19 (suspected clinical vaccination failure) as per the death certificate. 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 pulmonary embolism, acute respiratory failure, pneumonia, suspected covid-19 infection on 10-SEP-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: 90000196332.; Sender''s Comments: V0 20211009924-COVID-19 VACCINE AD26.COV2.S-pulmonary embolism, acute respiratory failure, pneumonia, 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). V0 20211009924-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: PULMONARY EMBOLISM; ACUTE RESPIRATORY FAILURE; PNEUMONIA; COVID-19


VAERS ID: 1770413 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211011940

Write-up: DEATH; This spontaneous report received from a consumer via social media concerned a 20 year old patient of unspecified 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, and batch number were not reported) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The batch number was not reported. The Company was unable to perform follow-up to request batch/lot numbers. "The reporter had seen on news regarding the death of 20 year old patient after receiving the JNJ vaccine". The reporter wanted to know if the vaccine was still safe. On an unspecified date, the patient died from an unknown cause of death and it was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211011940-COVID-19 VACCINE AD26.COV2.S -Death. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1770608 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Neoplasm malignant, Portal vein 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), Embolic and thrombotic events, venous (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101275291

Write-up: cancer blown out of nowhere; portal vein thrombosis; strokes.; This is a spontaneous report from non-contactable healthcare professionals (one is a physician assistant). A male patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 2021 (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The reporter stated that just Tuesday, they shipped out three cardiomyopathies, and a blood clot. On 27Sep2021, the patient on the floor just died and the reporter just pronounced him a second ago. The patient got his shot and literally two weeks later, the patient ended up with cancer blown out of nowhere, a portal vein thrombosis like and got strokes in 2021. The patient died on 27Sep2021. 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: Based on the current limited available information, a possible contributory role of the suspect product BNT162B2 to the development of events cancer, portal vein thrombosis and strokes cannot be excluded. The case will be reassessed if additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: portal vein thrombosis; cancer blown out of nowhere; strokes.


VAERS ID: 1770624 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-27
Onset:2021-06-07
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CRESTOR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atherosclerosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101294803

Write-up: Death; This is a spontaneous report from a contactable other healthcare professional (HCP). A 67-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via unspecified route of administration in right arm on 27May2021 at 09:00 as single dose for COVID-19 immunisation. The relevant medical history included atherosclerosis from unspecified date. Concomitant medications included rosuvastatin calcium (CRESTOR). No other vaccine in four weeks. The patient experienced death on 07Jun2021 at 04:45. No treatment received for the events. No covid prior vaccination and no covid tested post vaccination. The patient died on 07Jun2021. It was unknown if an autopsy was performed. The outcome of the event was fatal. The Lot number for the vaccine [BNT162B2] was not provided and will be requested during Follow-up.; Sender''s Comments: The information currently provided is too limited to make a meaningful medical assessment. However, per company causality assessment guidance, the event of death with unknown cause is assessed as related until the cause of death is clarified. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to RAs, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Death


VAERS ID: 1770625 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK0112 / 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 INC202101294996

Write-up: died; This is a spontaneous report from a contactable pharmacist. A 37-year-old female patient received bnt162b2 (COMIRNATY, Lot Number: FK0112; Expiration Date: 30Jan2022), via an unspecified route of administration on an unspecified date (37-year-old at time of vaccination) as single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient died on an unspecified date. Verbatim: The reporting pharmacist states that she is located in the (country A) but has patients in (country B) who travel back and forth for business. These patients are stuck in (country B) due to the high rates of the delta variant there the pharmacist explained. She states that Pfizer COVID 19 vaccines as well as Moderna COVID 19 vaccines are being donated by other countries to (country B) to help provide vaccination. She states that one of her patients who is in (country B) received one of these donated vaccine with lot number FK0112 and customer service was again to look up this lot number and provide the expiration date of (30Jan2022) stated the pharmacist. She relays that there have been multiple adverse events that have happened with this lot number and she would like to know if it is possible that there was something wrong with that lot. Her patient who was a 37-year-old healthy female received the vaccine from this lot and died 4 hours later. She would like to know why this could have occurred. What data is available on deaths being reported. It was unknown if an autopsy was performed. The cause of death was unknown.; Sender''s Comments: Based on the information available and close temporal association, a possible contributory role of the suspect BNT162B2 cannot be excluded for the reported events . The case will be reassessed once new information is available The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: died


VAERS ID: 1771072 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211009011

Write-up: BLOOD CLOT; This spontaneous report received from a consumer via a company representative via social media concerned a female of unspecified age, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown) dose, with frequency time 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient had a blood clot and died from the blood clot. It was unknown if an autopsy was performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient died from blood clot. This report was serious (Death).; Sender''s Comments: V0: 20211009011-COVID-19 VACCINE AD26.COV2.S-blood clot. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOT


VAERS ID: 1771073 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-06-07
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Death, Hypotension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 119
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210607; Test Name: Blood pressure; Result Unstructured Data: low
CDC Split Type: USJNJFOC20211011543

Write-up: DEATH; LOW BLOOD PRESSURE; This spontaneous report received from a consumer concerned a 69 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821288, expiry: 30-OCT-2021) dose was not reported, 1 total, administered on 07-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-JUN-2021, the patient experienced low blood pressure issues since vaccination, was known visited on 02-OCT- 2021. Laboratory data included: Blood pressure (NR: not provided) low. On 04-OCT-2021 after an appointment was missed patient friends went to patient house where patient was found on floor beside bed. The patient died from unknown cause of death. An autopsy was not performed at time of reporting. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on 04-OCT-2021, and the outcome of low blood pressure was not reported. This report was serious (Death).; Sender''s Comments: V0: 20211011543-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: 1771449 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-09
Onset:2021-06-06
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 AR / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 90
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See attached
Current Illness: Esrd, high blood pressure, osteogenesis imperfecta, depression, anxiety, chronic pain, insomnia,
Preexisting Conditions: Esrd, high blood pressure, osteogenesis imperfecta, chronic pain, insomnia.
Allergies: See attached
Diagnostic Lab Data: 9/3 and 9/4 2021.
CDC Split Type:

Write-up: Became unresponsive during non emergency transport to dialysis. Rerouted to nearest hospital. Transport company failed to supply hospital with patient info. Was admitted as generic patient around 5pm on Sept 3, 2021. Transport company failed to contact me with patient unresponsive, and emergency location. I couldn''t locate my son until after midnight.


VAERS ID: 1771519 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-10
Onset:2021-09-05
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ativan Levoxyl Norvasc Ecotrin Toprol Lexapro Aricept Privinil Lopressor
Current Illness:
Preexisting Conditions: dementia
Allergies: Codeine, erythromycin
Diagnostic Lab Data: Positive COVID-19 test
CDC Split Type:

Write-up: Patient expired due to COVID-19 after having been vaccinated.


VAERS ID: 1771542 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-09-15
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratidine Azithromycin Atorvastatin Diltiazem ER Fenofibrate Valsartan Aspirin Celecoxib Escitalopram L. acidophilus Dapagliflozin Metformin Pioglitazone Multivitamin Exenatide Imbruvica
Current Illness:
Preexisting Conditions: CLL in relapse Hypertension Hyperlipidemia T2DM
Allergies: NKDA
Diagnostic Lab Data: Positive COVID-19 test
CDC Split Type:

Write-up: Patient expired due to COVID-19


VAERS ID: 1771570 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-28
Onset:2021-09-09
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   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: Gabapentin
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: POSITIVE COVID-19 TEST
CDC Split Type:

Write-up: Patient expired with COVID-19 after COVID-19 vaccination


VAERS ID: 1771573 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-06
Onset:2021-08-20
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, Metoprolol Succinate XL, Aspirin, Escitalopram, Gabapentin, Furosemide, Cholecalciferol
Current Illness:
Preexisting Conditions: GERD, spinal abscess, hypertension, congestive heart failure, anemia, depression
Allergies: unknown
Diagnostic Lab Data: Positive COVID test
CDC Split Type:

Write-up: Patient expired due to COVID-19 after being vaccinated


VAERS ID: 1771581 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-07
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin Apixaban Valsartan Pantoprazole Ascorbic acid Cholecalciferol Multivitamin Thiamine Allopurinol
Current Illness:
Preexisting Conditions: AFib Gastritis Gastric ulcer
Allergies: Clonidine
Diagnostic Lab Data: Positive COVID-19 test
CDC Split Type:

Write-up: Patient expired on 09/07/21


VAERS ID: 1771603 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute hepatic failure, Death
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levemir subcutaneous insulin daily
Current Illness: Type 1 Diabetes mellitus, endometriosis, hypothyroidism
Preexisting Conditions: Type 1 Diabetes mellitus, endometriosis, hypothyroidism
Allergies: Clindamycin, Penicillin
Diagnostic Lab Data: In hospital medical record
CDC Split Type:

Write-up: Hospitalization, acute liver failure & death on 10/8/2021


VAERS ID: 1771613 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-26
Onset:2021-08-28
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / UNK - / -

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: 2021-08-28
   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: Patient fully vaccinated and died due to Covid related causes


VAERS ID: 1771639 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-11
Onset:2021-10-02
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 10805029 / UNK - / -

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: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lung Disease, Cardiovascular Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died due to covid related causes


VAERS ID: 1771697 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-24
Onset:2021-08-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Confusional state, Death, Diarrhoea, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fluoextin, Olanzapine, benztropine, haldol, losarton, amlodipine
Current Illness: Bipolar, hypertension
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomachache pain, vomiting, diarrhea, chest pain, headache, confusion and death


VAERS ID: 1771747 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-11
Onset:2021-01-29
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 209
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 Kidney Disease, Bipolar disorder with behavioral disturbances, GERD, Hypothyrodism, Hypertension, Hypernatremia
Allergies:
Diagnostic Lab Data: Patient tested positive for Covid 19 on 08/15/2021
CDC Split Type:

Write-up: NA


VAERS ID: 1771748 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-08-25
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/25/2021 PCR+ COVID-19 test at Hospital.
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 8/25/2021-8/29/2021. Death 8/29/2021. From Vital Records COD = RESPIRATORY FAILURE, COVID-19. Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: None listed. place of death: HOSPITAL-INPATIENT; certified, PRONOUNCING AND CERTIFYING PHYSICIAN.


VAERS ID: 1771763 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-08-20
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/24/2021 PCR+ COVID-19 test. 08/24/2021 Antigen+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 8/24/2021: Fever, Cough. Hospitalized 8/20/2021. Death 8/27/2021. From Records COD = CARDIORESPIRATORY ARREST, COVID-19 VIRAL PNEUMONIA. Per records, Other Significant Conditions include: None listed. lace of death: HOSPITAL-INPATIENT; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN, occ/ind: COOK, FOOD


VAERS ID: 1771765 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-19
Onset:2021-09-12
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Cardiac failure congestive, Cardiomegaly, Chronic kidney disease, Death, Dialysis, Endotracheal intubation, Hyperlipidaemia, Hypertension, Hypervolaemia, Hypoxia, Pneumonia, Pulmonary oedema, SARS-CoV-2 test positive, Type 2 diabetes mellitus
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (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), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Hyperlipidemia, Diabetes Mellitus type 2
Allergies:
Diagnostic Lab Data: Covid 19 RNA 09-12-2021
CDC Split Type:

Write-up: Patient tested positive for C19 on 09/12/2021. Pt was admitted to the hospital on 09/12/2021 and required intubation and immediate dialysis. Patient had an admitting diagnosis of acute hypoxemic respiratory failure: secondary to volume overload and C19 infection; C19 infection with Hypoxia, suspected pneumonia, acute on chronic kidney disease stage IV; pulmonary edema/volume overload due to congestive heart failure vs. worsening renal failure; acute on chronic congestive heart failure; cardiomegaly; hypertension; hyperlipidemia; diabetes type 2; atrial fibrillation in a controlled rate. Patient was intubated for 13 days before passing away.


VAERS ID: 1771777 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-30
Onset:2021-07-26
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 OT / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented with SOB, normally on NC at night, hypoxic on RA. Required O2. Dx with COVID PNA, received Remdesivir and steroids. Patient does not remember receiving vaccine. Discharged to inpatient hospice and later expired.


VAERS ID: 1771861 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-17
Onset:2021-08-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA GIVEN ON 7/20/2 / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA GIVEN ON 8/17/2 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Ascites, Blood culture negative, Blood fibrinogen decreased, Chronic hepatitis C, Computerised tomogram thorax abnormal, Culture urine negative, Death, Decreased appetite, Echocardiogram abnormal, Ejection fraction decreased, Fatigue, Hepatic cirrhosis, Hepatitis C virus test positive, Intensive care, International normalised ratio increased, Lung opacity, Platelet count decreased, Platelet transfusion, Pleural effusion, Prothrombin time prolonged, Thrombocytopenia, White blood cell count decreased
SMQs:, Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Liver infections (narrow), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 46
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: Cardiac echo 9/29/21 showed EF 40-45%. Repeat on 10/3/21 showed EF 10-15%.
CDC Split Type:

Write-up: Chart review showed he received 2 Moderna COVID-19 mRNA vaccines on 7/20/21 and 8/17/21. Wife called PCP on 8/19/21 to report that he had developed loss of appetite and fatigue and appeared ill. PCP recommended ED eval, but pt did not go until 9/29. At that time he was found to have profound thrombocytopenia with platelets of 18000 and wbc 2700. Previous CBC on 7/21/21 showed wbc 6200 and platelets 150,000. INR initially 1.7 (9/29) then increased to 2.8 (10/3). PT 18 -- $g27, PTT 45-- $g62, Fibrinogen 110 then decreased to <80 mg/dl. Blood and urine cultures did not show any growth. CT C/A/P showed airspace opacities LLL/RUL/RLL and moderate right pleural effusion, hepatic cirrhosis, large ascites, NORMAL spleen. He was started on broad spectrum abx. ALso started on high dose dexamethasone per hem/onc for possible ITP. He received multiple platelet transfusions. He had chronic hep C, mRNA load 1209 mIU/mL. He developed hypotension refractory to IVF and had to be transferred to the ICU on 10/3/21 and subsequently passed on 10/4/21.


VAERS ID: 1771931 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-08-26
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/26/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 8/26/2021-8/31/2021. Death 8/31/2021. Vital Records data not available yet.


VAERS ID: 1772014 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-09-17
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Dyspnoea, Hypoxia, Intensive care, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to the emergency room on 09/17/2021 with complaints of shortness of breath after testing positive for COVID-19 on 09/11/2021. Patient was transferred to the ICU on 09/17/2021 later in the day due to acute hypoxemic respiratory failure. The patient was in the ICU for a total of 9 days before passing away due to acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Patient was hypoxic and eventually went to asystole and died at 5:30 PM on 9/26/2021.


VAERS ID: 1772016 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-23
Onset:2021-08-25
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Fatigue, Pain, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Urinary tract infection, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-17
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Renal disease, Immunosuppressed (Leukemia)
Allergies:
Diagnostic Lab Data: 08/25/2021 Antigen+ COVID-19 test at INTERNAL MEDICINE GROUP; 09/03/2021 Antigen+ COVID-19 test at a Hospital; 09/09/2021 Antigen+ COVID-19 test at Hospital; 09/11/2021 Antigen+ COVID-19 test at Hospital; 09/15/2021 Antigen+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom onset: Fever, Aches, Shortness of breath/difficulty breathing, Fatigue or tiredness, Cough. Hospitalized 9/2/2021-9/17/2021. Death 9/17/2021. Vital Records data not available yet. Patient was hospitalized for UTI and was diagnosed with pneumonia. Patient was retired.


VAERS ID: 1772023 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-08-26
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Atrial fibrillation, Body temperature increased, COVID-19, Cardiac failure congestive, Chronic left ventricular failure, Condition aggravated, Death, Dementia, Diarrhoea, Hypertension, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (narrow), Pseudomembranous colitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, anxiety CHF Afib
Allergies:
Diagnostic Lab Data: 08/26/2021 PCR+ COVID-19 test
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom onset: low grade temp and diarrhea. Death 8/28/2021. From Vital Records COD = CHRONIC COMBINED SYSTOLIC CONGESTIVE AND DIASTOLIC CONGESTIVE HEART FAILURE, UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE. HTN, anxiety CHF Afib . Per vital records, COD ICD Codes include: Not yet coded ; Other Significant Conditions include: UNSPECIFIED ATRIAL FIBRILLATION. place of death: NURSING HOME-LONG TERM CARE FACILITY; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN, occ/ind: EDUCATOR, EDUCATION


VAERS ID: 1772039 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-28
Onset:2021-09-16
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / -

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: 2021-10-02
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case vaccinated with Janssen on 5/28/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/21/2021 and expired on 10/02/2021 while still hospitalized.


VAERS ID: 1772066 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-22
Onset:2021-09-14
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Pfizer. Second dose received on 3/22/2021. Tested positive for COVID on 9/14/2021. Admitted to Medical Center on 9/20/2021. Expired on 9/27/2021 while still hospitalized.


VAERS ID: 1772083 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-09-21
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 10
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: Case fully vaccinated with Moderna. Last dose on 2/26/2021. Tested positive for covid on 9/21/2021. Admitted to Medical Center on 9/27/2021. Expired on 10/01/2021 while still hospitalized.


VAERS ID: 1772110 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-09-16
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

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

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

Write-up: Case fully vaccinated with Pfizer. Last dose on 2/26/2021. Tested positive for COVID on 9/16/2021. Admitted to Hospital on 9/11/2021. Expired while still hospitalized on 9/27/2021.


VAERS ID: 1772156 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-01
Onset:2021-09-21
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna . Last dose on 4/1/2021. Tested positive for COVID on 9/21/2021. Admitted Medical Center on 09/21/2021. Expired on 9/30/2021 while still hospitalized.


VAERS ID: 1772180 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-22
Onset:2021-08-25
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 08/27/2021 PCR+ COVID-19 test at local Medical Center
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 8/25/2021-9/16/2021. Death 9/16/2021. Vital records data not available yet.


VAERS ID: 1772188 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-20
Onset:2021-08-30
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

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

Write-up: Fully vaccinated COVID-19 death


VAERS ID: 1772326 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-12
Onset:2021-08-28
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 23
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: 08/28/2021 PCR+ COVID-19 test at Hospital; 09/10/2021 PCR+ COVID-19 test at Hospital; 09/17/2021 PCR+ COVID-19 test at Hospital
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom onset date: Shortness of breath/difficulty breathing, Cough. Hospitalized 8/28/2021-9/10/2021, SOB and low O2 stats (86%) reported, developed pneumonia. Death 9/20/2021. From Records COD= CARDIAC ARREST, COVID-19 PNEUMONIA. Per records, Other Significant Conditions include: None listed. Place of death: HOSPITAL-INPATIENT; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occ/ind: MIDDLE MANAGEMENT, TELECOMMUNICATIONS .


VAERS ID: 1772352 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-09-17
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B211A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Aortic stenosis, COVID-19, Cardiac murmur, Central venous catheterisation, Death, Echocardiogram, Hyperkalaemia, Hypoxia, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Decubitis ulcer
Preexisting Conditions: Carotid Atherosclerosis, hypercholesterolemia, tremor
Allergies:
Diagnostic Lab Data: Echocardiogram
CDC Split Type:

Write-up: Patient was admitted to hospital with hypoxic failure and COVID-19 . Poor baseline health prior to COVID. Hypoxemia worsed; was initially treated with remdesivir, decadron and baricitnib. Possible secondary bacterial pneumonia so baricitinib stopped and bacterial antibiotics started. Prior decubitus present upon admit. Murmur with severe aortic stenosis. Acute Kidney Injury with hyperkalemia; not a dialysis candidate. Patient made comfort care. Admitted to hospital 9/17/21. Died 9/30/2021. CEntral LIne placed 9/28/21


VAERS ID: 1773394 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211010045

Write-up: BLOOD CLOT; This spontaneous report received from a physician via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died from blood clot. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20211009193 and 20211010279.; Sender''s Comments: V0:20211010045- covid-19 vaccine ad26.cov2.s -blood clot. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOT


VAERS ID: 1773639 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-28
Onset:2021-09-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Fatigue, Immunisation, Off label use, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101300326

Write-up: Two days later, he passed away.; felt fatigued; fever; achy; got the booster shot; got the booster shot; This is a spontaneous report from a non-contactable pharmacist. An elderly male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), intramuscularly on 28Sep2021 (Batch/Lot number was not reported) as dose 3 (booster), single for COVID-19 immunization (administered in a Pharmacy or Drug store); and influenza vaccine via an unspecified route of administration on 28Sep2021 (Batch/Lot number was not reported) for an unspecified indication. The patient''s medical history and concomitant medications were not reported. The patient got the booster shot on 28Sep2021. On 29Sep2021, the patient felt fatigued, fever, and achy. The patient took paracetamol (TYLENOL) and felt a little bit better. Two days later, he passed away. The outcome of felt fatigued, fever, and achy was unknown. It was not reported if an autopsy was performed. The cause of death was not reported. The patient died on 30Sep2021. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on temporal relationship the possibility of causal association between the event death and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Two days later, he passed away.


VAERS ID: 1773646 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Immunosuppression
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101311492

Write-up: heart attack; This is a spontaneous report from a contactable consumer (patient''s sister) . A 64-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (at the age of 64-years-old) (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. Medical history included immunosuppressed. Concomitant medications were not reported. The consumer stated that her 64-year-old sister had the Pfizer BioNtech covid 19 vaccine and was found dead the next day. No autopsy was done however they said it was likely due to a heart attack. The patient died on an unspecified date.; Reported Cause(s) of Death: it was l kely due to a heart attack


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=77&PERPAGE=100&VAX=COVID19&VAXTYPES=COVID-19&DIED=Yes

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166