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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: 1817829 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-20
Onset:2021-09-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 3 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Extra dose administered, 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), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: torsemide 20 mg 2 tablets once a day allopurinol 300 mg 1 tablet once a day levothyroxine 112 mcg once daily gabapentin 300 mg once daily methotrexate 2.5 mg 8tablets one time a week prednisone 2tablets once a day potassium chloride 10 meq
Current Illness: None
Preexisting Conditions: Cardiovascular disease History of Coronary Artery Bypass Graft. 2 years ago Rheumatoid Arthritis Polymyalgia Myalgia Rheumatica Hemochromatosis
Allergies: Atorvastatin: Muscle aches Bee Venom: Swelling at site Clindamycin: Nausea Cozaar: Cough Prinivil: Cough Shrimp flavor: Tongue swelling
Diagnostic Lab Data: The week prior to the event, on Thursday September 16th, I accompanied him to a one year check up with Cardiologist. He went over recent diagnostic tests including an Echocardiogram and a carotid artery ultrasound. He reported that both looked stable and he was in good shape. No worries. Slight increase in fluid was noted around his ankles, for which he increased his diuretic at that time. He was to return to the NP in 3 weeks to monitor the fluid reduction. He was scheduled to return to see cardiologist in 1 year.
CDC Split Type:

Write-up: My dad was taking a shower getting ready to go to a podiatry appointment. After about 1/2 hour, my mother checked on him and found him on the bathroom floor after his shower unresponsive. Calling 911, the responders came and found a faint heartbeat, but were unable to revive him. He was pronounced dead. medical examiner at the scene.


VAERS ID: 1817863 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-25
Onset:2021-08-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Cardiac arrest, Computerised tomogram normal, Death, Gait inability, Hallucination, Hyporesponsive to stimuli, Laboratory test, Loss of personal independence in daily activities, Mental disorder, Mobility decreased, Pain in extremity, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-29
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pravastin, Ramipil, Ipratropium atrovent nebulizer
Current Illness: COPD, Hyperlipidemia, Hyperextension
Preexisting Conditions: COPD
Allergies: None
Diagnostic Lab Data: CAT scan at Hospital. Battery of tests at same facility. Records available via Hospital requisition. Primary care records available via Doctor. Last physical dated Feb, 05, 2021 showed COPD and before mentioned medications. No dementia as noted by staff. Any instances of hallucinations or possible dementia happened after vaccination.
CDC Split Type:

Write-up: On Wednesday, August 25th, 2021 my mother awoke and assumed her normal daily routine. She had a breakfast of one egg, two slices of bacon and wheat toast. She was perfectly ambulatory and needed no help in walking, dressing, her personal hygiene or assistance in going to the restroom. At 12:30 that afternoon she walked down the stairs of her home and she and I left for her COVID vaccination at the local store. We arrived at store and immediately went to the pharmacy department where she received the Moderna vaccination. We continued shopping for grocery items for an additional 15-20 minutes, paid our bill and exited the store. As we were leaving the store she complained of soreness in her vaccinated arm and a feeling of weakness. I had to help her into our vehicle and upon arriving home had to physically carry her up the steps and into the house. I put her onto the couch where she could relax and watch television. She was alert and mentally clear but extremely weak. I researched reactions to the vaccination on line and attributed her initial weakened condition as normal reaction to the vaccination and that they could last 1-3 days with minor continuing symptoms for as long as two weeks. She continually worsened for the next three days and her mental state continually degenerated to where she seemed unaware of her surroundings and had difficulty responding to verbal stimuli. She could not walk, dress, bathe herself, lost control of her bowels and could not eat without assistance. I contacted my sister and she came over to help me care for her in regards to personal hygiene, feeding, dressing and putting her into and changing of adult diapers. After three days passed with her showing no signs of improvement, I reached out to her primary care physician and left a detailed message of her symptoms with the messaging service of what was happening and asked for advice. I was informed that it was a normal reaction to the vaccine and to monitor her for any worsening signs. On 17 September with her health showing no signs of improving we called 911 for emergency care and had her transported to hospital. A full battery of tests were performed including a CAT scan with no indications of what was causing this digression in her health. The staff stated she was exhibiting signs of dementia which we refute. Her last complete physical dated Feb 05, 2021 indicates her mental and Neurological state at baseline and her Psychiatric state as normal. She was discharged from hospital on Sept 22, 2021 and was transported home where she remained under family care pending assistance from local elderly programs. On Sept, 29th 2021 she was reclining in her armchair when she slumped over to the side and was unresponsive. 911 was called and paramedics arrived, transported her into the emergency vehicle where she went into cardiac arrest. The emergency response team administered CPR until arrival at hospital where she was pronounced dead. My mother went from a person able to care for herself with minimum assistance to a person who seemed to be in the last stages of Alzheimer?s disease in a matter of three weeks. She did not suffer from any of the mental or physical problems until immediately after the receiving the Moderna COVID vaccination. At 83 years of age she did have normal health issues associated with someone of her age. She was a colon cancer survivor and had been diagnosed with COPD and was on oxygen but she suffered no medical condition which would have resulted in her rapid decline and subsequent death such as happened immediately following her vaccination. Based on what I personally witnessed following her vaccination, I fully believe that if she had not taken it, that she would be with us still. There has not been enough time allowed or documentation of adverse reactions to the COVID vaccination, especially with the elderly or persons with pre-existing medical conditions.


VAERS ID: 1818084 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-23
Onset:2021-08-29
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   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: Hypothyroidism, Anemia, Alzheimer''s
Allergies: Unknown
Diagnostic Lab Data: Tested positive 8/26/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic 8/26/2021 - headache and SOB


VAERS ID: 1818134 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-27
Onset:2021-08-29
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   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: Diabetes
Allergies: Unknown
Diagnostic Lab Data: tested positive on 8/21/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic:(unknown onset date) subjective fevers


VAERS ID: 1818136 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-17
Onset:2021-10-19
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide, levothyroxine,losartan, memantine, sertraline,
Current Illness:
Preexisting Conditions:
Allergies: Sodium Metabisulfite, Sulfa (Sulfonamide Antibiotics), Shrimp, Duloxetine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted as inpatient on 10/19 with Covid. complex medical history including dementia, HTN, constipation, and hypothyroidism, admitted with acute hypoxic resp failure d/t COVID-19 infection . Palliative Care was consulted to assist with goals of care and to transition to comfort focused care at the end of life.


VAERS ID: 1818141 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-17
Onset:2021-08-30
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pneumonia, SARS-CoV-2 RNA, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: 2021-08-30
   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: Unknown
Current Illness:
Preexisting Conditions: COPD, HIV, Hypertension, Tobacco use
Allergies: No known allergies
Diagnostic Lab Data: Tested on 8/23/2021 SARS coronavirus+SARS coronavirus 2 Ag: Detected and 2019-NCOV RNA PNL XXX NAA+PROBE: Detected
CDC Split Type:

Write-up: Diagnosed with COVID-19 on 8/23/2021 and experienced shortness of breath, pneumonia.


VAERS ID: 1818158 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-29
Onset:2021-08-28
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cardioversion, Confusional state, Death, Dialysis, End stage renal disease, General physical health deterioration, Hypotension, Hypoxia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: diagnosed COVID positive 1 wk prior to hosp admission (8/28); End-stage renal failure, dialysis 3xwk; has missed 2 rounds of dialysis due to increased weakness; EMS brought pt to hosp due to confusion and weakness; dx with COVID pneumonia; hypoxic; experienced hypotension and A Fib with RVR during dialysis tx in hospital; required emergent cardioversion; DNR/DNI; pt''s condition rapidly worsened on the day of dc from hospital to a nursing facility and pt expired in the hospital


VAERS ID: 1818171 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-23
Onset:2021-03-14
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6202 / 2 AR / -

Administered by: Private       Purchased by: ?
Symptoms: Adult failure to thrive, Agitation, Catatonia, Cerebrovascular accident, Death, Deep vein thrombosis, Ischaemic stroke
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-21
   Days after onset: 98
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Quinapril Baby Asprin
Current Illness: Meningioma Brain Tumor (right temporal lobe)
Preexisting Conditions: High Blood Pressure (managed with medication), mild hearing loss
Allergies: none
Diagnostic Lab Data: Far too many, please contact hospitals where she was treated. March 16-April 12 April 12-May 3 May 3-May 28 May 28-June 21st
CDC Split Type:

Write-up: My mother had a minor stroke the week of March15th she went to the ER on March 16th but since an MRI was not performed they missed the stoke. 10 days later on Friday March 26th she had a larger Ischemic stroke and was hospitalized. She was moved to acute rehab when they found a blood clot in her leg on April 12th. By the end of the month she became non verbal and catatonic so she was moved back to Hospital on May 3rd, 2021. She was so agitated they couldn''t even give her a MRI to verify if she indeed she had another stroke. On May 28th she was moved to sub acute rehab and failed to thrive or respond to rehabilitation treatment. She died on June 21, 2021 just 4 months after her second Pfizer shot.


VAERS ID: 1818173 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-08-23
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardioversion, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Pyrexia, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with dyspnea, fever, positive for COVID; started on remdesivir, dexamethasone, supplemental O2; hx of CHF, COPD; 8/30 experienced Cardiac arrest, spontaneous circulation after defibrillation; pt was intubated and eventually made a DNR; pt''s condition worsened while in the hospital and she expired in the hosp.


VAERS ID: 1818190 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-29
Onset:2021-09-18
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN, dementia, GERD, hx of uterine / breast cancers
Allergies: Unknown
Diagnostic Lab Data: tested positive on 9/14/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic on 9/13/2021: cough and "other"


VAERS ID: 1818204 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-22
Onset:2021-09-20
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Headache, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   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: Substance abuse, OSA, BPH, HTN, Depression, A-fib, CAD, Tobacco use, COPD, Dementia
Allergies: Unknown
Diagnostic Lab Data: Tested positive on 9/18/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic on 09/18/2021: headache and myalgia


VAERS ID: 1818213 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-11
Onset:2021-09-20
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Cardiac failure congestive, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), 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: 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: Cardiac pacemaker, chronic anticoagulation, complete atrioventricular block
Allergies: Unknown
Diagnostic Lab Data: Tested on 9/13/2021 for COVID-19 2019-nCoV RNA XXX NAA+probe-Imp: Detected
CDC Split Type:

Write-up: Patient tested positive for COVID-19 on 9/13/2021. They were asymptomatic at the time, but on hospice for CHF.


VAERS ID: 1818238 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-18
Onset:2021-09-23
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pneumonia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), 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: 2021-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: CKD, Dementia, HTN, former smoker
Allergies: Unknown
Diagnostic Lab Data: Tested positive on 9/14/2021 SARS-CoV-2 Ag Resp Ql IA.rapid
CDC Split Type:

Write-up: Symptomatic on 9/13/2021: subjective fever, cough, Pneumonia, difficulty breathing


VAERS ID: 1818264 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-08-09
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute left ventricular failure, Asthenia, COVID-19, Cardiac resynchronisation therapy, Chronic left ventricular failure, Death, Decreased appetite, General physical health deterioration, SARS-CoV-2 test positive, Taste disorder
SMQs:, Cardiac failure (narrow), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with acute on chronic systolic heart failure; CRTD placed; pt c/o weakness, poor appetite, food tasted like "cardboard"; positive COVID test; DNR; O2 @6L/M via face mask; pt''s condition worsened and he passed away in the hospital


VAERS ID: 1818265 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-07-20
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Work       Purchased by: ?
Symptoms: Death, Hypersensitivity, Myocarditis, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-26
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CF meds.
Current Illness: cf
Preexisting Conditions: cf
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: my sister went to the er on July 20th with what seem to be a illergic reaction... she said she was itching all over and was swelling. They sister passed away on July 26th from myocarditis which is stated o. The cdc website a direct side effect of the moderna shot.


VAERS ID: 1818285 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-09-11
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, Endotracheal intubation, Extubation, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Supraventricular tachyarrhythmias (narrow), 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: 2021-09-23
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt diagnosed positive for COVID 4 dys prior to hosp admission; admitted due to worsening SOB, cough, hypoxic, A Fib with RVR; COVID pneumonia; intubated; O2 requirements increased; family decided to extubate; comfort measures were instituted; pt''s condition worsened and he expired in the hosp


VAERS ID: 1818312 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-26
Onset:2021-07-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alcohol use, Asthenia, Blood alcohol increased, Brain herniation, Brain injury, Computerised tomogram head abnormal, Death, Fall, Injury, International normalised ratio normal, Pneumocephalus, Prothrombin time normal, Skull fracture, Subdural haematoma
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-03
   Days after onset: 1
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: Amlodipine
Current Illness: Unk/none
Preexisting Conditions: Hx SDH and TBI
Allergies: Penicillin, egg
Diagnostic Lab Data: 7/2/21 - EtOH: 340 , PT: 11.9, INR: 1.1 , Head CT: Large R holohemispheric SDH, L subfalcine herniation and effacement of the basal cisterns, L cerebellar intraparenchymal hematoma, L temporal bone fx, pneumocephalus.
CDC Split Type:

Write-up: Fall down stairs, +EtOH, catastrophic brain injury, death. Though her death seems to be clearly caused by direct head trauma, the cause of her fall may be multifactorial including weakness from recent vaccination in combination with EtOH.


VAERS ID: 1818365 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-15
Onset:2021-10-20
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Fatigue, Imaging procedure abnormal, Pneumonitis, Vaccine breakthrough infection
SMQs:, Interstitial lung disease (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lupron Depot 22.5 MG every 3 months Xarelto 15 mg PO daily Amiodarone HCl 200 mg PO daily Bicalutamide 50 MG PO daily OLANZapine 2.5 MG PO daily Toprol XL 25 MG Tablet PO daily Potassium Chloride ER 10 MEQ PO daily Aricept 10 MG Tabl
Current Illness: Essential hypertension Paroxysmal atrial fibrillation Prostate cancer Alzheimer''''s disease with late onset Heart failure with preserved ejection fraction Type 2 diabetes mellitus without complications Chronic kidney disease, stage 4 (severe) Macular degeneration Recurrent falls
Preexisting Conditions: Essential hypertension Paroxysmal atrial fibrillation Prostate cancer Alzheimer''''s disease with late onset Heart failure with preserved ejection fraction Type 2 diabetes mellitus without complications Chronic kidney disease, stage 4 (severe) Macular degeneration Recurrent falls
Allergies: None
Diagnostic Lab Data: Imaging demonstrating bilateral pneumonitis
CDC Split Type:

Write-up: Death due to extensive pneumonitis, with onset three weeks after breakthrough COVID-19 infection diagnosed on September 22, 2021; initially presenting as severe fatigue necessitating hospitalization.


VAERS ID: 1818410 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-24
Onset:2021-10-17
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Adenocarcinoma gastric, Angiogram pulmonary normal, Anticoagulant therapy, COVID-19, Chronic left ventricular failure, Condition aggravated, Death, Dyspnoea, Ejection fraction decreased, General physical health deterioration, Hypoxia, Illness, Interstitial lung disease, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   Days after onset: 5
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: acetaminophen (TYLENOL) 650 MG suppository albuterol HFA (ALBUTEROL) 108 (90 Base) MCG/ACT inhaler benzonatate (TESSALON PERLES) 100 MG capsule bisacodyl (DULCOLAX) 10 MG suppository clopidogrel (PLAVIX) 75 MG tablet dexamethasone (DECADRON
Current Illness:
Preexisting Conditions: Pulmonary fibrosis with Rheumatoid Arthritis COPD, mild Hypoxia Aspergilloma Acute on chronic respiratory failure with hypoxia ILD (interstitial lung disease) CAD (coronary artery disease) Ischemic cardiomyopathy Essential hypertension ICD (implantable cardioverter-defibrillator), dual, in situ AF (paroxysmal atrial fibrillation) Acute on chronic systolic (congestive) heart failure Chronic systolic heart failure Chronic systolic heart failure GERD (gastroesophageal reflux disease) Chronic wound infection of abdomen, initial encounter COME (chronic otitis media with effusion), bilateral Septic shock Macrocytic anemia AKI (acute kidney injury) Acute kidney failure Dyslipidemia Rheumatoid arthritis Other ventral hernia without mention of obstruction or gangrene Colostomy in place
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/18/2021; COVID-19 positive 10/17/2021; fully vaccinated BRIEF OVERVIEW: Discharge Provider: DO Primary Care Provider at Discharge: DO Admission Date: 10/18/2021 Discharge Date: 10/20/2021 Discharge disposition: Home Condition on discharge: Stable DETAILS OF HOSPITAL STAY: Hypoxia [R09.02] HOSPITAL COURSE: Acute on chronic respiratory failure with hypoxia. Resolved. Back on baseline O2 needs of 6L COVID19 infection. Improving ILD -presents w/ 1 month of progressive dyspnea w/ 2 days of more acute worsening -in ED was saturating well on FIO2 of 50% from BL 6L NC -CT angio thorax shows no acute process -is vaccinated -wife is getting over COVID19 -wean off oxygen as able. Patient nearing his baseline -Remdesivir, steroids, SQ lovenox per COVID19 treatment with improvement. -To finish Decadron course at home. Lovenox at home -pulmonary evaluated Chronic systolic heart failure s/p AICD -EF 35% -appears euvolemic -continue home meds -CHF diet, daily weights, I/Os No ACEi or Spironolactone Rx due to soft BP and currently recovery from COVID 19. To be considered later on by his cardiologist. Also pt considering hospice due to new diagnosis of gastric adenocarcinoma and chronic illness, so may not be indicated Hospice note 10/21/2021: Reason for referral: 10/21/21: I spoke with patient''s spouse by phone, she was tearful regarding his declines. He was seen by hospital team yesterday and at that time did not feel that they were ready for hospice care, he wanted time to recover from Covid before making a decision (patient is currently Covid positive). He was discharged from the hospital yesterday with a referral for home care. Wife then called this morning stating that he has been up most of the night with shortness of breath., on 15L NC, Medical equipment store is bringing a second concentrator this morning as he only had one that went to 10L and was then using a supplemental tank which they used up last night. Nurse did info visit in hospital and started the discussion on morphine for SOB symptoms, they were hesitant on this at first but after last night, he states he is willing to try to get some relief. Patient passed away on 10/22/2021 per hospice note


VAERS ID: 1818543 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-02
Onset:2021-09-26
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Depressed level of consciousness, Facial paralysis, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-18
   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: NONE
Current Illness:
Preexisting Conditions: CIRRHOSIS, CHF, GERD, TIPS
Allergies: CODIENE
Diagnostic Lab Data: POSITIVE COVID TEST 09/30/2021
CDC Split Type:

Write-up: BROUGHT TO HOSPITAL FOR FACIAL DROOP AND DECREASED ALERTNESS


VAERS ID: 1818558 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2020-01-10
Onset:2020-01-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-01-10
   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: Dementia-related decline
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died several hours after receiving first COVID-19 vaccine from Pfizer.


VAERS ID: 1818591 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Adverse event, Death, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ?
Current Illness: heart condition pacemaker
Preexisting Conditions: heart
Allergies: ?
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling and other adverse events, finally hospitlalized and then sent home to die.


VAERS ID: 1818596 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-01-13
Onset:2021-10-03
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen-HYDROcodone 325 mg-10 mg oral tablet, 1 TAB, PO, Q6H (Every 6 hours), PRN albuterol-ipratropium 2.5 mg-0.5 mg/3 mL inhalation solution, 3 mL, NEB, 4 times a day Aplisol 5 tuberculin units/0.1 mL intradermal solution, 5 Unit, I
Current Illness:
Preexisting Conditions: Bell''s palsy Patient GERD - Gastro-esophageal reflux disease Patient MRSA Patient AKA - Above knee amputation Patient Angina Patient Arthritis Patient Back pain Patient COPD Patient DVT - Deep vein thrombosis Patient Depression Patient Hernia repair Patient Hypertension Patient Knee gives way Patient Knee replacement Patient
Allergies: NKA
Diagnostic Lab Data: POSITIVE COVID TEST 10/03/2021
CDC Split Type:

Write-up: SOB O2 54% ON RA


VAERS ID: 1818604 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-22
Onset:2021-10-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   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: Furosemide, Iron, Klor-Con, Levothyroxine, Metoprolol, Tylenol
Current Illness: No acute illnesses
Preexisting Conditions: Atrial Fibrillation, Chronic Diastolic Heart Failure, Cecal Mass, Hypothyroidism, h/o GI bleed so not anticoagulated
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found deceased by family 2 days after vaccine administered.


VAERS ID: 1820398 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic kidney disease; Congestive heart failure; Hypertension; Renal cancer
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211045466

Write-up: ACUTE KIDNEY INJURY; ACUTE HYPOXIC RESPIRATORY FAILURE; This spontaneous report was received from literature: Characteristics and outcomes of adverse events after COVID-19 vaccination. 2021 Oct 13; 2/5. This report concerned a 92 year old male. The objective of this study was to describe fatal and non-fatal possible Adverse Events after COVID-19 vaccine administration. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: hypertension, congestive heart failure, chronic kidney disease, and renal cancer. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced acute kidney injury and acute hypoxic respiratory failure. On an unspecified date, the patient died of acute kidney injury and acute hypoxic respiratory failure. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The authors concluded that although reported adverse events (AEs) were not necessarily caused by the vaccination, this study provided further information about possible AEs after COVID-19 immunization, especially those requiring hospital admission. This study also supported prior data that serious AEs post vaccination were much lower than primary COVID-19 infections. Also, need for further studies to investigate causalities between vaccines and reported AEs across all age groups was highlighted. This report was serious (Death).; Sender''s Comments: V0: 20211045466-covid-19 vaccine ad26.cov2.s-acute kidney injury. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY 20211045466-covid-19 vaccine ad26.cov2.s-acute hypoxic respiratory failure. 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: ACUTE HYPOXIC RESPIRATORY FAILURE; ACUTE KIDNEY INJURY


VAERS ID: 1820408 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient was healthy and an Olympian.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211048841

Write-up: DIED DAYS AFTER THE SHOT; This spontaneous report received from a consumer via a company representative concerned a 35 year old male with unspecified race and ethnicity. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient was healthy and an Olympian. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported,1 total, start therapy date was 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 days after the shot and the patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211048841-Covid-19 vaccine ad26.cov2.s-Died days after the shot. 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: 1821065 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-06
Onset:2021-05-04
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Coronary artery disease, chronic kidney disease, dementia, hypertension, hyperlipidemia, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died on 05/04/2021. COVID Negative at time of death.


VAERS ID: 1821085 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-02
Onset:2021-10-07
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821109 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-24
Onset:2021-10-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Feeling cold, Flank pain, Headache, Malaise, Pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   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: Because this was an unattended death in her home, police were called. They photographed the body and took all of her prescriptions for a medical investigation.
Current Illness: breast surgery - 9/30/2021
Preexisting Conditions: diabetes stroke in November 2019 COVID 19 pneumonia - October 2020 - five week hospitalization
Allergies: aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the Moderna COVID-19 booster at 11:15am on 10/24/21, she felt normal until 10pm that evening. The she was chilling slightly, headache and general body aches. On 10/25/21, at around 10am, she became short of breath and experienced pain in her left side. She measured her O2 and was a 94; after using some auxilary oxygen (her husband''s machine) at 3 liters, she reached 97. General malaise continued and at approximately 8pm, she suddenly collapsed and died.


VAERS ID: 1821117 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-03
Onset:2021-10-04
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19
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: 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:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821139 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-25
Onset:2021-10-09
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Ageusia, Anosmia, COVID-19, Death, Dyspnoea, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Cardiovascular disease or serious heart condition
Allergies: Unknown
Diagnostic Lab Data: Vaccine information: Pfizer 1st Dose: 3/6/21; 2nd Dose: 3/27/21 - administered at mass vaccination site Pfizer 3rd Dose 9/29/21 lot #301358A COVID-19 Tests: 10/9/21 - Rapid - Positive - Lab Specimen ID: 331112799 10/9/21 - PCR - Positive - Lab Specimen ID: L11301695.6000.968
CDC Split Type:

Write-up: COVID-19 Vaccine Breakthrough Case: Hospitalization & Death The case tested positive for COVID and went to the emergency room and was admitted on 10/9/21. The case unfortunately passed away on 10/20/21. The individual received a monoclonal antibody infusion on 10/9/21. As part of his COVID-19 symptoms, the individual had difficulty breathing, loss of smell/taste, and a fever. The case also developed pneumonia and acute respiratory distress syndrome (ARDS).


VAERS ID: 1821160 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-09
Onset:2021-10-03
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821164 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-10-20
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE2588 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Death, Loss of consciousness, Myocardial infarction
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   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: MR/Paralyzed since Birth, Epilepsy
Allergies: Pennicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt.''s Sister states that after receiving the 1st dose of Phizer 09/10/2021, started experiencing symptoms 10/19/2021 pt. found unconscious on the floor, Emergency Room visit *transported suffered 3 Heart Attacks, Cardiac Arrest resulting in Death 10/20/2021.


VAERS ID: 1821184 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-21
Onset:2021-10-22
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046821A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / 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: 2021-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sever history of pulmonary HTN, ILD, chronic hypoxia on 8L NC as baseline, HTN, T2 DM on insulin, afib, and CKD.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died after testing positive for COVID-19 on 10/4/2021


VAERS ID: 1821214 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-02-22
Onset:2021-09-18
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Asthenia, COVID-19, COVID-19 pneumonia, Chills, Chronic kidney disease, Condition aggravated, Cough, Death, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Immunosuppression, Nausea, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Shock, Vaccine breakthrough infection, Viral sepsis, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Interstitial lung disease (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), 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: 2021-10-04
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Acute Kidney Failure; Chronic Kidney Disease; History of Renal Transplant; History of Skin Cancer; Vitamin D Deficiency; Obesity; Takayasu''s Disease; Immunosuppresion due to drug therapy; Hypertension; long-term use of systemic steroids
Allergies: Documented allergies to amoxicillin, dextran sulfate, nitrofurantoin, ibuprofen, penicillin
Diagnostic Lab Data: PCR positive COVID-19 test on 09/18/2021, despite being fully vaccinated.
CDC Split Type:

Write-up: This is a breakthrough case of COVID-19 that resulted in death. The individual was vaccinated with the Pfizer product on 02/01/2021 and 02/22/2021. The individual tested positive via PCR for COVID-19 on 09/18/2021 and was admitted to the hospital on that same day. The individual reported COVID-19 symptoms of fatigue, weakness, cough, shortness of breath, fever, chills, nausea, vomiting, diarrhea, and feeling lightheaded. They were hospitalized until their death on 10/04/2021. Death Certificate details are as follows: Part I Cause of Death A: Acute Respiratory Distress Syndrome B: COVID 19 Pneumonia Part II Other Significant Conditions: Viral Sepsis, Shock, Immunosuppression, Acute Kidney Failure ON Chronic Kidney Disease, Hospital Acquired Pneumonia The patient was considered to be immunosuppressed at the time of death, due to medication use; the person was a kidney transplant recipient.


VAERS ID: 1821230 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-08-31
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Condition aggravated, Confusional state, Death, Fall, Hypoxia, Packed red blood cell transfusion, Pyrexia, SARS-CoV-2 test positive, Sickle cell anaemia with crisis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Myelodysplastic syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt admitted to hospital in sickle cell crisis after a fall at home; confused; febrile, hypoxic; positive for COVID; increasing O2 requirements (15L NRB); pRBCs given; hx of HTN,COPD, sickle cell; condition worsened and pt experienced cardiac arrest and expired in the hospital


VAERS ID: 1821241 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-20
Onset:2021-10-24
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 0
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died after being diagnosed with COVID concurrently with a devastating left thalamic IPH with extensive IPH and ventricular blood.


VAERS ID: 1821256 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cholecystitis infective, Death, Echocardiogram, Effusion, Myocarditis
SMQs:, Infectious biliary disorders (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Multiple ECHOs
CDC Split Type:

Write-up: Myocarditis with effusion. Hospitalized at hospital and then other hospital and then discharged. Readmitted at hospital with infected gallbladder but myocarditis limited treatment. Now deceased. Happened over 3 weeks.


VAERS ID: 1821271 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-08-20
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cerebrovascular accident, Death, Dehydration, Endotracheal intubation, General physical health deterioration, Hypotension, Multiple organ dysfunction syndrome, SARS-CoV-2 test positive, Sepsis, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with dehydration, AKI, tested positive for COVID; intubated; suffered an acute CVA in hospital; remained hypotensive despite vasopressors; made a DNR; sepsis with acute organ dysfunction due to COVID - Septic Shock; pt''s condition worsened and she expired in the hospital


VAERS ID: 1821282 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Epistaxis, Myocardial infarction, Oropharyngeal pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data: No autopsy performed
CDC Split Type:

Write-up: Patient''s daughter states that the patient started having a sore throat on 9/30. She was taken to the hospital on 10/4 (reason not available currently). The patient was then found deceased at her home bent over her empty bath tub on 10/6/21. She had a bloody nose when she was found. Cause of death was determined to be a heart attack or stroke.


VAERS ID: 1821313 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-20
Onset:2021-10-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Hypotension, Oxygen saturation decreased, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: low 02 sats, with shortness of breath increased pulse rate (120) low BP vomited x 1 she was given a breathing tx and starte 02, she was then sent out to the hospital, paramedics could not get a BP, she was transported to the nearest hospital


VAERS ID: 1821320 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-25
Onset:2021-09-03
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18086O9 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19
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: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient diagnosed and hospitalized with COVID-19 while fully vaccinated.


VAERS ID: 1821321 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-09-10
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cough, Death, Diarrhoea, Lethargy, Respiratory depression, Rhinorrhoea, SARS-CoV-2 test positive, Urinary tract infection, Urine output decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt has hx of dementia; brought to ED with increasing lethargy x 1wk, non-productive cough, rhinorrhea, diarrhea, decreased UOP; started on supplemental oxygen; diagnosed positive for COVID; started on decadron and remdisivir; antibiotics for suspected UTI; DNR/DNI; respiratory status decreased despite being on Vapotherm 40 L 100% and supplemental NRB mask @ 15 LPM; O2 sats in 60 - 70s; full comfort measures instituted; pt expired in the hospital; acute hypoxic respiratory failure due to COVID pneumonia


VAERS ID: 1821324 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-05
Onset:2021-09-18
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Aspartate aminotransferase increased, Blood creatinine increased, Blood glucose normal, Blood lactic acid normal, COVID-19, Chest X-ray abnormal, Death, Decreased appetite, Dehydration, Fatigue, Haemoglobin decreased, Lung infiltration, Malaise, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 16
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: albuterol 2 puffs Q6h PRN amlodipine 10 mg PO QD atorvastatin 10 mg PO QD Symbicort 2 puffs BID PRN cetirizine 10 mg PO QD PRN tamsulosin 0.4 mg PO QD
Current Illness: tobacco use
Preexisting Conditions: tobacco use
Allergies: NKDA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: Moderna Dose 1 2/5/21 (016M20A) Moderna Dose 2 3/5/21 (013A21A) COVID Positive 9/18/21 9/20/21: -Patient is an 89yo male with medical history of tobacco use -History obtained from ER provider and chart review. Daughter unreachable on phone and patient very fatigued -Presenting because of worsening COVID symptoms, anorexia , dehydration -Tested COVID positive on 9/18 -In the ER he was febrile 100.5F, HR 96bpm, BP 111/67 with oxygen saturation of 91-96% on room air -CXR showed interval increased bilateral pulmonary infiltrate. -Labs remarkable for glucose 140, Cr 2.57,ast 57, normal lactate, trop 0.04 , Hb 11.5 -He recieved 1L NS bolus -Patient will be admitted under hospitalist service for dehydration and AKI due to COVID 10/4/21: Patient is on 100 % FIO2 on BIpAP. I discussed with his sons who have agreed about the poor prognosis and change him to DNR status with comfort measures, but they would like to continue supportive measures for the moment. Per family request pt taken off BiPAP for comfort cares, Dr. aware. Patient passed away.


VAERS ID: 1821333 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-19
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiomegaly, Chest X-ray abnormal, Heart rate increased, Oxygen saturation decreased, Pneumonia, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: cardiomegaly with bibaslar pneumonia
CDC Split Type:

Write-up: low 02 sats, increased pulse (124) vomited x 1 Chest x-ray on 10/21 showed cardiomegaly with bibaslar pneumonia


VAERS ID: 1821341 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-07-20
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Death, Dyspnoea, Fatigue, General physical health deterioration, Positive airway pressure therapy, Prone position, Pyrexia, Renal failure, SARS-CoV-2 sepsis, SARS-CoV-2 test positive, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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 (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt diagnosed and hospitalized x 2days with positive COVID test prior to this hosp admission; pt presented to ED with fever, chills, fatigue and increasing SOB, placed on Airvo; hx of DM and RA; eventually placed on BiPAP; alternated with BiPAP and Airvo; pt was tiring and requested intubation; placed in prone position most of the time; family requested no CPR; developed Shock, renal failure related to COVID sepsis; pt''s condition worsened and he expired in the hospital


VAERS ID: 1821342 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-26
Onset:2021-08-31
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH LOT NOT LISTED / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal infection, Abdominal pain, Blood culture, Blood gases normal, Blood pressure systolic increased, COVID-19, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Cough, Death, Dyspnoea, Enteritis, Fatigue, Full blood count normal, Gastrointestinal disorder, Inflammation, International normalised ratio normal, Lung disorder, Metabolic function test normal, Oxygen saturation decreased, Prothrombin time normal, Pyrexia, SARS-CoV-2 test positive, Troponin normal, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine 2.5 mg PO QD aspirin 81 mg PO QD atorvastatin 80 mg PO QD carbidopa-levofopa 25-100 mg PO TID clopidogrel 75 mg PO QD doxazosin 4 mg PO HS furosemide 20 mg PO QD hyoscyamine 0.125 mg SL Q6h PRN lorazepam 0.5 mg PO Q4h PRN metopro
Current Illness: CAD OSA peripheral neuropathy Parkinson''s osteoarthritis back pain
Preexisting Conditions: CAD OSA peripheral neuropathy Parkinson''s osteoarthritis back pain
Allergies: NKDA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: Pfizer Dose 1 2/5/21 (lot not listed in system) Pfizer Dose 2 2/26/21 (lot not listed in system) COVID Positive 9/2/21 9/2/21: Patient is a 77 yo male with medical history of CAD , Parkinson disease, Prediabetes, HLD, OSA He presented with SOB, non productive cough and fever . he also endorses abdominal pain and being fatigued He denies sick/ COVID contacts but says wife also has similar complaints 3 days after his illness started He is COVID vaccinated In the ER vitals remarkable for fever and elevated SBP 140- 170 with RR 30s and requiring 2 L supplemental oxygen CXR showed mild bilateral airspace disease in the lower lobes, may represent atelectasis or infectious infiltrates. CT abdomen done showed mesenteric stranding in right lower quadrant and a trace amount of free fluid, suggesting adjacent infection or inflammation. The appendix is not visualized, indeterminate for appendicitis. However patient states his appendix has been removed CBC, CMP were wnl, VBG was wnl, trop negative , UA unremarkable , PT/INR unremarkable . Blood cultures sent in the ER He received tylenol 650, Duoneb, 2g IV Ceftriaxone, 2.7 L LR , 4 mg IV Zofran in the ER 9/17/21: Patient is a 77 yo male with medical history of CAD , Parkinson disease, Prediabetes, HLD, OSA who presented with SOB, non productive cough and fever. He is COVID vaccinated. In the ER vitals remarkable for fever and elevated SBP 140- 170 with RR 30s and requiring 2 L supplemental oxygen. CXR showed mild bilateral airspace disease in the lower lobes, may represent atelectasis or infectious infiltrates. CT abdomen done showed mesenteric stranding in right lower quadrant and a trace amount of free fluid, suggesting adjacent infection or inflammation. CBC, CMP were wnl, VBG was wnl, trop negative , UA unremarkable , PT/INR unremarkable. COVID PCR returned POSITIVE. He received Tylenol 650, Duoneb, 2g IV Ceftriaxone, 2.7 L LR , 4 mg IV Zofran in the ER. Pt was subsequently admitted to the hospitalist service for further evaluation and management. Pt was started on Dexamethasone and Remdesivir. Ceftriaxone was continued. Pt with increasing O2 needs ultimately requiring 100% OptiFlow. Pulmonology was consulted at that time. Pt was started on Actemra. Pt also developed enteritis during admission was was treated with a 7 day course of Flagyl. Pt with fluctuating O2 needs. Pt did not desire intubation. Ultimately pt and family decided on comfort cares and home hospice. 9/20/21: Patient deceased.


VAERS ID: 1821390 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-09-07
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Cough, Death, Decreased appetite, Dyspnoea, Headache, Hypotension, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt presented with SOB, HA, non-productive cough, anorexia, weakness x 5dys; positive for COVID; dx with COVID pneumonia; started on decadron and remdisivir; given monoclonal antibodies; hx of HTN; went into septic shock, hypotensive despite vasopressor treatments; pt expired in the hospital


VAERS ID: 1821423 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-07-26
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Oxygen saturation decreased
SMQs:, Angioedema (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

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? Yes
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: pt with hx of DMT2, heart and liver transplant; previous CMV viremia; previously tested positive for COVID, placed on antibiotic for pneumonia; presented to ED due to O2 sats at home in the 70s; Optiflow 50L and 70% FiO2; pt''s O2 sats worsened; intubated; transitioned to comfort care measures; pt expired in the hospital


VAERS ID: 1821431 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-26
Onset:2021-10-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 310258A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory distress syndrome, Acute respiratory failure, Aspiration, Azotaemia, COVID-19 pneumonia, Chest X-ray, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax, Endotracheal intubation, Hepatic cirrhosis, Hypercapnia, Pneumomediastinum, Pneumonia pneumococcal, Renal tubular necrosis, Thrombocytopenia, Ultrasound kidney, Ultrasound scan
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Renovascular disorders (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest XR 10/25, 10/24x2, 10/21x2, 10/20, 10/19x2, 10/18, 10/5 Chest CT 10/11, 10/5 Lower Extremity US 10/7 CT Abd 10/24 CT Head 10/24 Renal US 10/22
CDC Split Type:

Write-up: Admitted 10/5/21 to Hospital. Intubated 10/19. Discharge Dx: Acute hypoxic hypercarbic respiratory failure due to COVID PNA, COVID PNA with ARDS, AKI d/t ATN, pneumomidiastinum, uremic bleed, aspiration and neumococcal PNA, acute thrombocytopenia, liver cirrhosis. Changed to comfort care and terminally extubated 10/25/21


VAERS ID: 1821462 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-08-27
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, COVID-19 pneumonia, Death, General physical health deterioration, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt tested positive in nursing home for COVID; hx of dementia, HTN; brought to hospital due to worsening respiratory failure; dx with COVID pneumonia, AKI; made a DNR/DNI; comfort care measures; pt''s condition declined and she expired in the hospital


VAERS ID: 1821590 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-24
Onset:2021-08-03
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J96.01 - Acute respiratory failure with hypoxia N17.9 - Acute kidney failure, unspecified K92.2 - Acute upper GI bleed K92.2 - Upper GI bleed


VAERS ID: 1821601 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-10
Onset:2021-07-27
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Blood osmolarity decreased, Death, Hyponatraemia, Jaundice
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (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), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: death ABDOMINAL PAIN JAUNDICE N17.9 - Acute kidney failure, unspecified E87.1 - Hypo-osmolality and hyponatremia


VAERS ID: 1821612 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-08-29
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death U07.1 - COVID-19


VAERS ID: 1821624 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-21
Onset:2021-09-03
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presented to ED with SOB; tested positive for COVID; dx with COVID pneumonia; given monoclonal antibody; continued to require high amounts of O2; given high doses of steroids; respiratory support with NIPPV; DNI; removed NIPPV and pt expired in the hospital


VAERS ID: 1821632 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-07-04
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / UNK - / -

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

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

Write-up: death N17.9 - Acute kidney failure, unspecified D69.6 - Thrombocytopenia (CMS/HCC)


VAERS ID: 1821642 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-10-22
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I63.9 - Cerebrovascular accident (CVA), unspecified mechanism


VAERS ID: 1821651 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-10-03
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hyponatraemia, Hypoosmolar state, Pneumonia, Seizure, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death R56.9 - Unspecified convulsions E87.1 - Hypo-osmolality and hyponatremia D69.6 - Thrombocytopenia, unspecified R56.9 - Seizure J18.9 - Pneumonia


VAERS ID: 1821662 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-15
Onset:2021-10-20
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1821676 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-25
Onset:2021-10-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Autopsy, Chills, Death, Extra dose administered
SMQs:, Guillain-Barre syndrome (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: CHF, A-fib, GERD, HTN, Anxiety, Pacemaker
Allergies:
Diagnostic Lab Data: full autopsy, tryptase study
CDC Split Type:

Write-up: Patient experienced chills & weakness following the vaccine. Patient died the following day. No gross anatomical findings of anaphylaxis at autopsy. Tryptase study pending.


VAERS ID: 1821677 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-19
Onset:2021-10-14
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / -

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

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

Write-up: death N17.9 - Acute renal failure (ARF).


VAERS ID: 1821687 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-10-15
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death COVID


VAERS ID: 1821692 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-20
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1821773 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-03-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Brain scan abnormal, Death, Haemorrhagic stroke, Magnetic resonance imaging, Pain, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-18
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: High blood pressure Rx, reflux Rx
Current Illness:
Preexisting Conditions: High blood pressure and reflux
Allergies: Not known
Diagnostic Lab Data: MRI, brain scans between 3/8/2021-4/18/2021 when she passed away at Medical Center in Emergency
CDC Split Type:

Write-up: She had a hemorrhagic stroke March 8th at 7pm, she was non responsive almost the next 4 weeks . We git some hand responses only. Last week she was in horrible pain, we put her on hospice so they would get rid of her pain?and we let her go. I didn?t consider the vaccine at first, but after reading about it causing hemorrhagic strokes and only 10 days after her 2nd Covid 19 vaccine, I?m convinced, she died because of the vaccine.


VAERS ID: 1821942 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-05
Onset:2021-10-03
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest
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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: CARDIOPULMONARY ARREST


VAERS ID: 1823353 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-04-01
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body mass index, Cerebral venous sinus thrombosis, Chills, Dizziness, Fatigue, Headache, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high; Chronic migraine; Gastrointestinal disorder; Multiple sclerosis (Diagnosed more than 20 years ago); Obesity (Body-mass index of 33.3. (Healthy is 18.5 to 24.9))
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Body mass index; Result Unstructured Data: 33.3; Comments: Healthy is 18.5 to 24.9
CDC Split Type: USJNJFOC20211042919

Write-up: CONSTANT HEADACHE; COMPLICATIONS OF CEREBRAL VENOUS SINUS THROMBOSIS; DIZZINESS; CHILLS; NOT FEELING WELL; TIRED AND FATIGUE; NAUSEA; This spontaneous report received from a consumer via a company representative via social media concerned a 60-year-old female of unknown race and ethnicity. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: obese with a body-mass index of 33.3, high blood pressure, chronic migraines, common colon condition, and diagnosed more than 20 years ago with multiple sclerosis, a potentially disabling disease of the brain, for which the patient took medication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, 1 total administered on 08-APR-2021 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. It was reported that "The patient died 13 days after she received the single-shot vaccine on 08-April-2021, just five days before federal health agencies temporarily paused the vaccine administration while they examined an unusual blood-clotting disorder". The patient "appears to have succumbed" to a "rare but nevertheless documented" complication associated with the viral vector vaccine, cerebral venous sinus thrombosis. According to the Regulatory Authority, the condition is characterized by a blood clot in the venous sinuses, part of the brain''s blood drainage system". "In the days after the shot, the patient was not feeling well, she was tired. The autopsy report documents constant headache, fatigue, chills, dizziness and nausea. The reporter stated that the patient did not looked well, but the next week, she went to work". On 17-Apr-2021, the reporter mentioned that the patient stated "her head hurt", and reported suggested her to rest. The patient contacted her doctor, who recommended Motrin and prescribed an anti-nausea medication. The reporter stated that "People were offering to take patient to the hospital, but she assured them sleep would make it better. She would give it another day. On 21-April-2021, the patient, divorced and was living alone, did not go to the office. She stopped responding to messages, inciting panic. A friend with a key was enlisted to check on patient. She found the patient was dead on her bed." The autopsy report lists the cause as "complications of cerebral venous sinus thrombosis" and "recent administration" of a COVID-19 vaccine as the contributing condition. The report, however, notes "no definitive identifiable neuropathological features" of the disease. On 21-APR-2021, the patient died from complications of cerebral venous sinus thrombosis. An autopsy was performed on 20-SEP-2021. It was also reported that "As of 22-Oct-2021, more than 15 million Americans have gotten the J&J vaccine. There are believed to be five confirmed deaths, including the patient". The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the not feeling well, tired and fatigue, chills, dizziness, nausea and constant headache was not reported. This report was serious (Death). This case, from the same reporter is linked to 20211043203, 20211043850, 20211043449 and 20211042990.; Sender''s Comments: V0: 20211042919-COVID-19 VACCINE AD26.COV2.S-Complications of cerebral venous sinus thrombosis. 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: COMPLICATIONS OF CEREBRAL VENOUS SINUS THROMBOSIS


VAERS ID: 1823357 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Septic shock
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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
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:
Current Illness: Hypertension; Multiple sclerosis; Type II diabetes mellitus
Preexisting Conditions: Medical History/Concurrent Conditions: Cerebrovascular accident; Congestive heart failure
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211048130

Write-up: SEPTIC SHOCK; ACUTE HYPOXIC RESPIRATORY FAILURE; This spontaneous report was received from literature: This report concerned an 88 year old male of unknown race and ethnic origin. The objective of this study was to describe fatal and non-fatal possible Adverse Events after COVID-19 vaccine administration. The patient''s height, and weight were not reported. The patient''s past medical history included: congestive heart failure, and cerebrovascular accident, and concurrent conditions included: hypertension, diabetes mellitus type 2, and multiple sclerosis. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, one total administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced septic shock, and acute hypoxic respiratory failure and was hospitalized (date unspecified). Number of hospitalization days were not reported. On an unspecified date, the patient died from septic shock, and acute hypoxic respiratory failure. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The authors concluded that although reported adverse events (AEs) were not necessarily caused by the vaccination, this study provided further information about possible AEs after COVID-19 immunization, especially those requiring hospital admission. The study also supported prior data that serious AEs post vaccination were much lower than primary COVID-19 infections. Also, need for further studies to investigate causalities between vaccines and reported AEs across all age groups was highlighted. This report was serious (Death, and Hospitalization Caused / Prolonged). This case, from the same reporter is linked to 20211045466.; Sender''s Comments: 20211048130-covid-19 vaccine ad26.cov2.s-septic shock, and acute hypoxic respiratory failure. 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: SEPTIC SHOCK; ACUTE HYPOXIC RESPIRATORY FAILURE


VAERS ID: 1823359 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Brain death, Brain operation, Cerebral infarction, Death, Laboratory test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Heart valve operation
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: Laboratory test; Result Unstructured Data: cerebral infarction
CDC Split Type: USJNJFOC20211048955

Write-up: COLLAPSING; EMERGENCY BRAIN SURGERY; BRAIN DEAD; CEREBRAL INFARCTION; DEATH; This spontaneous report received from a consumer (news article) via a company representative concerned a 57 year old male of an unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s past medical history included: heart valve surgery (33 years ago). The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown expiry: unknown) dose was not reported, 01 total, administered on 17-SEP-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch numbers. No concomitant medications were reported. On 06-OCT-2021 the patient was collapsed and rushed to a hospital. He was diagnosed with a cerebral infarction there and underwent emergency brain surgery, but was eventually declared brain dead. Number of days hospitalized and discharge information was not reported. 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 unknown cause of death on 10-OCT-2021, and the outcome of brain dead, collapsing, cerebral infarction and emergency brain surgery was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: V0 20211048955-COVID-19 VACCINE AD26.COV2.S-death, brain dead, cerebral infarction, collapsing, emergency brain surgery. 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: 1823367 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
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: USJNJFOC20211049949

Write-up: DEATH; This spontaneous report received from a consumer via social media company representative concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose were not reported, 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 an unknown cause of death. It was unknown if an autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211049949-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: 1823368 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211050018

Write-up: CONFIRMED DEATHS; This spontaneous report received from a consumer via a company representative via social media concerned 4 patients. No past medical history or concurrent conditions were reported. Patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, frequency 1 total, for prophylactic vaccination. The batch number were not reported. The company is unable to perform follow up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, 4 confirmed deaths and patients died from unknown cause of death. It was unspecified if autopsies were performed. As per the traditional media report, "As of Oct. 22, more than 15 million Americans have gotten the J&J vaccine. There are believed to be five confirmed deaths." 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 20211047279 and 20210654540.; Sender''s Comments: V0: 20211050018-covid-19 vaccine ad26.cov2.s-confirmed deaths. 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: 1823650 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIRA
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101400152

Write-up: This is a solicited report from a non-Pfizer sponsored program (marketing program name FACILITATED COLLECT) received from a contactable consumer (patient''s caregiver), based on information received by Pfizer from the (manufacturer control number 21K-163-4121505-00). An 81-year-old elderly male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), dose 1 intramuscular on an unspecified date (Batch/Lot number, expiration date was not reported) as single dose for COVID-19 Vaccination; and adalimumab (HUMIRA, Solution for injection in pre-filled pen), Subcutaneous from an unspecified date (Batch/Lot number, expiration date was not reported) to an unspecified date, at unspecified dose for Moderate to severe adult Crohn''s disease. The patient''s medical history and concomitant medications were not reported. On an unknown date, the patient experienced fatal COVID-19. On unknown date, the patient died. The cause of death was reported as COVID-19. It is unknown if an autopsy was performed. The patient''s caregiver reported that patient died of COVID-19. The action taken in response to the event for adalimumab was Not Applicable. It was unknown if patient was enrolled in a COVID-19 Vaccine Trial. The reporter''s Causality for adalimumab with the event was a reasonable possibility. The reporter''s Causality for bnt162b2 with the event was possible. The lot number for the vaccine bnt162b2, was not provided and will be requested during follow up.; Sender''s Comments: Based on the reported information ,a causal relationship between the events and suspected drug 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: COVID-19; COVID-19


VAERS ID: 1823656 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes (diagnosed with this over 20 years ago when he was in his diabetes.)
Allergies:
Diagnostic Lab Data: Test Name: Weight; Result Unstructured Data: Test Result:170 to 180 lbs
CDC Split Type: USPFIZER INC202101408062

Write-up: COVID/respiratory acidosis/pneumonia/COVID-19 pneumonia; COVID/respiratory acidosis/pneumonia/COVID-19 pneumonia; Acute hypoxic respiratory failure; Congestive heart failure; This is a spontaneous report from a contactable other healthcare repofessional (LPN, but was the patient''s domestic partner). A 55-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/Lot number was not reported), dose 1 and dose 2, both via an unspecified route of administration on an unspecified date in Apr2021 (at the age of 55-year-old) as single dose for COVID-19 immunization. Medical history included diabetes, diagnosed with this over 20 years ago when he was in his diabetes. None prior vaccinations within 4 weeks. Family history included diabetes that ran in the family and cardiovascular disease. Concomitant medication was reported as none. Patient passed away on 15Sep2021 and he was vaccinated with the Pfizer COVID vaccines and he ended up getting COVID. He was placed on a ventilator on 13Sep2021 and then passed away on 15Sep2021. He had both doses of the Pfizer COVID vaccine in Apr2021. Patient didn''t have a primary care provider but he was admitted to the hospital for pneumonia and they had found out that he had COVID when they were going to transfer him to a nursing home for physical therapy but at that time he didn''t have a primary care provider. The patient was admitted to the hospital from 26Aug2021 to 15Sep2021. He had developed respiratory acidosis on 13Sep2021 and then placed on the ventilator. He was admitted to the hospital due to pneumonia and then they had discovered he had COVID while there. The patient''s death certificate said that the cause of death was COVID-19 pneumonia, acute hypoxic respiratory failure, congestive heart failure. The patient underwent lab tests and procedures which included weight: 170 to 180 lbs on an unspecified date. The patient died on 15Sep2021 due to drug ineffective, COVID-19 pneumonia, acute hypoxic respiratory failure and congestive heart failure. An autopsy was not performed. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Sender''s Comments: Based on the known safety profile of the vaccine BNT162B2, a temporal relation between the events drug ineffective, COVID-19 pneumonia, acute hypoxic respiratory failure and congestive heart failure and the administration of the vaccine 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: Congestive heart failure; COVID/respiratory acidosis/pneumonia/COVID-19 pneumonia; COVID/respiratory acidosis/pneumonia/COVID-19 pneumonia; Acute hypoxic respiratory failure


VAERS ID: 1823660 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Nevada  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101409224

Write-up: died; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received bnt162b2 (COMIRNATY) via unspecified route on an unspecified date single dose for covid-19 immunization. The patient medical history included pre-existing conditions (unspecified). The patient''s concomitant medications were not reported. The patient experienced died on an unspecified date. The reporter talked to a doctor and the doctor had a patient, who had pre-existing conditions, died. The patient died on an unspecified date. It was unknown if an autopsy was performed. The lot number for BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: died


VAERS ID: 1823661 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101410885

Write-up: her father passed away after getting the Pfizer covid-19 vaccine; This is a spontaneous report from a Pfizer sponsored Program Database Support from a non-contactable consumer (patient''s child). A male patient of an unspecified age received bnt162b2 (Pfizer covid-19 vaccine), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The consumer wanted to know if the Pfizer covid-19 vaccine is FDA approved. Consumer stated on the call that her father passed away after getting the Pfizer covid-19 vaccine. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: her father passed away after getting the Pfizer covid-19 vaccine


VAERS ID: 1823663 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Nevada  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder
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 INC202101411810

Write-up: heart condition; This is a spontaneous report from a contactable consumer. An elderly male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose number unknown, single for covid-19 immunisation. The patient had pre- existing conditions. The patient''s concomitant medications were not reported. The patient experienced heart condition and died. 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: heart condition


VAERS ID: 1823666 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135DA / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary thrombosis, Respiratory arrest, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101417077

Write-up: The patient had blood clots in arms that went to lung; The patient had blood clots in arms that went to lung; stopped breathing; This is a spontaneous report from a contactable consumer (patient''s wife). A 38-year-old male patient received bnt162b2, dose 2 via an unspecified route of administration, administered in left arm on 22Sep2021 (Lot Number: 30135DA) as dose 2, single at the age of 38 years old for COVID-19 immunization. Medical history included ongoing asthma diagnosed as a kid. There were no concomitant medications. Historic vaccine was bnt162b2 administered in right arm on 25Aug2021 (lot: FC3183) as dose 1, single at the age of 37 years old for COVID-19 Immunization. The patient worked and was on the do not vaccinate list. Someone mandated all employees to be vaccinated. The patient was on the do not vaccinate list but was denied by his workplace. The patient''s workplace approved others to not be vaccinated. The patient told the workplace receiving the vaccine was against his religious beliefs and the workplace denied the patient. Before the patient received the Pfizer Vaccine, the caller told her husband not to get the Pfizer Vaccine. The caller was also going to get the Pfizer Vaccine. Cause of death: The patient had blood clots in arms that went to lung. The blood clots formed a cluster when the paramedic was doing CPR, when the patient stopped breathing. The patient had fresh blood clots in the arms. Autopsy details available: The caller stated the autopsy details will be available in a few days. Someone told the caller, someone believed the patient''s death was a reaction to the Pfizer Vaccine. No any other vaccinations within four weeks prior to the first administration date of the suspect vaccine. The patient died on 27Sep2021. An autopsy was performed and results were not provided. The outcome of events was fatal.; Reported Cause(s) of Death: The patient had blood clots in arms that went to lung; The patient had blood clots in arms that went to lung; stopped breathing


VAERS ID: 1823671 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-10-13
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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: USPFIZER INC202101426032

Write-up: death; This is a spontaneous report from a contactable consumer. A 16-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE at the age of 16-year-old for covid-19 immunisation. The patient medical history and concomitant medications were not reported. patient previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 13Jul2021 at the age of 16-year-old for covid-19 immunization. The patient experienced death on 13Oct2021. The patient died on 13Oct2021. The lot number for vaccine (BNT162B2), was not provided and will be requested during follow-up; Reported Cause(s) of Death: death


VAERS ID: 1823674 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Utah  
Vaccinated:2021-10-15
Onset:2021-10-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-16
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101427492

Write-up: she passed away less than 24 hrs; This is a spontaneous report from a contactable consumer (patient parent). A 28-year-old female patient (daughter) received the second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 15Oct2021 (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Consumer reported that her 28 year old daughter received her 2nd pfizer vaccine dose on 15Oct2021 and she passed away less than 24 hrs. The medical examiner was conducting a thorough review. The patient died on 16Oct2021. An autopsy was performed and results were not available. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Reported Cause(s) of Death: passed away less than 24 hrs


VAERS ID: 1823677 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101432945

Write-up: causing distruction and death; This is a spontaneous report from a Pfizer-sponsored program Database Support from a non-contactable consumer. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced sleep at night that is causing destruction and death that Pfizer is causing.The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: causing distruction and death


VAERS ID: 1823680 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101440332

Write-up: lost parent to Covid; lost parent to Covid; This is a spontaneous report from a non-contactable consumer (daughter). This consumer reported similar events for both parents. This is one of her parents cases. A patient of unspecified age and gender received BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE) via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The daughter recently lost parent to covid and not sure if this was a fresh or the vaccine side effects. The outcome of event was fatal. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER_INC-202101440331 same drug and AE., different patient; Reported Cause(s) of Death: lost parent to Covid; lost parent to Covid


VAERS ID: 1824822 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Rhode Island  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cardiac arrhythmia; Chronic lung disease; Congestive heart failure; Diabetes; Hepatic disease; Hypertension; Metastatic carcinoma; Obesity; Renal failure
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 RT-PCR test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211046629

Write-up: CONFIRMED COVID-19 INFECTION; This spontaneous report was received from literature. This report concerned multiple patients (3 females and 5 male) of above 18 year''s age and unspecified race and ethnicity. The objective of this study was to describe the vaccine breakthrough cases and their outcomes compared to unvaccinated COVID-19 cases, we analyzed and compared all consecutive patients, with or without prior vaccination, who were admitted to our hospital network due to COVID-19 from JAN-2021 to APR-2021. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: congestive heart failure, cardiac arrhythmias, hypertension, chronic pulmonary disease, diabetes, renal failure, liver disease, obesity, and metastatic cancer. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN and expiry: UNKNOWN) dose, 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, after vaccination, 8 patients with reverse transcription polymerase chain reaction (RT-PCR) test positive and primary diagnosis of covid-19 (confirmed covid-19 infection) were admitted into a hospital. All the patients had oxygen requirement upon admission. The patients had also used dexamethasone and remdesivir. Among the 8 patients 1 patient had tested positive within 1-7 days, 6 patients were tested positive between 8-14 days and 1 patient had tested positive between 15-21 days after vaccination. In the patients who tested positive within the first two weeks (1-14 days) after vaccination one patient was admitted in Intensive care unit (ICU), one patient required mechanical ventilation, one patient had death or discharged to hospice and one patient had died on unspecified date. It was unknown if an autopsy was performed. The outcome of ICU admission, mechanical ventilation, death, death or discharged to hospice was not reported in the remaining three patients who were tested positive between 1-14 days after vaccination and in the patient who had tested positive between 15-21 days after vaccination. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patients were died of covid-19 on an unspecified date. The author concluded that even a single dose of vaccination was associated with decreased risk of death. As of AUG-2021, 72% of the adult population has received at least one dose of the COVID vaccine, while more than 1.7 billion vaccine doses have been administered worldwide. The need for ongoing mass vaccination efforts is still of utmost importance, while vaccination in middle and low-income countries should remain an absolute priority. The outcome of covid-19 was death on an unspecified date. This report was serious (Death, Hospitalization Caused / Prolonged, and Life Threatening).; Sender''s Comments: V0: 20211046629-covid-19 vaccine ad26.cov2.s-confirmed covid-19 infection. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: COVID-19


VAERS ID: 1825009 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-10-04
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Chest X-ray abnormal, Lung infiltration
SMQs:, Cardiac failure (narrow), Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a very pleasant 83-year-old female patient of Dr. with medical history significant for coronary artery disease, previous history of CABG, paroxysmal atrial fibrillation on chronic anticoagulation with Coumadin, previous history of ablation, previous history of breast cancer and mastectomy in 1994, sick sinus syndrome history of pacemaker, previous history of seizure disorder, valvular heart disease, previous history of aortic valve replacement surgery in May 2018, history of GI bleed admitted for the above reason. As per the history obtained from the chart and also from the patient. Patient has been brought to the emergency room yesterday because patient has been feeling increasing generalized COVID-19, per patient''s daughter patient was diagnosed approximately 6 weeks ago - received regeneron, chest x-ray with multifocal infiltrates however clinical picture more consistent with a CHF exacerbation, will start patient on empiric steroid, zinc/Ascorbic acid, consult infectious disease


VAERS ID: 1825035 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-10-07
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Death, Dyspnoea, Febrile neutropenia, General physical health deterioration, Pleural effusion, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: 2021-10-23
   Days after onset: 16
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: albuterol (VENTOLIN) (2.5 mg/3 mL) 0.083% nebulizer solution allopurinol (ZYLOPRIM) 300 MG tablet apixaban (ELIQUIS) 5 MG TABS tablet aspirin (HALFPRIN) 81 MG tablet calcium-vitamin D (OSCAL-500+D) 500-200 MG-UNIT tablet fludrocortisone (FL
Current Illness: None known
Preexisting Conditions: DVT of leg (deep venous thrombosis) DVT of leg (deep venous thrombosis), left Benign essential HTN Lung nodule History of hypercholesterolemia Insulin-requiring or dependent type II diabetes mellitus BMI 32.0-32.9,adult Carotid atherosclerosis Hearing loss Dizziness Loss of height BPH (benign prostatic hyperplasia) Obesity Bursitis Atrial flutter with rapid ventricular response Chest pain Orthostatic hypotension Elevated troponin AKI (acute kidney injury) Acute hyperkalemia Dyspnea Bilateral pleural effusion Pericardial effusion Pericarditis with effusion Pleural effusion on left Pleural effusion on right Anemia, unspecified type Acute on chronic systolic (congestive) heart failure Paroxysmal atrial fibrillation Neutropenic fever History of chemotherapy High grade B-cell lymphoma Recurrent syncope Cough Sepsis Elevated lactic acid level Hypomagnesemia Current use of long term anticoagulation Platelets decreased Pancytopenia Acute respiratory failure with hypoxia Pneumonia due to COVID-19 virus Elevated d-dimer Pleural effusion On antineoplastic chemotherapy
Allergies: None Known
Diagnostic Lab Data: Patient reported COVID-19 positive on 10/7/2021.
CDC Split Type:

Write-up: Patient presented to emergency department with shortness of breath on 10/13/2021. He had been diagnosed with COVID-19 on 10/7/2021. He was previously admitted to hospital from 9/8/2021 to 9/13/2021 with neutropenic fever, community acquired pneumonia, and pleural effusion. He was diagnosed with non-hodgkin lymphoma and was undergoing treatment at time of presentation. He was admitted for further management of COVID-19 infection. Patient continued to deteriorate during his admission and was eventually put on comfort measures only. Patient expired on 10/23/2021.


VAERS ID: 1825093 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-10-27
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Incomplete course of vaccination
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: partially vaccinated-covid related death


VAERS ID: 1825097 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-10-05
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatine phosphokinase, Blood gases, Blood lactate dehydrogenase abnormal, Blood lactic acid, Brain natriuretic peptide, C-reactive protein, COVID-19 pneumonia, Chest X-ray, Computerised tomogram thorax, Cough, Culture, Diarrhoea, Differential white blood cell count, Dyspnoea exertional, Electrocardiogram, Fibrin D dimer, Full blood count, Headache, Hepatic cirrhosis, Inflammation, Influenza A virus test, Influenza B virus test, International normalised ratio, Malaise, Metabolic function test, Nausea, Non-alcoholic steatohepatitis, Pain, Portal hypertension, Procalcitonin, Prothrombin time, Pulmonary arterial hypertension, Pyrexia, Red blood cell sedimentation rate, Reflex test, Respiratory syncytial virus test, Retching, SARS-CoV-2 test, Serum ferritin, Sputum discoloured, Troponin I, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: in ED 10/6/21 BLOOD GASES VENOUS BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN (INFLAMMATION) CK COMPREHENSIVE METABOLIC PANEL D-DIMER QUANTITATIVE ESR FERRITIN LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID LDH TOTAL PROCALCITONIN PROTIME/INR PTT SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I performed 2 times URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE CTA CHEST EKG XRAY CHEST PORTABLE -
CDC Split Type:

Write-up: 74yr old female who presents to ED with complaints of not feeling well. Patient states she woke up yesterday morning with a headache and body aches. Patient states she has had a fever and an increase in her cough. Patient states she has been coughing up thick, yellow phlegm. States she feels short of breath with exertion. Patient on O2 via NC at 4L, states this is her normal at home. Patient states she has diarrhea but states this is not new for her. Patient states she has had the dry heaves. Patient states they had a family gathering over the weekend. Patient states she has been vaccinated for covid. Pneumonia due to COVID-19 virus AIRBORNE PRECAUTIONS CONTACT PRECAUTIONS INFECTION CONTROL REFERRAL CULTURE, BLOOD FERRITIN LDH TOTAL CK cefTRIAXone (ROCEPHIN) in D-2.22% 50 mL IV piggyback (DUPLEX) (premix) 2,000 mg 2. Cough INFECTION CONTROL REFERRAL SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL COMPLETE BLOOD COUNT WITH DIFFERENTIAL COMPREHENSIVE METABOLIC PANEL C-REACTIVE PROTEIN (INFLAMMATION) LACTIC ACID ESR BLOOD GASES VENOUS albuterol-ipratropium (DUO-NEB) 2.5-0.5 mg/3 mL inhalation solution 3 mL methylPREDNISolone sod succ (SOLU-medrol) injection 60 mg PROCALCITONIN XRAY CHEST PORTABLE - 3. Nausea ondansetron (ZOFRAN) injection solution 4 mg ondansetron (ZOFRAN) injection solution 4 mg 4. Other headache syndrome INFECTION CONTROL REFERRAL SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL COMPLETE BLOOD COUNT WITH DIFFERENTIAL ondansetron (ZOFRAN) injection solution 4 mg ketorolac (TORADOL) intravenous injection 15 mg 5. Shortness of breath INFECTION CONTROL REFERRAL SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL COMPLETE BLOOD COUNT WITH DIFFERENTIAL COMPREHENSIVE METABOLIC PANEL C-REACTIVE PROTEIN (INFLAMMATION) D-DIMER QUANTITATIVE TROPONIN I EKG LACTIC ACID ESR CULTURE, BLOOD BRAIN NATRIURETIC PEPTIDE albuterol-ipratropium (DUO-NEB) 2.5-0.5 mg/3 mL inhalation solution 3 mL methylPREDNISolone sod succ (SOLU-medrol) injection 60 mg PROCALCITONIN XRAY CHEST PORTABLE - CTA CHEST TROPONIN I 6. PAH (pulmonary arterial hypertension) with portal hypertension BLOOD GASES VENOUS 7. Elevated troponin level 8. Positive D dimer CTA CHEST 9. Elevated serum lactate dehydrogenase (LDH) 10. AKI (acute kidney injury) URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE sodium chloride 0.9% (bolus) IV solution 250 mL 11. Liver cirrhosis secondary to NASH PROTIME/INR PTT ASSESSMENT/PLAN/DECISION MAKING: -Transferred to another healthcare facility.


VAERS ID: 1825226 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-02-19
Onset:2021-08-29
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200/EN6204 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Fall, Feeling abnormal, General physical health deterioration, Incisional drainage, Positive airway pressure therapy, Subcutaneous abscess
SMQs:, Dementia (broad), Acute central respiratory depression (broad), Accidents and injuries (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 59
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 58 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID- 19, HTN, Hyperlipidemia, Chronic Kidney Disease stage III, Hearing Loss, Centrilobular emphysema, CHF, CAD and Osteoarthritis.
Preexisting Conditions: HTN, Hyperlipidemia, Chronic Kidney Disease stage III, Hearing Loss, Centrilobular emphysema, CHF, CAD and Osteoarthritis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to Emergency Room at local Medical Center on August 29, 2011 with complaints of not feeling right and fell at home. The patient was diagnosed with COVID-19 infection, he was previously fully vaccinated on 2/19/2021 & 3/12/2021. Patient completed Remdesivir and Decadron, patients oxygen requirements increased during hospitalization, requiring additional course of steroids. Patient required CPAP during the Hospital Course. After using the CPAP, the patient developed a facial abscess. ENT did an incision and drainage. The patient completed antibiotics. Patient was admitted to a Specialty Hospital. to continue care. On 10/27/2021 the patient met with the physician and family members and due to his significant decline, poor prognosis and increased oxygen needs, the patient chose to go comfort cares and expired on 10/27/2021 1835.


VAERS ID: 1825328 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-01
Onset:2021-10-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Adult failure to thrive, Asymptomatic COVID-19, COVID-19 pneumonia, Death, Myocardial infarction, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-15
   Days after onset: 5
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: Unknown
Current Illness: Cardiovascular Disease
Preexisting Conditions: Cardiovascular Disease
Allergies: Unknown
Diagnostic Lab Data: PCR + 10/10/21 Antigen + 10/10/1
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 92-year-old male patient. The patient received two doses of the Pfizer vaccine on 02/09/21 and 03/02/21. The patient received their third dose of the Pfizer vaccine on 10/01/21. On 10/10/21 (10 days post dose 3), the patient took a PCR test and a rapid test and was positive on both. According to contact tracing team who spoke with daughter of case, case was asymptomatic with the 3rd dose of the Pfizer vaccine. On 10/12, the case was moved to Hospice care as they are not treating the case for COVID, however, as they speaker mentioned a "heart attack." The patient died on 10/15/21 (15 days post 3rd dose). The cause of death is listed as ?Acute respiratory failure; Pneumonia due to Covid ;Covid? on the death certificate. Other significant conditions contributing to death but not resulting in underlying causes are listed as ?adult failure to thrive syndrome.? Known pre-existing conditions include cardiovascular disease.


VAERS ID: 1825340 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2020-12-29
Onset:2021-10-10
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, Bundle branch block right, COVID-19, Chest X-ray abnormal, Dyspnoea, Electrocardiogram abnormal, Exposure to SARS-CoV-2, Lung infiltration, Lung opacity, Pleural effusion, Prohormone brain natriuretic peptide increased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 17
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 of a 65 years old female with past medical history of high blood pressure, HFrEF, COPD, CAD with CABG x 5 and hyperlipidemia presents to the ED due to complaints of shortness of breath, On EMS arrival patient was found in the 70s O2 room air, given breathing treatments during route to the ED, she is vaccinated against covid. She has been exposed to family members at home. Denies any hx of diarrheas, abdominal pain, headache, fever or other associated symptoms. Urine and bowel pattern within normal limits, patient is also aware that she has a mass in her lung and she has been unable to have a CT, since she has been denies twice by her insurance. Patient is independent ADLs and instrumental ADLs. Denies any toxic habits/ former smoker On admission: ProBNP is 29783. Her creatinine is noted to be 5.2. Previous creatinine from September of 2021 was 2.4. EKG shows sinus rhythm at 73 beats per minute with incomplete right bundle-branch block. XR Chest 1V 1. Focal masslike opacity in the left midlung. This may reflect a well-defined focus of consolidation or pneumonia however a mass is not ruled out. Further characterization with CT chest recommended. 2. Left basilar infiltrates and adjacent mild left-sided effusion. 3. Background of COPD and scattered fine reticular opacities suspected chronic. Tested + COVID 10/10/2021 1256


VAERS ID: 1825439 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-08-18
Onset:2021-10-12
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Previously submitted data on this patient, E report #679858 submitting f/u information. Pt expired 10/28/2021 PRINCIPAL DIAGNOSIS COVID-19 Infection SECONDARY DIAGNOSES Principal Problem: COVID-19 Infection Active Problems: Pneumonia Due To COVID-19 Leukemia Lymphocytic Chronic Not Having Achieved Remission (HCC) Acute Respiratory Failure With Hypoxia (HCC) Leukemia Lymphocytic Chronic In Relapse (HCC) Chronic Kidney Disease (CKD), Stage 3b Glomerular Filtration Rate (GFR) 30 To 44 (HCC) Thrombocytopenia (HCC) Depression Major Recurrent Partial Remission (HCC) PreDiabetes Hypertension Essential Primary Hypogammaglobulinemia (HCC) Decline Functional Status Depression Major Recurrent (HCC) Shortness Of Breath


VAERS ID: 1825514 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-09-12
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardio-respiratory arrest, Death, Hypoxia, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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: 2021-09-20
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt diagnosed positive for COVID, received monoclonal antibodies and afterwards became hypoxic, transferred to ED and admitted to hospital; hx of CAD, OSA, COPD; O2 @15 L via NC; pt found in room with O2 off her face; coded a total of 3 x; after the last code, family made her a DNR; pt''s condition worsened and she died in the hospital; COVID pneumonia


VAERS ID: 1825543 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-09
Onset:2021-09-07
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cough, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: 2021-09-23
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: COPD, CAD, depression, Parkinson''s
Allergies: Unknown
Diagnostic Lab Data: 09/07/2021 positive antigen test for NCOV-2019 SARS-CoV-2 Ag Resp Ql IA.rapid: 09/08/2021 positive PCR for NCOV-2019 2019-NCOV RNA PNL XXX NAA+PROBE:
CDC Split Type:

Write-up: Covid-19 diagnosis and symptom onset 9/7/2021 including cough, pneumonia


VAERS ID: 1825563 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-10-20
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anaemia, Anticoagulant therapy, Anticoagulation drug level above therapeutic, Asthenia, COVID-19, COVID-19 pneumonia, Computerised tomogram head normal, Condition aggravated, Death, Decreased appetite, Endotracheal intubation, Fall, Gait disturbance, Gastrointestinal endoscopic therapy, Gastrointestinal polyp haemorrhage, International normalised ratio increased, Mental status changes, Oesophagogastroduodenoscopy, Pneumonia, Pulseless electrical activity, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-23
   Days after onset: 3
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: acetaminophen (TYLENOL) 325 MG tablet aspirin 81 MG tablet Blood Glucose Monitoring Suppl MISC carvedilol (COREG) 25 MG tablet Ferrous Sulfate (IRON) 325 (65 Fe) MG TABS glucose blood VI test strips (ONE TOUCH ULTRA TEST) strip insulin glar
Current Illness: 10.1.21: Procedure: ENDOSCOPIC MUCOSAL RESECTION (EMR), UPPER GI. Friable bleeding gastric polyps. Multiple friable polyps in the stomach. Benign appearing. These were treated by cold BAS (band and slough) EMR.
Preexisting Conditions: Rheumatic aortic insufficiency Rheumatic mitral insufficiency CHF (congestive heart failure) Permanent atrial fibrillation Elevated prostate specific antigen (PSA) Cardiomyopathy, nonischemic HDL deficiency VT (ventricular tachycardia) Cardiac resynchronization therapy defibrillator (CRT-D) in place Mixed hyperlipidemia Essential hypertension Macular degeneration Orthostatic hypotension Diabetes mellitus type 2 with complications GERD (gastroesophageal reflux disease) S/P aortic valve replacement S/P mitral valve repair Exudative age-related macular degeneration, unspecified laterality, unspecified stage Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side Thoracic aortic aneurysm, without rupture Supratherapeutic INR Shock Acute respiratory failure with hypoxia Cardiac arrest COVID-19 AKI (acute kidney injury)
Allergies: Lipitor [Atorvastatin] Statins [Hmg-coa-r Inhibitors]Myalgia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased (10.23.21); Hospitalized (10.20.21); COVID-19 positive (10.20.21); fully vaccinated Primary Care Physician at Discharge Admission Date: 10/20/2021 Date of Death: 10/23/21 Time of Death: 5:47 PM Preliminary Cause of Death: Pneumonia due to COVID-19 virus DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Supratherapeutic INR Acute on chronic anemia Acute respiratory failure due to COVID-19 HOSPITAL COURSE: 86yo Afib on coumadin, trip/fall on 10/20, admitted to IM for INR-7.3, recent GIB (9/13 EGD with coag, 10/1 21 friable polyps resected for oozing and need for anticoagulation), found to be COVID + (full vax with Pfizer and booster), symptoms of weakness, poor appetite since 10/14, 10/22 Azith/Rocephin started for CAP, pt mentation declining, taking off his oxygen, not following commands, early AM 10/23 pt removed oxygen, went into PEA arrest. ROSC obtained after 15min. Intubated, cooled to prevent fever, no target temp. CT head done and NEG, EEG ordered however son came in to see patient, held a family mtng and decided to go comfort care. Therefore pt was extubated this afternoon, sedation off and passed away peacefully.


VAERS ID: 1825612 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-29
Onset:2021-10-23
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-23
   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: Haldol, Lorazepam, Morphine,
Current Illness: Malignancy of prostate, malignancy of bone,
Preexisting Conditions: Malignancy of prostate, malignancy of bone,
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Death


VAERS ID: 1825631 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-29
Onset:2021-10-25
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   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: Ipratropium Albuterol Sol, Morphine, Lorazepam, Hydroxizine, Albuterol, Haldol
Current Illness: COPD, CKD, HTN, Anxiety, arthritis
Preexisting Conditions: COPD, CKD, HTN, Anxiety, arthritis
Allergies: Aspirin, Codeine, Oxycodone, Phenobarbital, Aleve
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Death


VAERS ID: 1825645 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-09-28
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Diarrhoea, Dyspnoea, Frequent bowel movements, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 29 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient is a 78-year-old female with a history of hypertension, hyperlipidemia that presented to the emergency department due to diarrhea. Patient states she has had diarrhea x2 weeks. She notes it to be watery and frequent. Also complains of being weak with shortness of breath. On arrival to the ED patient noted to be hypoxic with oxygen saturation of 77%. Denies any chest pain. Denies any fevers, chills nausea. Patient found to be COVID-19 positive. Patient states she was vaccinated in January of this year, Pfizer. States her diarrhea has improved. Currently is on heated high-flow.


VAERS ID: 1825665 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-08-23
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cardiac arrest, Cough, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Oxygen saturation decreased, Positive airway pressure therapy, SARS-CoV-2 test
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), 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 (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt admitted to the hosp with increasing SOB over past 2 days; hx COPD; positive test for COVID; placed on BiPAP due to increasing O2 requirements; acute on chronic respiratory failure with hypoxemia; cough continued to worsen and O2 requirements increased requiring intubation; cardiac arrest occurred and pt died in the hospital despite aggressive measures to prolong life


VAERS ID: 1825680 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-08-22
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test, Vaccine breakthrough infection
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknow
Current Illness: Unknown
Preexisting Conditions: Diabetes Mellitus, asthma, morbid obesity
Allergies: Codeine
Diagnostic Lab Data: COVID Antigen test on 7/25/2021.
CDC Split Type:

Write-up: Patient had breakthrough infection and deceased.


VAERS ID: 1825688 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-30
Onset:2021-10-10
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 RNA
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: 2019 Novel Coronavirus RNA specimen collection on 9/24/2021
CDC Split Type:

Write-up: covid death 10/10/2021


VAERS ID: 1825695 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-13
Onset:2021-10-08
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test
SMQs:, COVID-19 (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV-2 Antigen specimen collection 10/1/2021 2019 Novel Coronavirus RNA specimen collection 10/1/2021 SARS-CoV-2 Antigen specimen collection 10/4/2021
CDC Split Type:

Write-up: death on 10/8/2021


VAERS ID: 1825704 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-07
Onset:2021-08-28
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private       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: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 PCR Test on 8/20/201
CDC Split Type:

Write-up: They had a breakthrough infection and deceased.


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