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

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

Government Disclaimer on use of this data



Case Details

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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: 1943164 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-12
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angina pectoris, Condition aggravated, Coronary artery bypass, Death, Disseminated intravascular coagulation, Fibrin D dimer increased, International normalised ratio, Multiple organ dysfunction syndrome, Vascular graft occlusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Myocardial infarction (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, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate (FOSAMAX) 70 MG tablet Take 1 tablet by mouth every 7 days. aspirin 81 MG tablet Take 81 mg by mouth daily. atorvastatin (LIPITOR) 40 MG tablet Take 40 mg by mouth nightly. calcitRIOL (ROCALTROL) 0.25 MCG capsule Take 1 capsule
Current Illness: CAD
Preexisting Conditions: Allergic rhinitis due to pollen (Chronic) Anxiety Carotid artery stenosis History of adenomatous polyp of colon Prediabetes Mixed hyperlipidemia (Chronic) Primary hyperparathyroidism 4 gland parathyroid hyperplasia: status post 3.5 removal 6/2013. POST-OP HYPOCALCEMIA Hypertension, benign (Chronic) Hypocalcemia Hypothyroidism, acquired (Chronic) Osteopenia, senile DEXA 11/2015 WRIST T SCORE -2.5 FOSAMAX RESTARTED DEXA 1/03 STABLE, 9/11 O-PENIA D/C FOS. 11/13STABL Hx of Hypotestosteronemia Stage 3 chronic kidney disease Coronary artery disease; Stents x2 7/2017 CABD x4 7/4/21 S/P CABG x4 S/P carotid endarterectomy LBBB (Left Bundle Branch Block)
Allergies: Brilinta (ticagrelor)- Shortness Of Breath 9/11/2017
Diagnostic Lab Data: Elevated D-dimer, and PTT, INR. Lab met qualification for DIC.
CDC Split Type:

Write-up: 3-4 weeks after CABG went into DIC. 2 grafts completely occluded. Multisystem failure and death. Prior to CABG- Angina. started in April 2021


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


VAERS ID: 1773647 (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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101311664

Write-up: 1 person to die from the vaccine; This is a spontaneous report from a Pfizer-sponsored program. This is a spontaneous report from a contactable consumer or other non hcp. A patient of unspecified age and gender received bnt162b2(PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. It was reported that 1 person to die from the vaccine on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. The reporter reported his views about the vaccine. The event was assessed as serious(fatal). The lot number for the vaccine, [BNT162B2] was not provided and will be requested during follow-up. Follow-up activities closed. Batch/lot number not available for vaccine/BNT162B2; Reported Cause(s) of Death: 1 person to die from the vaccine


VAERS ID: 1773649 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Oklahoma  
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: 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 INC202101311948

Write-up: Received the Pfizer COVID-19 Vaccine and passed away days later/Unknown cause of death; This is a spontaneous report from the Pfizer-sponsored program. A contactable consumer reported that a female patient (aunt) of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunization. The patient medical history and concomitant medications were not reported. The received the Pfizer COVID-19 Vaccine and passed away days later, Unknown cause of death. She passed away after receiving the vaccine, the Pfizer COVID-19 Vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. Case was reported as serious. The lot number for BNT162b2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1773650 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
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 - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness, Breast cancer, Death, Hepatic cancer
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Breast malignant tumours (narrow), Liver malignant tumours (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101312056

Write-up: died 2 days after getting that booster; blindness; serious cancers, like breast and liver cancer; serious cancers, like breast and liver cancer; This is a spontaneous report from a contactable consumer. A female patient of unspecified age received third dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA A VACCINE, formulation: solution for injection) via an unspecified route of administration on an unspecified date as Dose 3 (Booster), Single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient historical vaccine included bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: solution for injection) via an unspecified route of administration on an unspecified date as Dose 1, Single and via an unspecified route of administration on an unspecified date as Dose 2, Single for COVID-19 immunization. The reporter stated that, the patient got that booster shot. On an unknown date, the reporter stated that the patient died 2 days after getting that booster. The reporter mentioned that the patient health was terrible. The reporter do not wanted to talk about patient because it was depressing. The reporter mentioned that the patient had blindness and serious cancers, like breast and liver cancer. At the time of the death, outcome of the events blindness and serious cancers, like breast and liver cancer was unknown. It was not reported if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: One of them died 2 days after getting that booster


VAERS ID: 1773651 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Oklahoma  
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: 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 INC202101312065

Write-up: passed away days later; This is a spontaneous report from a Pfizer-sponsored program. A female patient of an unspecified age received bnt162b2 (BNT162B2 also reported as Pfizer Covid-19 vaccines, lot unknown), via an unspecified route of administration on an unspecified date at dose unknown, single for Covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. She took the Pfizer Covid-19 vaccine and passed away days later (unspecified date). It was not reported if an autopsy was performed. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow-up.; Reported Cause(s) of Death: passed away days later


VAERS ID: 1774805 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / OT
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Wrong product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2021SA331616

Write-up: went in for a flu shot, gave her Covid vaccine by mistake; Initial information received on 03-Oct-2021 regarding an unsolicited valid Social Media non-serious case from a consumer/non-hcp (health care professional ). This case involves an unknown age female patient who went in for a INFLUENZA VACCINE shot, but received her COVID-19 (corona virus disease) VACCINE by mistake (wrong product administered) and died shortly after on an unknown date. It was unknown if the patient had any medical history, concomitant disease or risk factor. The patient''s past medical treatment(s), vaccination(s), concomitant medication(s) and family history were not provided. On an unknown date, the patient received a dose of suspect COVID-19 VACCINE not produced by Sanofi Pasteur instead of INFLUENZA VACCINE (unspecified manufacturer) (lot number and expiration date not reported) via unknown route in an unknown administration site for prophylactic vaccination. It was a case of an actual medication error due to wrong vaccine administered (same day latency). It was reported "it is happening. Just heard yesterday about a lady who went in for a flu shot, gave her Covid vaccine by "mistake" Told her mistakes happen. She died shortly after." It was unknown if the patient experienced any additional symptoms/events. There were no laboratory data/results available. At time of reporting, the outcome unknown for the reported event. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder''s compliance with the requirements set out in the Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. There will be no information on the batch number for this case.


VAERS ID: 1774920 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-11
Onset:2021-10-02
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Blood fibrinogen increased, COVID-19 pneumonia, Cardiac arrest, Death, Epistaxis, International normalised ratio increased, Leukocytosis, Positive airway pressure therapy, Procalcitonin increased, Respiratory failure, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (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), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital under a medical service to the COVID-19 unit due to hypoxic respiratory failure secondary to COVID-19 pneumonia. He was started on remdesivir Decadron 6 mg b.i.d. Along with therapeutic dose Lovenox. He was admitted to another unit on BiPAP and pulmonology was consulted. Given his leukocytosis and elevated procalcitonin he was started on cefepime and azithromycin. The patient developed a nose bleed PTT and INR was extremely elevated thus he was given Kcentra and vitamin K. Fibrinogen was high not suggestive of DIC. Overnight the patient cardiac arrested code was called at despite ACLS measures the team was unable to obtain ROSC and resuscitation efforts were discontinued. The patient was pronounced deceased at 0249.


VAERS ID: 1774923 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-11
Onset:2021-10-04
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Angiogram pulmonary normal, Anticoagulant therapy, COVID-19 pneumonia, Death, Dialysis, Electrolyte imbalance, General physical health deterioration, Livedo reticularis, Peripheral coldness, Peripheral ischaemia, Platelet count decreased, Pneumonia bacterial, Renal failure, Thrombocytopenia, Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Chronic kidney disease (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: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted due to acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Additionally was found to have bacterial pneumonia started on cefepime and Zithromax. He was started on remsedivir along with Decadron. CTA was negative for pulmonary embolism. A few days into hospitalization the patient developed acute kidney injury nephrology was consulted felt it was likely secondary to thrombus. The patient also developed bilateral foot ischemia surgery is consulted and recommended continuation of anticoagulation. Surgery is consulted for line placement as the patient''s renal failure progressed to needing dialysis with electrolyte abnormality and the patient''s warfarin was reversed. The following day the patient developed severe thrombocytopenia with platelet count and in the 30s thus further anticoagulation was held and hematology was consulted. The patient''s lower extremity ischemia progressed and his extremities were cold mottled from the knee down. Multiple conversations were had with the patient and family and yesterday they decided given his overall poor prognosis and worsening condition the patient his family decided to cease aggressive care efforts and requested comfort measures. The patient passed away today with family at bedside.


VAERS ID: 1774925 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-15
Onset:2021-10-07
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted and being treated for covid. She was receiving maximal therapy (see my progress note from today), but unfortunately underwent a cardiopulmonary arrest. Patient started to be resuscitated, but discussions with family revealed that she did not want to be put on a machine. She was made a DNR and comfort medications (morphine) were administered given pain of CPR. Patient passed shortly after stopping CPR.


VAERS ID: 1775009 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-23
Onset:2021-02-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM

Administered by: Private       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? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 32
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: copd
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Major stoke three days after injection. He was unable to recover and subsequently passed away after one month.


VAERS ID: 1775146 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-23
Onset:2021-09-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metropolol, morphine, adderall, anti-depressant I don?t know the name because they took down her my chart.
Current Illness: Mild hypertension, fibromyalgia, irritable bowel syndrome, add
Preexisting Conditions: Same as above
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother died suddenly on 9/25/2021 around noon while swimming in a pool. Pathologist cause of death was aortic dissection.


VAERS ID: 1775170 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-22
Onset:2021-05-23
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ELO14O / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3202 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   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: Chest pain, shortness of breath, Acute Myocardial Infarction


VAERS ID: 1775206 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-06-02
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   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: insulin, metoformin, lisinopril, esmeprasole
Current Illness: hypertension, hyperlipidemia, type II diabetes, morid obesity
Preexisting Conditions: same as above
Allergies: artificial sweetners
Diagnostic Lab Data:
CDC Split Type:

Write-up: myocardial infarction resulting in death


VAERS ID: 1775309 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray, Death, Respiratory arrest, White blood cell count
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin 1mg Hytrin
Current Illness: Delirium Decubitus Open head wound as a result of necrotizing fasciitis
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data: Cxr Wbc
CDC Split Type:

Write-up: Respiratory arrest Death


VAERS ID: 1775475 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-09-18
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Breath sounds abnormal, Death, Heart sounds abnormal, Pupil fixed, Skin warm
SMQs:, Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Signee called to resident''''s room. Upon entering room resident noted lying on his left side. Skin noted to be warm to touch. Eyes open and fixed. Absent movement of chest noted. Heart and lungs sounds auscultated and noted to be absent. Absent vital signs. Resident assessed by signee. Time of death- 1:52pm. Call placed to Dr. New order received to release body to funeral home of choice. Call placed to on-call guardianship office. Call placed to resident''''s son. No answer and signee un-able to leave message due to mailbox being full. Number for resident''''s daughter-in-law listed but not a working number. No funeral home is listed with facility or guardianship office. Will continue to keep calling resident''''s son. Awaiting returned call.


VAERS ID: 1775575 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-16
Onset:2021-09-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E2114 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Computerised tomogram normal, Death, Decreased appetite, Dysstasia, Eye movement disorder, Feeding disorder, Hypertension, Hypotension, Influenza like illness, Injected limb mobility decreased, Lethargy, Magnetic resonance imaging normal, Mobility decreased, Muscle spasticity, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Ocular motility disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 8
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: Calcium 600 Vitamin D3 Cholestoff B12 Preser Vision Amlodipine Tab 2.5 mg
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: Cat scan MRI Normal Blood work normal
CDC Split Type:

Write-up: Day 1: lethery and weak Day 2: Flulike symtoms and no appetite Day 3: Vomiting, weaker, by evening could not stand up, lost ability to move left arm or leg up. Was taken to emergency room admitted to Hospital Day 4: Able to talk cat scan and MRI show no Neurological issue Legs is spastic and eyes open and close rapidly Day 3: Can mot sit upright ,Growing weaker Start antibiotics Day 4: Still cannot eat, Speaks last words, Low blood pressure and fever Day 5: High blood pressure and low blood pressure @nd Cat scan and MRI show nothing Start antibiotics Day 6 :start steriods, blood work normal Day 7: Eyes still track fighting for life Day 8: Dies


VAERS ID: 1775761 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-19
Onset:2021-02-01
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 027L20A / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Balance disorder, Coordination abnormal, Disorientation, Dizziness, Fall, Impaired driving ability, Loss of personal independence in daily activities
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: see below
Current Illness: none
Preexisting Conditions: overweight, controlled blood pressure
Allergies: Demerol, Leboquin, Vytorin, pecans, walnuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 2 weeks he was having minor balance problems. We were told that these are not unusual symphoms and would go away. After second shot on 2/25/21, balance problems increased with dizziness and disorientation. His symphoms increased and he began falling 3-4 times a day. He was unable to finish weedeating the yard (we have 4-1/2 acres). That had never been a problem before. Through April he got much worse, dizziness, bodycoordination, and hand coordination. He had to stop driving, yard work, and building his4-place airplane. We saw Dr. in May. He was hoping it was weakness and started him with PT and Balance Training. No Change, particularly with balance. He began sleeping much more during the day with multiple naps and longer hours at night. He had always slept 6 hours at night and no daytime naps. He was so tired and the effort to get out of a chair was too much. By the middle of May he was having problems dressing, putting on his shoesand socks and buttoning his shirt. He was falling often and I insisted he use a cane for balance. IIn May and June I took him to all his doctors, internist, cardiac specialist, and even had his eyes tested in case they were part of the problem. He had a MRI of the brain that was negative, and heard imaging and cartatid artery sounding 6/8/2021. All were fine. He began falling more and tangling his feet, even using a came. sleeping mrre, and not able to do much at all. On June 26 we went t a special serive. He could not walk up the 8 steps to the Church. Two young men nearly carried him up the stairs. He was unable to dress himself for the occassion. The cane was no use, he fell three times that afternoon. He started having even more trouble with his feet tangling and was falling more. Often he did a slow roll forward. At 4:21 the morning of July 8, he was standing by the bed. I asked him what was the problem. He said that he needed to go to the bathroom. I ran around and grabbed him and half held him to the bathroom. He could not stand up on his own! I almost could not get him back into bed. He could not sit far enough back on the bed that he did not slide forward off the bed. The next morning, I took him to Hospital. After taking a chest xray, blood, and brain CAT scan, they brought him back to me and sat him in the love seat in the Emergency Room waiting room. After a few minutes he collapsed on me. He was not breathing and had a fixed stare. They got him into triage and got him breathing and his heart going. When stabilaized, they took him up fpr another CAT scan. He coded again! The first CAT was perfectly clear and this one, 40 minutes later, showed a massive bleed, not an anurism, deep in the Basal Ganglia/Thalmus area of the brain. He never regained consciousness and died 16 days lateer. Since his blood pressure had been carefully controlled all his adult life, he did not have uncontrolled blood pressure, ever! He was happy and occupied building his plane during the lockdown when we self-isolated for well over a year. He had so little pressure on him and commented several times what a perfect year we had had! We agreed it was one of our happiest. So pressure, unhappiness, or a bad family situation were not present to cause a stroke. In the nearly 58 years I was married to him he only had flu once and a light cold once. He took the shots for me bacause I had factors that indicated Covid would be particularly hard on me...Type 2 diabetic, 2 autoammune diseases, was 79, and had a double spinal fusion on the 8th of Decemver, 2020. Prescriptions: Mens Centrum Silver- Daily, Naproxin 500mg twice daily, Gabapentin 100mg 1 daily Omeprazole- Twice Daily, Allopurinol 300mg 1 daily, Mirtazapine 7.5mg 1 daily, Synthroid .175mg - 1 daily, vitimin D3 1 daily Zyrtec 1 daily, Oxybutynin 5mg twice daily Lisinopril 12.5mg - twice daily


VAERS ID: 1775763 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-25
Onset:2021-03-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Biopsy lung, Bronchoalveolar lavage, Bronchoscopy, Cardiac failure, Chest X-ray abnormal, Chills, Condition aggravated, Cough, Death, Dyspnoea, Fibrin D dimer increased, Gram stain positive, Interstitial lung disease, Malaise, Neutrophilia, Organising pneumonia, Oxygen saturation decreased, Pneumonitis, Positive airway pressure therapy, Pulmonary fibrosis, Pyrexia, SARS-CoV-2 test negative, Smear site unspecified normal, Tremor
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), 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), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 27
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: Prior to Admission Medications Prescriptions Sig: Take 500 mg by mouth daily. Cholecalciferol, Vitamin D3, (VITAMIN D) 1,000 unit Capsule Sig: Take 2,000 Units by mouth daily. MULTI-VITAMIN ORAL Sig: Take by mouth daily. amlodipine
Current Illness: ED NOTE: Patient is a 75 year-old female with history of interstitial pulmonary fibrosis, coronary artery disease status post 5-vessel CABG x2 complicated by LV aneurysm, hypertension, hyperlipidemia, obstructive sleep apnea who is transferred to ED from UC after she presented there with shortness of breath. The patient initially began to notice she was having difficulty breathing four days prior to presentation on the day she received the Johnson & Johnson COVID-19 vaccination. The following day she developed fevers, shaking chills, and malaise, which she attributed to the vaccination and controlled with ibuprofen. Her shortness of breath progressed, however. Today she appeared unwell to her son and she told him she felt she could not breath. He checked her oxygen saturation and found it to be 57% on room air. He place her on his uncle''s supplemental oxygen to recover her, but her oxygen saturation would drop precipitously when he would take her off. He took her to Urgent Care where she had an initial oxygen saturation of 88% which corrected with 2 L/min supplemental oxygen. Chest x-ray revealed severe pulmonary fibrosis with possible superimposed pulmonary edema. Laboratories were significant for a mild neutrophilia and elevated D-dimer. COVID-19 testing was negative. An dose of enoxaparin 1 mg/kg x1 was administered and the patient was transferred to Medical Center for further management. On arrival the patient is now requiring BiPAP to maintain adequate oxygen saturations. She denies any cough or sputum production but does endorse ongoing shaking chills. She denies any sick contacts. She does not use any supplemental oxygen or inhalers at home. She lives at home and is independent with mobility.
Preexisting Conditions: Arthritis ? Congestive heart failure ? Diabetes mellitus ? Essential hypertension ? Idiopathic neuropathy ? Left ventricular aneurysm ? Myocardial infarction ? Obstructive sleep apnea syndrome ? Other and unspecified hyperlipidemia ? Progressive fibrotic interstitial lung disease
Allergies: clonidine, morphine, penicillin, iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 4/21/2021. Was hospitalized twice after receiving Covid vaccine. Patient is a 75-year-old woman with interstitial lung disease, HFpEF, HTN, CAD (2v CABG 1999) who was admitted on 4/8/2021 for dyspnea and cough. She had recently been admitted to medical center 3/28-3/31/2021 for acute hypoxemic respiratory failure that was felt to be due to HFpEF vs pneumonia vs pneumonitis-ILD. She was treated with antibiotics, steroids, and diuretics at that admission. Upon this admission, patient was again treated with antibiotics, steroids, and diuretics. She had a bronchoscopy with BAL and transbronchial biopsy on 4/14/2021. BAL Gram stain showed few GPC and PJP smear negative. Transbronchial biopsy revealed organizing pneumonia. She was treated with pulse dose steroids with taper. She was continued on antibiotics and diuretics. Despite these therapies, her respiratory status worsened. She required HFNC. On the morning of 4/21/2021, patient''s respiratory status deteriorated. After discussion with family, they opted to pursue comfort care. Patient passed away and was pronounced at 0633 on 4/21/2021.


VAERS ID: 1775791 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-28
Onset:2021-09-16
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   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: Lexapro 20 mg daily Crestor 5mg daily Synthroid 125mcg daily Lorazepam .5mg bid
Current Illness: None
Preexisting Conditions: Hypothyroid Hypercholesterolemia Anxiety disorder Dementia
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found unresponsive in bed without pulse or respiration?s


VAERS ID: 1775807 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ763AC / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: on 10/08/2021 we received a call from a nurse that the patient was found dead in her bed. she was not having any ailment prior to that.


VAERS ID: 1775828 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-27
Onset:2021-05-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Death, Dyspnoea, Hyperhidrosis, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: SWEATING, CHILLS, ACHES, SHORTNESS OF BREATH, TIGHTNESS IN CHEST FOLLOWED BY DEATH ON 06/06/2021


VAERS ID: 1775928 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211014552

Write-up: DEAD; This spontaneous report received from a consumer concerned a 24 year old female with an unspecified 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. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, reporter said that after vaccination his cousin was dead. 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 an unknown cause of death. This report was serious (Death). This case, from the same reporter is linked to 20211014628 and 20211014652.; Sender''s Comments: V0:20211014552-covid-19 vaccine ad26.cov2.s-dead. 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: 1776028 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-11
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: USJNJFOC20211012640

Write-up: BLOOD CLOT; This spontaneous report received from a consumer via social media via company representative concerned multiple patients (2 patients) of unspecified sex and age. No past medical histories or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown expiry: unknown) dose, start therapy date were not reported, 1 total 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 multiple patient developed blood clots and died from blood clot. It was unknown if autopsy was performed. As per the reporter," The CDC (Centers for Disease Control and Prevention) has reported only two other confirmed deaths nationwide". The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patients died from blood clot on an unspecified date. This report was serious (Death). This case, from the same reporter is linked to 20211009011.; Sender''s Comments: V0: 20211012640-COVID-19 VACCINE AD26.COV2.S-blood clot. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: BLOOD CLOT


VAERS ID: 1776306 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-13
Onset:2021-08-23
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Apnoea, Areflexia, COVID-19, Cardio-respiratory arrest, Cellulitis, Chronic kidney disease, Condition aggravated, Cough, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Endotracheal intubation, Hypervolaemia, Hypoxia, Laboratory test normal, Liver disorder, Oxygen saturation decreased, Peripheral swelling, Pulmonary oedema, Pulseless electrical activity, Pupil fixed, SARS-CoV-2 test positive, Troponin normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (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: 2021-09-16
   Days after onset: 24
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: carvedilol metolazone torsemide
Current Illness: On 8/23/21: 57-year-old male with PMHx of NASH cirrhosis, CKD, type 2 diabetes with peripheral neuropathy, and hypertension presented as a direct admission from outpatient cardiology appointment. He was admitted to medicine for management of volume overload suspected secondary to chronic kidney and liver disease. On initial admission he required up to 6 liters NC to maintain SPO2 greater than 88%. His resp decline was felt to be multifocal related to both his COVID infection as well as to pulmonary edema secondary to his known NASH cirrhosis, CKD, and HFpEF. He completed a five day course of remdesivir (stop date 8/29/21) and will continue dexamethasone for a total of ten days (stop date 9/3/21). Respiratory: Positive for cough and shortness of breath. Cardiovascular: Positive for leg swelling. Negative for chest pain. Discharge Disposition/Condition on 9/1/21 Disposition: Home with Home Health Condition: Stable (s/sx potential problems absent or manageable)
Preexisting Conditions: Past medical history: has a past medical history of Awaiting organ transplant status, Cellulitis (06/28/2021), Chronic diastolic congestive heart failure (CMS/HCC), Essential hypertension (04/02/2018), Extended spectrum beta lactamase (ESBL) resistance, History of urethral stricture (1/22/2018), Liver cirrhosis secondary to NASH (CMS/HCC), MRSA bacteremia (4/2/2018), Nephrolithiasis, Osteomyelitis of great toe of left foot (CMS/HCC) (7/15/2020), Paraspinal abscess (CMS/HCC) (4/4/2018), Portal hypertension (CMS/HCC), Stage 3b chronic kidney disease (CMS/HCC) (07/12/2021), and Type 2 diabetes mellitus with diabetic chronic kidney disease (CMS/HCC).
Allergies: pregabalin buspirone metformin NSAID prednisone
Diagnostic Lab Data: COVID PCR positive for covid on 8/23/21 and 9/10/21
CDC Split Type:

Write-up: On 09/10/21: Patient is a 57 y.o. male with recent COVID infection, HFpEF, NASH cirrhosis, CKD IIIb, and IDDM2 who presented to ED via EMS post-code after PEA arrest. According to patient''s wife, he developed acutely worsening shortness of breath early this morning. Wife called EMS after his shortness of breath did not improve upon resuming his home oxygen 3L NC which he had discontinued two days prior due to subjective improvement. Family estimates he stopped breathing less than 5 minutes prior to EMS arrival. EMS reports patient was apneic and in wide-complex PEA on arrival. He was coded for 20 minutes before ROSC. He arrived intubated and on levophed. Cardiogenic etiology considered due to transient hypoxia; however troponins without significant delta, EKG did not show ST abnormalities concerning for ischemia, or MI. Bedside echo without concerning findings. Infectious workup negative. Aggressively diuresed patient with minimal renal recovery. On exam patient was lacking gag reflex and pupils unreactive. Due to concern for severe anoxic encephalopathy and PVS, all sedation was stopped. Patient remained without any purposeful movement, without gag reflex, and without reactive pupils after $g48 hours of complete cessation of sedating agents. Poor prognosis discussed with wife (NOK) and daughter. They both stated he has previously said he would not want to continue with current measures in this type of situation. Wife (NOK) ultimately decided to withdrawal care and pursue comfort care. Patient was terminally extubated and discharged to inpatient hospice


VAERS ID: 1776366 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-06
Onset:2021-09-06
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Ageusia, Agitation, Angiogram pulmonary, Anosmia, Asthenia, Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Cardiac failure, Chills, Chronic obstructive pulmonary disease, Condition aggravated, Cystic lung disease, Death, Decreased appetite, Dyspnoea, Emphysema, Fatigue, Fibrin D dimer increased, General physical health deterioration, Hyperhidrosis, Hypotension, Hypoxia, Intensive care, Lung consolidation, Lung opacity, Ocular hyperaemia, Oxygen saturation decreased, Pain, Palpitations, Pneumonia, Procalcitonin increased, Productive cough, Pyrexia, SARS-CoV-2 test positive, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (Tylenol) 325 MG tablet aspirin 81 MG EC tablet atorvastatin (Lipitor) 40 MG tablet carvedilol (Coreg) 12.5 MG tablet cetirizine (ZyrTEC) 10 MG tablet Eliquis 5 MG tablet isosorbide mononitrate ER (Imdur) 30 MG 24 hr tab
Current Illness: None
Preexisting Conditions: Past Medical History He has a past medical history of: COPD Hypertension Chronic Systolic Heart Failure with bivent AICD Valvular Heart Disease Ischemic cardiomyopathy DM II with hyperglycemia Hyperlipidemia PAD Hx of DVT CAD with angina pectoris Rotator cuff tear arthropathy of right shoulder Insomnia BPH Moderate depression without psychosis Hx of A-fib Hx of Tobacco use disorder Hx of substance use disorder
Allergies: NKDA
Diagnostic Lab Data: COVID PCR positive on 09/06/2021
CDC Split Type:

Write-up: 80 y.o. male with a PMH of COPD, CHF, HTN, DM II, hx of DVT, afib, pacemaker, depression, PAD, HLD, depression, and recent viral pneumonia who presented to ED with shortness of air, worsening productive cough, generalized weakness, loss of appetite, body aches, subjective fevers, and chills. Patient presented to ED and was found to be hypoxic with spo2 of 80% requiring supplemental oxygenation and eventually had oxygen increase to 40L 70%. Patient had one episode of hypotension that resolved with 500ml fluid bolus. MICU was consulted due to increased high flow settings and deferred patient to progressive care. On assessment, patient''s o2 saturation of 87% with RR of 35 on 35% 30 liters high flow nasal cannula. Increased the patient to 50% 35 liters with o2 saturation of 92%. Constitutional: Positive for appetite change, chills, diaphoresis, fatigue and fever. Negative for unexpected weight change. HENT: Negative for congestion, hearing loss, sore throat, tinnitus and trouble swallowing. Loss of taste/smell Eyes: Negative for pain, redness and visual disturbance. Respiratory: Positive for cough and shortness of breath. Negative for wheezing. Cardiovascular: Positive for palpitations. Negative for chest pain and leg swelling. Chronic palpitations. #Acute on chronic hypoxic respiratory failure 2/2 COVID 19-PNA c/b CAP in setting of severe COPD and HFrEF - reports of severe COPD on home O2 (unsure of settings) and HFrEF 20-25% - COVID-19 positive on 9/6/21; s/p J&J vaccine earlier this year - CT PE 9/6: negative for PE, b/l GGO and consolidation, L$gR. emphysematous changes w/ peripheral blebs and airtrapping. Some peripheral honeycombing concerning for fibrotic changes with traction bronchiectasis - elevated d-dimer, LDH, CRP, and procal - 9/6: started on remdesivir + dexamethasone 6 mg daily, CAP coverage with ceftriaxone and azithromycin - not currently a candidate for barcitinib per ID due AKI - on transfer to MICU, was on HFNC 60L @ 100%, but this is likely 2/2 agitation and patient intermittently removing cannula. Precedex started and able to wean HFNC to 50L @70%. Plan: - Continue ceftriaxone for 5 days (thru 9/10) and azithromycin for 3 days (thru 9/8) for CAP coverage Patient continued to decline after admission as expected ultimately to his death on 09/16/2021 at 1134AM . Patient was pronounced dead by hospital bedside RN.


VAERS ID: 1776387 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-23
Onset:2021-10-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide, Vit D-3, Fish Oil, Victoza, Losartan, Metformin, Vit B-12. Jardiance
Current Illness: None
Preexisting Conditions: Diabetes HTN Hyperlipidemia
Allergies: Bees
Diagnostic Lab Data: CoVid test negative.
CDC Split Type:

Write-up: Found unresponsive after coworker heard a thud. Code Blue called. CPR initiated, AED applied and no shockable rhythm x3. Code continued for 45 minutes with paramedics on scene and drugs administered. Time of death called by ER physician on phone.


VAERS ID: 1776391 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-30
Onset:2021-10-04
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: 2021-10-10
   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: CONGESTIVE HEART FAILURE, T2DM, HTN, MULTIPLE MYELOMA UNDERGOING CHEMOTHERAPY.
Allergies:
Diagnostic Lab Data: POSITIVE COVID TEST 10/4/21
CDC Split Type:

Write-up: DEVELOPED SYMPTOMS AND TESTING POSITVE FOR COVID19 10/4/21


VAERS ID: 1776412 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-08-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Decreased appetite, Diarrhoea, Eye haemorrhage, Lethargy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Retinal disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions: COPD, Alzheimers, TIA, Kidney issues, Urinary incontentence, swelling in the leg and foot, enlarged prostate.
Allergies: Sulfa drugs.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood in corner of patients eye, severe diarrhea, lethargy, loss of appetite.


VAERS ID: 1776504 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-23
Onset:2021-03-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Injury, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: See attached list
Current Illness: See attached list
Preexisting Conditions: Asthma, diabetes, coronary disease, depression, APS
Allergies: See attached list
Diagnostic Lab Data: 03/24/2021
CDC Split Type:

Write-up: Loss of consciousness; fall; injury - over about 1 hour


VAERS ID: 1776569 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-12
Onset:2021-10-08
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid 19 death


VAERS ID: 1776605 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

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

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: Mirapex, Rytary, Lasix, Lisinopril, Spironolactone, Metoprolol ER, Mag oxide, Coumadin, Vit D3, Atorvastatin, ASA
Current Illness: tooth extraction 1 week prior
Preexisting Conditions: CHF, Afib, Parkinson''s
Allergies: Clindamycin
Diagnostic Lab Data: n/a (saw scheduled regular cardiologist about 1 hour following vaccination - no new issues)
CDC Split Type:

Write-up: death approximately 18 hours following vaccination. Asymptomatic. Died in sleep.


VAERS ID: 1776628 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-03
Onset:2021-10-10
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPIRED; COVID BREAKTHROUGH CASE


VAERS ID: 1776636 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-08-11
Onset:2021-08-23
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: iodine supplement
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of heart attack 10 days after vaccine with no family history or prior indication of heart problems


VAERS ID: 1776673 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pulmonary embolism, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta Relafen
Current Illness: Dementia and urinary incontinence
Preexisting Conditions: Dementia
Allergies: knda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was alert, ambulating in hallway. Patient a sudden, unexpected death in her sleep. Most likely suspect pulmonary embolis. However, patient has no pre-exisiting condition to explain this sudden death


VAERS ID: 1776894 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 3 UN / IM

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

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Warfarin, Alprazolam, losartan-hydrochlorothiazide, sertraline, atorvastatin, metoprolol,
Current Illness: none
Preexisting Conditions: hypercholesterolemia, dyspnea, prostate cancer, hypertension, migraine, diabetes type 2, coronary artery disease, anxiety, transient global amnesia, tobacco use
Allergies: Levaquin, Statins
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I received a call from patient''s daughter who was upset he received the COVID booster on Monday October 4, 2021 and died of a MI on October 6, 2021. I am not sure where he received the booster or where he received it.


VAERS ID: 1776925 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:2021-02-28
Onset:2021-08-25
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002V21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Asthenia, Atrial fibrillation, Computerised tomogram abnormal, Death, Electrocardiogram abnormal, Fatigue, Heart rate increased, Oxygen saturation decreased, Palpitations, Pneumonia bacterial, Productive cough, Respiratory failure, Respiratory tract congestion, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT revealed bacterial PNA
CDC Split Type:

Write-up: Patient has hx of hypertension and Stage 3 kidney disease, obstructive sleep apnea with c/o palpitations, productive cough, congestion, fatigue, and weakness. Patient''s HR was up and EKG revealed atrial fib with RVR. He was given antibiotics and steroids He was discharged on 8/22 and was readmitted on 8/25 with worsening of symptoms patient developed sepsis and returned with afib with RVR again. Patient''s oxygen demand increased and worsening resp. failure patient was intubated and placed on a ventilator. Patient also had a NSTEMI Patient was terminally extubated and expired on 8/28.


VAERS ID: 1776938 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-25
Onset:2021-09-23
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: past medical history bilateral above-the-knee amputations, A. fib, prior left bundle branch block, prior DVT PE, prior chronic heart failure unclear if reduced ejection fraction
Allergies:
Diagnostic Lab Data: COVID PCR +9/23 and 9/26.
CDC Split Type:

Write-up: COVID PCR +9/23/21. Admitted for shortness of breath on Bi-pap.


VAERS ID: 1777314 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, No reaction on previous exposure to drug
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novolog, pradaxa, pantoprazole, bumetanide, clopidogrel, sildenafil, calcitriol, brilinta, amlodepine, atorvastatin, potassium chloride, spironolactone, metoprolol, lantus
Current Illness: hypotension
Preexisting Conditions: COPD, Congestive heart failure, Diabetes
Allergies: Xarelto, Eliquis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did well with the first two doses, received the booster and two hours after he passed away. According to the wife, he was alright in the two hour time frame post vaccination. He went shopping and showed no signs of anaphylaxis or intolerance.


VAERS ID: 1777335 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-02-04
Onset:2021-06-24
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lacertine 25mg, Simvastatin 20mg, and Aspirin 81mg
Current Illness: Hypertension and High Cholesterol
Preexisting Conditions: Hypertension and High Cholesterol
Allergies: No
Diagnostic Lab Data: Autopsy
CDC Split Type: vsafe

Write-up: My husband died of a massive pulmonary embolism four moths after receiving the vaccine on 06/24/2021 ( never had any symptoms or injuries prior to receiving the vaccine). I found my husband dead in our home upon arriving from work. An autopsy was performed and that''s how I learned that he died of a massive pulmonary embolism..


VAERS ID: 1924298 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-22
Onset:2021-04-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B214 / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ? / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetic
Preexisting Conditions: Diabetes Type 2
Allergies: Shellfish/Shellfish Derived Products
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea and vomiting, died in her apartment 2-3 days after COVID-19 Moderna 2nd shot administered. On March 25, 2021, our daughter received her first COVID-19 Moderna vaccination. On April 22nd, she received her 2nd Moderna vaccination, and our daughter grew ill and died in her apartment alone 3 days later. On April 23rd she telephoned to Inform my husband and I that she was nauseous and vomiting, and that she Informed her doctor of her symptoms. She said, her doctor told her that her symptoms where normal and should subside within a few days. On April 26 at 2:27 pm she was pronounced dead and her body was transported to the coroners office. The doctor on staff, wrote the cause of death as Atherosclerotic Cardiovascular Disease. Considering the fact that she was fine prior to taking the COVID-19 vaccine, my husband and I questioned cause of death. How was/is he able to say for sure that the 2nd COVID-19 vaccination was not the/a contributing factor to her death, particularly withstanding the absence of chain of events leading up to her death? His response literally was "I''ve seen so many cases like this, and I know what they look like. I can just look at a patient and tell what the cause of death was." This is a major concern for us, how could he know for sure without knowing anything about our daughter''s medical history? Our daughter was a young 52 aged female with no prior history of heart disease, and she was well, up until receiving the 2nd COVID vaccination. Our hearts are crushed, she took very good care of us. We are seniors, and she was a major part of our lives, she prepared our meals. went grocery shopping, visited a minimum of 4 times weekly...We loved her so and she loved us. Sincerely, parents of deceased


VAERS ID: 1778769 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-10-09
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes Hypertension Chronic Renal Disease COPD
Allergies: Unknown
Diagnostic Lab Data: PCR test administered by Hospital
CDC Split Type:

Write-up: Patient Contracted COVID-19 Patient Died from COVID-19 on 10/09/2021


VAERS ID: 1778825 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received COVID booster shot (3rd dose) on 10/7/21. On 10/10/21 pt was found unresponsive/ no pulse/no resp. Hospice nurse pronounced death at 0820 on 10/10/21


VAERS ID: 1778854 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-04
Onset:2021-10-09
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1778866 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-09
Onset:2021-10-09
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE. VACCINE PROVIDED BY PHARMACY


VAERS ID: 1778922 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-16
Onset:2021-10-07
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Arterial catheterisation, Auscultation, Breath sounds abnormal, COVID-19, Cardio-respiratory arrest, Central venous catheterisation, Computerised tomogram thorax abnormal, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hyperkalaemia, Hypoxia, Intensive care, Intestinal ischaemia, Lung infiltration, Lung opacity, Multiple organ dysfunction syndrome, Oxygen saturation decreased, Pallor, Pneumonia, Pulmonary embolism, Rales, Renal failure, Respiratory fatigue, SARS-CoV-2 test positive, Septic shock, Tachycardia, Tachypnoea, Wheezing, pH body fluid
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 1
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: acyclovir, amylase-lipase-protease, Biotin 2500, buPROPion, ca, Caffeine calCITriol copper gluconate Cyanocobalamin cyclobenzaprine ferrous sulfate furosemide HYDROcodone-acetaminophen latanoprost multivitamin olanzapine omeprazole
Current Illness: N/A
Preexisting Conditions: COPD, ARF, esophageal obstruction, major depressive disorder, coagulopathy, Drug-induced hypokalemia, pulmonary emboli
Allergies: N/A
Diagnostic Lab Data: SARS-COV-2 (COVID-19) by NAA, Micro (See Responses to 18)
CDC Split Type:

Write-up: 9/24 PMHx of COPD, pneumonia, pulm HTN, Anxiety who presents for SOB w/ wheezing x 3 days. Diag. w/ Pneumonia upon assessment. 9/25 CT suspicious for small pulmonary emboli. Examination of the lungs reveals numerous groundglass airspace opacities throughout the upper lobes and lower lobes bilaterally. 9/28 Lungs reduced to auscultation bilaterally. Right lower lobe crackles. On CT There is interval worsening in aeration with development of bilateral infiltrates diffusely throughout both lungs. The pleural spaces remain clear. 10/4 patient currently requiring warmed high flow oxygen at 45L. Overnihgt desaturations into 10/5 10/6 pt desat to 62%, pt pale, tachypenic, tachycardic. Rapid response called to aid 10/6 Again RRT was called due to hypoxia Osat was in mid 80s%, pt was on high flow 10/6 She has been transferred to the ICU due to worsening respiratory status. Discussed plan for EGD tomorrow with patient and her daughter at the bedside. 10/6 Called to ICU patient showing signs of respiratory fatigue, requested to intubate patient. Patient oxygenated with ambu bag and mask with FiO2 100%. Intubation followed. 10/7 Central Line Placement - Right Internal Jugular 10/7 COIVD+ Result 10/7 Discussed with family poor prognosis, and clinical deterioration, will remain full code 10/8 CRITICAL CARE PROCEDURE NOTE - ARTERIAL CATHETER INSERTION 10/8 Septic shock with multiple organ failure, suspect ischemic bowel 10/8 Code blue called at 05:31 pm. On arrival to room, patient had achieved ROSC. Per nursing staff patient has been severely acidotic throughout the day with pH<7. Patient is on multiple pressors. Renal failure with hyperkalemia. There was suspicion for possible ischemic bowel however CT of abdomen could not be obtained as patient is too unstable. Patient had coded again while I was at rapid response. Per nurse staff ED doctor present for the code and pronounced patient


VAERS ID: 1779007 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-31
Onset:2021-08-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Death, Disorientation, Dyspnoea, Feeling abnormal, Gait disturbance, Influenza like illness, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Metformin, lisinopril and gabapentin
Current Illness:
Preexisting Conditions: Hypertension, prior MI status post stents, diabetes mellitus 2
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The decedent was feeling poorly prior to receiving his first Moderna vaccine on August 31, 2021. Approximately 2 hours after the vaccine, he developed a low-grade fever and body aches. He left for a trip the same day and his flu-like symptoms worsened. He later developed difficulty breathing. On September 7 or date of death, he developed cold sweats, low grade fever and labored breathing. He also became disoriented and had trouble walking. His date of death: 09/07/2021.


VAERS ID: 1779036 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-06-01
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Deep vein thrombosis, Gait disturbance, Oedema peripheral, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XARELTO, LEVOTHYROXINE, ALBUTEROL, FLUVOXAMINE
Current Illness: TOBACCO ABUSE
Preexisting Conditions: CHRONIC OBSTRUCTIVE PULMONARY DISEASE; THYROID DISEASE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The decedent received her second Pfizer Covid vaccine on 04/07/2021. Some time later, she developed edema and in her legs with trouble walking. She presented to Hospital and diagnosed with bilateral deep venous thromboses in June 2021. A postmortem Covid-19 test is positive. She died on 08/22/2021.


VAERS ID: 1779140 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-11
Onset:2021-10-09
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1779181 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-16
Onset:2021-10-09
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1779214 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-10-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ694AA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: loratadine, fluticasone, omeprazole, lisinopril, tizanidine, carvedilol, hydrocortisone tablet, amlodipine, advair, magnesium oxide, potassium chloride liquid, imodium, prochlorperazine, gabapentin, ferrous sulfate, nortriptyline
Current Illness: anemia, ileostomy, type 2 Diabetes mellitus, Wolff-Parkinson-White, chronic pancreatitis, nicotine dependence, adrenal insufficiency, GERD, Crohns, hypertension, mild intermittent asthma, sleep apnea, hypokalemia
Preexisting Conditions: anemia, ileostomy, type 2 Diabetes mellitus, Wolff-Parkinson-White, chronic pancreatitis, nicotine dependence, adrenal insufficiency, GERD, Crohns, hypertension, mild intermittent asthma, sleep apnea, hypokalemia
Allergies: cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Notified by medical examiner that patient was found deceased at home 10/08/2021, no report of symptoms in interim


VAERS ID: 1779236 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-22
Onset:2021-10-06
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Death, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (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), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully-vaccinated and admitted to the hospital with COVID. Patient had multiple comorbidities and passed away while in the hospital secondary to severe respiratory failure and ARDS.


VAERS ID: 1779241 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-10-09
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anal incontinence, Anxiety, Bedridden, Breath sounds abnormal, Breath sounds absent, Death, Diarrhoea, Dyspnoea, Grimacing, Moaning, Oedema peripheral, Pain, Painful respiration, Pallor, Perineal pain, Peripheral coldness, Pulse absent, Somnolence, Vaginal discharge, Vaginal fistula
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Dyskinesia (narrow), 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), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   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: Initial visit. Patient is sitting up in bed drinking some juice. She is somewhat drowsy, drifting off to sleep when not directly engaged. PPS 30%; bedbound. Patient denies pain when asked; states she feels much better than last night. Son reports that she had a good deal of pain and anxiety last night, but it is much better this AM after she received some Roxanol and Ativan before bed. When she does have pain, it is in the perineum. Having copious amounts of thin, malodorous brown drainage/stool coming from the vaginal fistula. She often groans and grimaces when peri-care is performed. from Skin is intact and pale/cool to touch. Fingers and legs very cool to touch. Unable to obtain sats as fingers were cold to touch and unable to warm them up. Respirations unlabored at rest; labored if repositioned and with pain. LS diminished throughout. Edema 2+ BLE. BS active; having constant stool leaking. Discussed timeline, prognosis, and reviewed patient?s routine medications and CCK. Written instructions provided. Discussed POC with son. No refills needed. Instructed to call hospice with any changes or concerns. Visit made to pronounce death. Patient had no pulse or respirations at time of visit


VAERS ID: 1779294 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-03
Onset:2021-09-23
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, 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: 2021-10-02
   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: dapagliflozin 5 mg tablet 5 mg PO DAILY tab clopidogrel 75 mg tablet 75 mg PO DAILY #90 tab carvedilol 6.25 mg tablet 6.25 mg PO BID #180 tab acetaminophen 300 mg-codeine 30 mg tablet 1 tab PO DAILY tab mupirocin 2 % topical o
Current Illness: PNEUMONIA, ACUTE RESPIRATORY FAILURE, HYPOTENSION, ACUTE KIDNEY INJURY
Preexisting Conditions: CHRONIC KIDNEY DISEASE, ACUTE RESPIRATORY FAILURE, HYPOTENSION, ACUTE KIDNEY INJURY, MORBID OBESITY, TYPE 2 DIABETES MELLITUS, HYPERKALEMIA, CHORNIC OBSTRUCTIVE PULMONARY DISEASE
Allergies: DOXYCYCLINE
Diagnostic Lab Data: 09/23/2021 , POSITIVE COVID-19 PCR
CDC Split Type:

Write-up: BREAKTHROUGH INFECTION


VAERS ID: 1779444 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-25
Onset:2021-05-31
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59678-0580-15 / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Laboratory test, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 134
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Migraines, Chronic Bronchitis
Allergies:
Diagnostic Lab Data: Autopsy to include various tests
CDC Split Type:

Write-up: Myocarditis resulting in death.


VAERS ID: 1779504 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-08
Onset:2021-08-31
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admission to critical care hospital with COVID-19 diagnosis on admission. Passed on 9/22/21


VAERS ID: 1779515 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-10-07
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Diabetes mellitus inadequate control, Respiratory failure, Sepsis
SMQs:, Anaphylactic reaction (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), 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: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated against Covid-19, died on 10/07/2021 from complications of Covid-19 pneumonia respiratory failure, sepsis, and uncontrolled diabetes. Second Moderna dose administered on 03/31/2021. Second Moderna dose Lot # 025B21A. Patient


VAERS ID: 1779581 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, 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: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever sore arm.
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Sulpha drugs
Diagnostic Lab Data: Autopsy performed by local Coroners Office.
CDC Split Type:

Write-up: Woke up with a fever of 99.4. When I checked on her in the evening she was dead.


VAERS ID: 1779892 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-25
Onset:2021-04-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


VAERS ID: 1779903 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-25
Onset:2021-03-31
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 AR / SYR

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

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

Write-up: Coughing then turned to pneumonia


VAERS ID: 1780142 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-22
Onset:2021-10-04
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Anaemia postoperative, Blood loss anaemia, COVID-19, Chest X-ray normal, Computerised tomogram normal, Death, Gastrointestinal disorder, Hypotension, Lactic acidosis, Packed red blood cell transfusion, Respiratory failure, SARS-CoV-2 test positive, Stoma site haemorrhage, Transfusion, Vasopressive therapy
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Respiratory failure (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   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: acetaminophen PRN, atorvastatin, citalopram, Lomotil PRN, loperamide, midodrine, omeprazole, ondansetron PRN, TPN, zolpidem PRN
Current Illness:
Preexisting Conditions: history of endometrial CA, s/p hysterectomy, XRT, requiring bowel resection and diverting ostomy, short gut syndrome, chronic nausea on TPN, bladder CA s/p incomplete resection, solitary kidney with CKD3, chronic ureteral obstruction s/p nephrostomy tube placement
Allergies: Erythromycin, Penicillins
Diagnostic Lab Data: COVID status positive 10/4/21 and 10/6/21
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/17/21 and 4/22/21 at another facility. On 9/27/21, patient admitted to our facility for acute blood loss anemia from ostomy. COVID status was negative on 9/27/21 and 9/29/21. However, COVID status changed to positive on 10/4/21 and 10/6/21. Patient expired on 10/9/21 likely related to abdominal pathology. Here''s the discharge summary from hospitalist: "Patient with recurrent bleeding episodes from her stoma requiring total of 8 U PRBC. CT for GIB was negative for active bleeding on admission. She was seen by GI service who felt there is no role for GI controlling bleed. Colorectal surgery was contacted after an other episode of large quantity bleed. Unfortunately she developed progressive hypoxic respiratory failure with abdominal distention, lactic acidosis, progressive hypotension requiring HFNC, vasopressor support, transfusion. CXR was surprisingly clear and felt that severe hypoxia likely related to abdominal pathology."


VAERS ID: 1780477 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-08-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cough, Death, Dyspnoea, Fatigue, Productive cough
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 11
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: Exforge HCT, Metformin, Omega 3
Current Illness: none
Preexisting Conditions: Hypertension, Diabetes II both under control
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, phlegm, shortness of breath, fatigue, for 12 days an then death.


VAERS ID: 1780517 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: uptravi, Sildenafil,Letairis
Current Illness: no
Preexisting Conditions: Long QT,Pulmonary Hypertension
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had a heart attack and was gasping for air


VAERS ID: 1782222 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-01
Onset:2021-09-01
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   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: Diabetes, Cardiovascular Disease, Chronic Renal Disease, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1782231 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-12
Onset:2021-09-01
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Lung Disease, Diabetes, Cardiovascular Disease, Chronic Renal Disease, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1782247 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-17
Onset:2021-08-31
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized for heart problems. Patient died due to COVID-19. Patient was fully vaccinated.


VAERS ID: 1782301 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-10-13
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


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