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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: 1825715 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-26
Onset:2021-10-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040D21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: DECEASED


VAERS ID: 1825790 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-29
Onset:2021-09-10
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, Death, Dyspnoea, Endotracheal intubation, Extubation, Hypotension, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 days prior to hosp, pt tested positive for COVID; admitted with increasing SOB; taking Medrol Dosepak and antibiotic; O2 @ 6L via NC initially; progressed to BiPAP and eventually required intubation; experienced hypotension and A Fib; pt was extubated in palliative manner; she died in the hosp


VAERS ID: 1826661 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-01
Onset:2021-08-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Dizziness, Feeling abnormal, Haemorrhage, Headache, Loss of consciousness, Sudden death, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 84
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Bi-polar medication, recently started methadone. Lyrica, restless leg medicine the new one
Current Illness: IBS, neuropathy, fibromyalgia, bi-polar, cronic pain,
Preexisting Conditions: Hx drug use, Hx of suicidal attempts,
Allergies: Unknown
Diagnostic Lab Data: Was just starting to a neurologist but i am unsure who that was
CDC Split Type:

Write-up: Shortly after receiving vaccine my mother began to suffer dizziness, blackouts, and a headache that would not stop no matter what she did. Tylenol, ibuprofen, fainting spells and brain fog like amnesia. There were recent visits to the emergency room and never before but the er had difficulty stopping bleeding from trying to start an iv then sudden death october 24th body found in apartment at 930 pm pacific time.


VAERS ID: 1827177 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
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: USJNJFOC20211053420

Write-up: DEATH; This spontaneous report received from a consumer concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced death. On an unspecified date, the patient died from unknown cause of death. It was unknown if the 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: 20211053420-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: 1827385 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
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: AZATHIOPRINE; INFLECTRA [INFLIXIMAB]; CAFFEINE; PREDNISONE; SUNBLOCK SPF25; NEUTROGENA ULTRA SHEER
Current Illness:
Preexisting Conditions: Comments: The patient was healthy as an Olympian before vaccination
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211045102

Write-up: DEATH; This spontaneous report received from a consumer concerned a 35 year old male of unspecified race and ethnicity. Initial information was processed along with the additional information received on 26-OCT-2021. The patient''s height and weight were not reported. The patient was healthy as an Olympian before vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: L17021UA1 and 51737 and expiry: 28-FEB-2023 and 31-AUG-2023) dose, start therapy date were not reported,1 total administered for prophylactic vaccination. Concomitant medications included azathioprine, Inflectra, prednisone, caffeine, Neutrogena clear liquid lotion sunscreen SPF30/sunblock unspecified and Neutrogena ultra sheer mist sunscreen broad spectrum SPF70 5OZ for unspecified indication. It was reported that on an unspecified date, the patient was died days after the J and J (Johnson and Johnson ) shot. The cause of death was unknown. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of unknown cause. This report was serious (Death). This case, from the same reporter is linked to 20211049317 and 20211043304.; Sender''s Comments: V0: 20211045102-covid-19 vaccine ad26.cov2.s -Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1827560 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Drug ineffective, Multiple sclerosis, Suspected COVID-19
SMQs:, Lack of efficacy/effect (narrow), Optic nerve disorders (broad), Demyelination (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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 INC202101413395

Write-up: SARS 2; SARS 2; MS; This is a spontaneous report from a contactable consumer (patient''s friend). A female patient of an unspecified age received bnt162b2 (COMIRNATY, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date (unknown age at time of vaccination) as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Patient''s friend reported: "Saw my doctor on the 19th and showed him the lesions on my lower, left, abdomen, and he said nothing as to why the lesions appeared after the first Pfizer injection, which was about one or two days. As those of us who do research the FDA did not follow their rules in approving any drug for wide consumption. So, these new vaccines never were tested for years, and they cannot save older citizens with underlying heath conditions. I also lost a friend (the patient). She had MS and in ten days she was called home, or died of SARS 2." The outcome of MS was unknown. The patient died on an unspecified date. It was unknown if an autopsy was performed. The cause of death was SARS 2. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: SARS 2; SARS 2


VAERS ID: 1827561 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-22
Onset:2021-08-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure measurement, Cerebrovascular accident, Coma, Confusional state, Death, Hypotension, Illness
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   Days after onset: 9
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210822; Test Name: blood pressure; Result Unstructured Data: Test Result:low
CDC Split Type: USPFIZER INC202101416403

Write-up: became worse, she could not speak, the right part of the limbs did not move/diagnosed a stroke; coma; evening of the same day she was gone; low blood pressure; ill; confused in conversation; This is a spontaneous report from a contactable consumer. A 97-year-old female patient (reporter''s mother) received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 22Aug2021 (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. On 22Aug2021 the patient was vaccinated. After 2 hours, when they were returning home, the patient became ill (she began to react unusually to events, confused in conversation, slowed down her speech). After 10 we arrived home, the situation did not change, being scared, the reporter immediately called an ambulance. The doctor said that this was a normal phenomenon after vaccination, and because of low blood pressure, he gave an injection that increases blood pressure, recommended sleeping and resting. The reporter did not calm down on this and called the doctor who did the vaccination, she repeated the same thing that everything would pass in 2-3 days, and that this condition fully complies with the recommendations. The doctor and reporter called several times during 22Aug2021 and 23Aug2021, she assured they that she had called the COVID center, and they said the same thing - a normal reaction of the body. At about 8.30 am on 24Aug2021, the patient became worse, she could not speak, the right part of the limbs did not move, an ambulance was immediately called, the doctor diagnosed a stroke, then took her to the specialized hospital. As a result, she was in a coma (24Aug2021) until 31Aug2021, and in the evening of the same day she was gone. The patient died on 31Aug2021. It was not reported if an autopsy was performed. The outcome of events was not reported. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: evening of the same day she was gone


VAERS ID: 1827568 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-02
Onset:2021-10-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: INSULIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101429081

Write-up: Passed away in the sleep; This is a spontaneous report received from a non-contactable consumer. A 67-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; Batch/lot number and expiration date were not reported), via an unspecified route of administration in the right arm on 02Oct2021 05:00PM (at the age of 66-years-old) as dose 3 (booster), single for COVID-19 immunisation at a pharmacy or drug store. The patient''s medical history included diabetes mellitus from an unknown date and unknown if ongoing. Concomitant medication included insulin taken for an unspecified indication, start and stop dates were not reported. The patient was previously vaccinated with BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection) on an unspecified date in Feb2021 (at the age of 66-years-old; Batch/lot number and expiration date were not reported) as dose 2, single and on an unspecified date in Jan2021 (at the age of 66-years-old; Batch/lot number and expiration date were not reported) as dose 1, single, both via an unspecified route of administration in the right arm and for COVID-19 immunisation. No other vaccine in was administered in four weeks. The patient had no COVID prior vaccination and was not tested for COVID post vaccination. The patient has no known allergies. On 07Oct2021 09:00AM, 4 days later after the booster shot, the patient passed away in the sleep. It was unknown if treatment was received for the event. The outcome of the event was fatal. The patient died on 07Oct2021. An autopsy was not 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: Passed away in the sleep


VAERS ID: 1827569 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Neoplasm malignant, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Non-haematological malignant tumours (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: Test Name: Covid-19; Test Result: Positive
CDC Split Type: USPFIZER INC202101429440

Write-up: died of confirmed covid-19 after the Pfizer vaccination, he was confirmed cancer; died of confirmed covid-19 after the Pfizer vaccination albeit he was confirmed cancer; died of confirmed covid-19 after the Pfizer vaccination albeit he was confirmed cancer; This is a spontaneous report from a contactable other healthcare professional. A patient of unspecified age and gender received bnt162b2 (BNT162B2), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died of confirmed covid-19 after the Pfizer vaccination albeit he was confirmed cancer. The patient underwent lab tests and procedures which included sars-cov-2 test: positive. The patient died on an unspecified date. It was not reported if an autopsy was performed.; Sender''s Comments: Based on limited information in the case a possible causal association between the reported events Covid-19,Drug ineffective,Neoplasm malignant and the suspect drug BNT162B2 cannot be excluded totally. case will be reassess once additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: died of confirmed covid-19 after the Pfizer vaccination


VAERS ID: 1828410 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, Completed suicide
SMQs:, Suicide/self-injury (narrow)

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

Write-up: Nobody was listening to her.She couldn''t take it anymore and she took her life; Woman that had the shot the moderna shot had the same symptoms that I had.; This spontaneous case was reported by a consumer and describes the occurrence of COMPLETED SUICIDE (Nobody was listening to her.She couldn''t take it anymore and she took her life) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COMPLETED SUICIDE (Nobody was listening to her.She couldn''t take it anymore and she took her life) (seriousness criteria death and medically significant) and ADVERSE EVENT (Woman that had the shot the moderna shot had the same symptoms that I had.). The patient died on an unknown date. The reported cause of death was nobody was listening to her.she couldn''t take it anymore and she took her life. It is unknown if an autopsy was performed. At the time of death, ADVERSE EVENT (Woman that had the shot the moderna shot had the same symptoms that I had.) outcome was unknown. The caller stated that he was talking to his cousin and they had family friends that the woman that had the shot the Moderna shot had the same symptoms he had and nobody was listening to her. She couldn''t take it anymore and she took her life. No concomitant product use was provided by the reporter. No treatment medications were reported. Company Comment: This case concerns a female patient of an unknown age who with no reported medical history, who experienced unexpected event of completed suicide as a result of unknown adverse event stated as ?nobody was listening to her, she couldn''t take it anymore and she took her life. The event occurred following an unspecified period after an unspecified dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was unknown as dosing order details was not disclosed. Causality for the event with product use was not provided by the reporter. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a female patient of an unknown age who with no reported medical history, who experienced unexpected event of completed suicide as a result of unknown adverse event stated as ?nobody was listening to her, she couldn''t take it anymore and she took her life. The event occurred following an unspecified period after an unspecified dose of mRNA-1273 (Moderna COVID-19 Vaccine). The rechallenge was unknown as dosing order details was not disclosed. Causality for the event with product use was not provided by the reporter. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Reported Cause(s) of Death: Nobody was listening to her.She couldn''t take it anymore and she took her life


VAERS ID: 1828442 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-07-14
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 AR / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 54
Permanent Disability? Yes
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving both doses of Moderna COVID vaccine in January 2021 and February 2021, my mother started becoming ill. Previous to this she was active, could drive, go to the store, the hair salon and family functions. She started not feeling well in March 2021 and May 2021. In July 2021 she was admitted to the hospital for 3 days having trouble breathing. August 2021 she was admitted again for 5 days with the same breathing issues. She was released and taken to the Emergency room again within 36 hours. She was admitted to hospital for 3 days and released to a nursing home August 25,2021. Her prognosis is not good and she will probably die soon. These COVID shots have seriously injured my mother. UPDATE: Your gene therapy KILLED my mom. She died of myocardial infarction caused by this shot you call a vaccine. STOP THE LIES, STOP THE DEATH, STOP THE VAX!! Serious Adverse Events Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability or incapacity. The proportions of participants who reported at least one serious adverse event were 1% in the vaccine group and 1% in the placebo group. The most common serious adverse events occurring at higher rates in the vaccine group than the placebo group were myocardial infarction (5 cases in vaccine group vs. 3 cases in placebo group), cholecystitis (3 vs. 0), and nephrolithiasis (3 vs. 0). Three serious adverse events were considered by the U.S. Food and Drug Administration (FDA) as possibly related to vaccine: the one report of intractable nausea/vomiting and two reports of facial swelling in persons who had a previous history of cosmetic filler injections. The possibility that the vaccine contributed to the serious adverse event reports of rheumatoid arthritis (n=1), peripheral edema/dyspnea with exertion (n=1), and autonomic dysfunction (n=1) cannot be excluded. Data source: FDA briefing document external


VAERS ID: 1828445 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-10-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tramadol,fentanyl patch, miralax,colace, Depakote, Tylenol,norvasc, fluoxetine, trazodone, exelon
Current Illness: on Hospice for dementia with life expectancy of 6 months or less
Preexisting Conditions: on Hospice for dementia with life expectancy of 6 months or less demetina, malignant neoplasm kidney, HTN, hyperlipidemia, dysphagia, constipation, squamous cell carcinoma to nose, depression, anxiety, cognitive decline, low back pain, DM
Allergies: codeine, hydrocodone,propoxyphene,tetracycline,clinoril,darvon,indocin,phenergan,vasotec,tap
Diagnostic Lab Data: NA on Hopsice
CDC Split Type:

Write-up: observed resident to be passed away


VAERS ID: 1828580 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-09-03
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute kidney injury, Bacterial infection, COVID-19, Chest pain, Death, Dyspnoea, Endotracheal intubation, Gastrointestinal haemorrhage, Haemofiltration, Intensive care, Loss of consciousness, Pain, Pulseless electrical activity, SARS-CoV-2 test positive, Septic shock, Toxic encephalopathy
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (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), 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), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-18
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 41 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (VENTOLIN HFA) 108 (90 BASE) MCG/ACT HFA inhaler atenolol (TENORMIN) 25 MG tablet budesonide (RHINOCORT AQUA) 32 MCG/ACT nasal inhaler colchicine (COLCRYS) 0.6 MG tablet fluticasone Furoate (ARNUITY ELLIPTA) 100 MCG/ACT inhaler fl
Current Illness: None known
Preexisting Conditions: Hypercholesteremia Chronic pain Benign essential HTN Lumbar disc disease
Allergies: Sulfa drugs
Diagnostic Lab Data: COVID-19 test positive on 9/3/2021
CDC Split Type:

Write-up: Patient presented to emergency room on 9/4/2021 with generalized body aches and loss of consciousness. He was found to be COVID-19 positive on 9/3/2021. Patient''s symptom were mild at that time and was discharged home with instructions for further management. Patient presented to emergency room again on 9/7/2021 with chest pain and shortness of breath. He was immediately placed on high-flow nasal cannula and admitted for further management. He was treated with dexamethasone and baricitinib and was transferred to the ICU on 9/8/2021. Patient''s condition continued to deteriorate and he was intubated on 9/24/2021. Patient''s condition was further complicated with bacterial infection, septic shock, acute renal failure requiring CRRT, acute toxic metabolic encephalopathy, and GI bleeding. Patient went into PEA arrest on 10/18/2021 and was unable to be resuscitated. Patient expired on 10/18/2021.


VAERS ID: 1828586 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-03
Onset:2021-03-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Deafness, Death, Dizziness, Hepatic failure, Laboratory test, Renal failure, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), 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), Hearing impairment (narrow), Vestibular disorders (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 235
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diabetes medication
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data: Multiple from 4/4/2021 until 10/10/2021
CDC Split Type:

Write-up: Vertigo, Dizziness, Hearing loss progressing to kidney and liver failure and death.


VAERS ID: 1828596 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-05
Onset:2021-10-29
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1828603 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-16
Onset:2021-10-28
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1828678 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-23
Onset:2021-10-28
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Atrial fibrillation, Blood lactic acid, Brain natriuretic peptide increased, COVID-19, Chest X-ray abnormal, Dyspnoea, Glomerular filtration rate decreased, Malaise, Pleural effusion, Sepsis, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 0
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 was a 89 y.o female with medical hx including afib, htn, hypothyroidism who presented to OHRH ED with worsening SOB after being diagnosed with COVID19 on 10/20/2021. Symptoms started a few days prior. She was COVID 19 vaccinated. She was requiring some O2 via nc, but not more than a few L. However, she was in afib RVR and minimal pleural effusions seen in CXR. Pt''s GFR was only 35 no remdesivir not given. bnp 2800, lactic acid 5.4. ER concerned about suggestive of infectious process. No wbc, procal pending. No purulent sputum production. Cardiology consulted. Patient was resumed on oral medication and weaned from Cardizem drip. Cardiology also felt that her NSTEMI was demand ischemia from her underlying sepsis. Staff were able to control her heart rate. Unfortunately, she did have some issues with AKI, but they could not give any fluids due to shortness of breath and 3rd spacing. Pt was being treated empirically for severe sepsis. She received vancomycin and cefepime. According the the Dr. she was complaining of not feeling well when he visited her. The Doctor stated her morning labs had not yet resulted as they were not collected until 0847 hr. About 15 min after he saw her. MRT was called. He urgently went to the room, unfortunately, Pt. was already unresponsive.


VAERS ID: 1828681 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-27
Onset:2021-06-01
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A. 012A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Creutzfeldt-Jakob disease, Death, Lumbar puncture, Magnetic resonance imaging head, Prostatectomy
SMQs:, Dementia (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Prostate malignant tumours (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 87
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: Blood pressure medicine, staten drug, Plavix, Baby aspirin, Vitamin D, low dose of vitamin C
Current Illness: None
Preexisting Conditions: Had open heart surgery double bypass caught early that?s why he was on that medicine. Had his prostate removed in April 2021
Allergies: None
Diagnostic Lab Data: Spinal tap Brain MRI and brain autopsy
CDC Split Type:

Write-up: Died six months later from CJD.


VAERS ID: 1828685 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-10-02
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaemia, Aphasia, Atrial fibrillation, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Culture positive, Death, Dyspnoea, Dyspnoea exertional, Dyspnoea paroxysmal nocturnal, Haemoptysis, Hypotension, Intensive care, Malaise, Orthopnoea, Packed red blood cell transfusion, Platelet transfusion, Renal failure, Respiratory failure, Respiratory viral panel, Thrombocytopenia, Ventilation/perfusion scan normal, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (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: 2021-10-24
   Days after onset: 22
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: Albuterol Nebs PRN, Amlodipine 10 mg QD, Calcitriol 0.25 mcg QD, Advair 250/50 QD, Furosemide 40 mg BID, Metoprolol 50 mg BID, Ondansetron 4 mg Q8H prn, Mirtazepine 15 mg QD, Simvastatin 10 mg QD.
Current Illness:
Preexisting Conditions: COPD, CKD, Hepatits C, Anemia, Depression, A-Fib, GERD, HTN, HLD, Hypothyroidism
Allergies: Lisinopril (Anaphylaxis)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen Vaccine on 8/26/2021. Patient presented to ED on 10/2/2021 for shortness of breath, coughing and wheezing. Patient has a week of feeling unwell, saying she has had worsening dyspnea on exertion, PND and orthopnea. She also mentions stopping all of her medications for two days when that happened because she was feeling too unwell. 4 days ago, her shortness of breath acutely worsened. She had been dusting and the dust made her wheezing and coughing worse. Shortness of breath became severe enough that she needed to come to the ED. The patient was admitted on 10/3 for COPD exacerbation and COVID pneumonia. She developed worsening hypoxemic respiratory failure with increasing HFNC requirements and was subsequently transferred to the ICU on 10/11. Her renal failure worsened so a femoral quinton was placed but the patient became very hypotensive and hypoxic with every attempt at HD or CRRT. The patient decided that she would not want to pursue intubation in the setting of further respiratory deterioration. Code status was changed to DNAR-COT. Since dialysis made the patient too hypoxic while already on HFNC, the decision was made to not pursue further dialysis and the quinton was removed. Then, the patient''s pneumonia panel came back positive for pseudomonas and her respiratory culture indicated the presence of mold. She was started on cefepime and cresemba. Her oxygen requirements decreased and she was transferred back to the floor on 10/19. However, on 10/20 she was brought back to the ICU once again for worsening hypoxia requiring 60L/90% on HFNC. She also developed hemoptysis, anemia, and thrombocytopenia requiring transfusion of platelets and pRBCs. V/Q scan was negative for PE. On 10/23, the patient developed acute word finding difficulty while speaking with family member in the setting of a brief run of afib and ongoing thrombocytopenia. CT brain was ordered to assess for stroke/bleed. However, after discussion with the patient and her daughter, the decision was made to withdraw all support. She was made DNAR-AND and was started on comfort care. On 10/24/2021, patient was pronounced deceased.


VAERS ID: 1828690 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-29
Onset:2021-10-02
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Blood creatinine increased, Blood urea increased, COVID-19, Chills, Cough, Death, Dyspnoea, Endotracheal intubation, Haematuria, Hypoxia, Intensive care, Malaise, Mechanical ventilation, Pollakiuria, Pyrexia, Respiratory distress, Syncope, Thrombocytopenia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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 (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (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: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 325 mg QD, Atorvastin 40 mg QD, Metoprolol 100 mg QD, Minocycline 75 mg Q12H, Ramipril 5 mg QD.
Current Illness: Syncope with Monoclonal antibody infusion
Preexisting Conditions: Urinary tract Infection, Sepsis, Renal insufficiency, thrombocytopenia, CAD, Hypertension, Hyperlipidemia, Hypothyroid
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/31/2021 and 4/29/2021. Patient presented to outside facility ED on 9/30/2021 with chief complaint of feeling ill and fever of 2-3 days duration. Patient also had slight dry cough, diagnosed with COVID, and discharged home. On 10/2/2021 patient presented to ED with c/o SOB, chills, and generalized weakness that had been ongoing for 3 days PTA. Pt had also had hematuria and increased urinary frequency. ED workup revealed BUN 24, sCr 1.4 and thrombocytopenia, While in ED, following the Regen-COV infusion He became hypoxic requiring 15L/min O2 and syncopal episode lasting <30 seconds. He was admitted to med-surg for acute respiratory failure. On 10/10, his clinical course was complicated by worsening respiratory distress and he was transferred to ICU for further management. On 10/14/2021 patient required intubation and mechanical ventilation support. On 10/23 patient required multiple vasopressor support. On 10/24 family decided to transition to comfort care and patient expired on 10/24/2021.


VAERS ID: 1828696 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-24
Onset:2021-10-22
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Agitation, Asthenia, Back pain, Brain herniation, COVID-19, Chest X-ray normal, Computerised tomogram head abnormal, Confusional state, Death, Depressed level of consciousness, Dysstasia, Epidural haemorrhage, Fall, Hypoacusis, Imaging procedure abnormal, Neck pain, Productive cough, Pupil fixed, SARS-CoV-2 test positive, Sputum discoloured, Subdural haemorrhage, Urine analysis normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (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: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin C 500 mg BID, Aspirin 81 mg QD, Cholecalciferol 2000 units QD, Fexofenadine 60 mg QD, Levothyroxine 100 mcg QD, Meclizine 25 mg TID PRN, Midodrine 5 mg TID, Omeprazole 20 mg QD, Simvastatin 40 mg QD, Tramadol 50 mg Q6H PRN, Zinc 50
Current Illness:
Preexisting Conditions: CAD, GERD, Sleep apnea
Allergies: Codeine (Nausea)
Diagnostic Lab Data: Positive COVID-19 on 10/22/2021.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/2/2021 and 3/24/2021. Presented to ED on 10/22/2021 for evaluation of weakness that resulted in falls yesterday and today with associated upper back and neck pain. Pt is unable to give a complete ROS. States that he got COVID from his wife but does not know when his symptoms started, endorses a cough with green sputum for "a long time", weakness, and upper back and neck pain from fall. He states that he is so weak he is unable to stand up. Denies n/v, diarrhea, CP, SOB, ABD pain, ROS otherwise limited. PT extremely HOH. EMS reported O2 sat 90% on RA at home. Patient started on dexamethasone and remdesivir. Further history from patient indicated his prior diagnosis of bacterial of PNA was done over the phone. His imaging findings were consistent with bacterial PNA, he had no WBC and a relatively unimpressive procal, bacterial PNA was unlikely so abx were stopped. The following day patient became agitated and confused. He was alert only to himself but still attempted to converse and answer questions, he had no focal neurological signs. This was thought to be delirium from COVID-19, his UA was negative and his CXR was negative for aspiration and he did not show signs of sepsis. The following morning patient was obtunded and would not respond to sternal rub, he had nonreactive pupils. A stat CT head was ordered which revealed a massive extra-cranial bleed with 5 cm midline shift and subfalcine as well as uncal herniation. The bleed was most likely epidural or subdural in origin. Family elected to make patient comfort care and patient expired on 10/26/2021.


VAERS ID: 1828699 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-31
Onset:2021-10-15
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Aortic stenosis, Atrial fibrillation, Blood lactic acid increased, Body temperature decreased, COVID-19, COVID-19 pneumonia, Chest pain, Condition aggravated, Cough, Death, Dyspnoea, Echocardiogram, Endotracheal intubation, Haemofiltration, Hypotension, Intensive care, Renal failure, SARS-CoV-2 test positive, Transfusion, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), 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: 2021-10-26
   Days after onset: 11
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: Acetaminophen prn, Acyclovir 400 mg QD, Amlodipine 5 mg QD, : Apixaban 2.5 mg BID, Atorvastatin 10 mg QD, Cyclosporine 200 mg QAM 100 mg QPM, Escitalopram 10 mg QD, Furosemide 20 mg PRN leg swelling, Hydralazine 50 mg BID, Isosorbide mononi
Current Illness:
Preexisting Conditions: CAD s/p CABG, HTN, DM, Myelodysplastic syndrome, A-fib, Pacemaker for symptomatic bradycardia. , CHF, CKD, Hyperlipidemia, Pure red cell aplasia, Macular degenration, Eczema, Basal cell carcinoma of skin, BPH, bilateral pseudophakia, insomia, Mood disorder.
Allergies: NKDA
Diagnostic Lab Data: Positive COCVID-19 on 10/15/2021using one or a combination of Real-Time PCR based methods and multiplex reagents including that utilize primer/probe sets specific for the detection
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/27/2021 and 2/22/2021, and 8/31/2021. Patient presented to ED on 10/15/2021 with complaints of cough & SOB x 2 weeks - diagnosed with covid PNA 2d prior prescribed doxycycline. Pt presents today because he reports he was coughing and had sharp pain at center of chest/ xiphoid process. Pt transferred to the ICU due to increasing oxygen requirements from COVID pneumonia. Pt also found to be anemic at that time and transfused 1 unit w/ improvement in Hgb levels. Pt had a history of aortic stenosis so a TTE was performed which revealed severe aortic stenosis, which significantly increased his chances of a difficult intubation due to poor cardiopulmonary reserve. Pt subsequently began developing worsened respiratory status and required intubation. Pt then developed worsening renal failure requiring CRRT. CRRT caused pt to become extremely hypotensive despite being on 3 pressors and near max. Pt also developed afib w/ RVR and had to be started on amio gtt. CRRT was paused and initially BP recovered without use of pressors, however over the course of a few hours pressors had to be added back. Pt also began having elevation of lactic acid, low temperatures, and elevated WBC so was re-cultured at that time. Family decided at that time they would like to allow patient to have comfort care, and patient expired on 10/26/2021


VAERS ID: 1828700 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-10-15
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Anaemia, COVID-19, COVID-19 pneumonia, Cardiac failure acute, Death, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-19
   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: Acetaminophen 650 mg PRN, Alprazolam 0.25 mg TID PRN anxiety, Vitamin C 500 mg BID, Aspirin 81 mg QD, Brinzolamide 1% 1 drop left eye TID, Cholecalciferol 1000 units QD, Combigan 0.2/0.5 1 drop left eye BID, Cyclosporine 0.05% 1 drop each
Current Illness:
Preexisting Conditions: Anxiety, Aortic aneurysm, Atrial fibrillation, Squamous cell carcinoma, CKD stage 2, CHF, Hypertension, GERD, H/O, Aortic and Mitral valve prolapse, H/O Rheumatic fever, H/O endocarditis, insomnia, Left bundle branch block, Osteoporosis, Cardiac pacemaker, H/O Stroke, Tricuspid valve replaced, Thoaracic aortic aneurysm.
Allergies: Penicillin (Rash)
Diagnostic Lab Data: Positive COVID-19 test on 10/13/2021.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/2/2021 and 3/2/2021. Presented on 10/13/21 with dyspnea and hypoxia. Diagnosed with acute/chronic CHF, anemia and COVID pneumonia. Aggressively managed but failed to respond. Family opted for comfort care rather than continued aggressive management and she was admitted to hospice for end of life care.


VAERS ID: 1828735 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-22
Onset:2021-07-26
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   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: aleve
Current Illness:
Preexisting Conditions: high cholesteral
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My son died of a brain bleed. He was a healthy 39 yr old. It was sudden and unexpected.


VAERS ID: 1828774 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-29
Onset:2021-10-14
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated with Pfizer. Second dose received 4/29/2021. Tested positive for COVID on 10/14/2021. Admitted to Hospital on 10/15/2021. Expired on 10/20/2021 while still hospitalized.


VAERS ID: 1828795 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-23
Onset:2021-10-12
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Inappropriate schedule of product administration, SARS-CoV-2 test positive
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: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Case fully vaccinated with Moderna. Second dose administered on 4/23/2021. Tested positive for COVID on 10/12/2021. Admitted to Medical Center on 10/21/2021 and expired on 10/27/2021 while still hospitalized.


VAERS ID: 1828802 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-27
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, 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: 2021-10-27
   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: albuterol, azithromycin, benzonatate, olmesartan, oxybutynin, prednisone, rivaroxaban, rosuvastatin, ciprofloxacin
Current Illness: COVID positive,
Preexisting Conditions: Afib, asthma, bronchitis, hyperlipidemia, hypertension, rheumatoid arthritis
Allergies: shellfish, leflunomide, shrimp
Diagnostic Lab Data: Positive COVID test on 10-14-2021 after receiving booster shot on 10-13-2021
CDC Split Type:

Write-up: Death on 10/27/2021


VAERS ID: 1828858 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-10-22
Onset:2021-10-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dofetilide sulfasalazine rosuvastatin irbesartan aspirin
Current Illness:
Preexisting Conditions: CABGx4
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feeling ill, became unresponsive and called 911 Full resuscitation efforts given, patient expired in the field


VAERS ID: 1828873 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-10-28
Onset:2021-10-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   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: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feeling ill, weakness - cardiac arrest Full resusitation efforts, transported to Hospital ED


VAERS ID: 1828901 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-15
Onset:2021-10-21
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, C-reactive protein increased, COVID-19, Cardiac arrest, Cardioversion, Chest discomfort, Chest pain, Condition aggravated, Death, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Full blood count, Inappropriate schedule of product administration, Life support, Malaise, Metabolic function test, Resuscitation, SARS-CoV-2 test positive, Tachycardia, Troponin increased, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Respiratory failure (broad), Medication errors (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID-19 August 2021
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: See above. CBC, BMP. Troponin elevated at 20. CRP significantly elevated. CTA chest negative for PE. EKG with ST elevations. Echocardiogram with depressed EF 40-45%. SARS-CoV-2 positive.
CDC Split Type:

Write-up: Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully. She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21. She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h. Was feeling completely well prior to onset of chest discomfort. Symptoms were mild. No sick contacts or family members. ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure. EKG with diffuse ST elevation. Troponin elevated at 20. CTA chest negative for PE or pneumonia. SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination. Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors. STAT Echo resulted depressed EF 40-45%. Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic. Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest. Initial rhythm was VT. Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics. Unfortunately she was not able to be resuscitated and died. Cause of death possible acute myocarditis.


VAERS ID: 1828960 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-14
Onset:2021-10-13
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray normal, Death, Failure to thrive, SARS-CoV-2 test positive
SMQs:, Neonatal disorders (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: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, alendronate, amlodipine, ascorbic acid, atorvastatin, bisacodyl, vitamin d3, advair, folic acid, hydromorphone, probiotic, levothyroxine, melatonin, methotrexate, omeprazole, miralax, senna, sertraline, bactrim DS, umeclidini
Current Illness: N/A
Preexisting Conditions: AAA, PAD, CVA, GERD, RA/OA, hypothyroidism
Allergies: penicillins, codeine, meperidine, promethazine, secobarbital sodium, claritin
Diagnostic Lab Data: covid positive test on 10/13/21. chest x ray impression on 10/13/21- no acute abnormality
CDC Split Type:

Write-up: Patient presented to ED on 10/13/21 from a long term care facility with covid positive status. Patient is fully vaccinated, on hospice care. Due to failure to thrive, family transitioned the patient to private facility and patient passed on 10/24/21.


VAERS ID: 1828972 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-21
Onset:2021-09-19
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Death, Dyspnoea, Malaise, Positive airway pressure therapy, 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), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   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 diagnosed COVID positive 2 days before hospital admission; admitted with increasing SOB and malaise; O2 saturations @ home were 85%; placed on O2, 8L via NC; cough, treated with dexamethasone and baricitinib; has AKI therefore didn''t treat with remdesirvir; COVID pneumonia and ARF with hypoxia; placed on Vapotherm and eventually BiPAP; pt''s condition worsened; palliative care was consulted; pt was taken off BiPAP and she was kept comfortable; pt expired in the hospital


VAERS ID: 1828975 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-10-18
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cellulitis, Electrocardiogram, Full blood count, Hypokalaemia, Hypomagnesaemia, Hypoxia, Lethargy, Lung infiltration, Metabolic function test, Pallor, Pneumonia aspiration, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen ER Tablet Extended Release 650 MG, amLODIPine Besylate Tablet 10 mg, DULoxetine HCl Capsule Delayed Release Particles 30 MG, Furosemide Tablet 20 MG, Lidoderm Patch 5 % (Lidocaine), Losartan Potassium Tablet 25 MG, Omeprazole
Current Illness: Resident was recently admitted (9/2/21) to the nursing home following a fall. He was being treated for CHF and chronic respiratory failure and asthma.
Preexisting Conditions: acute and chronic respiratory failure with hypoxia, anxiety, asthma, atrial fibrillation, CHF, dysphagia, pacemaker, prostate cancer, hx of falls, htn.
Allergies: Hydrochlorothiazide, Sulfa Antibiotics, Garlic
Diagnostic Lab Data: He was hospitalized from 10/14-10/16/2021. 10/14/21- ECG, BMP, CBC, COVID-19 - negative,
CDC Split Type:

Write-up: On 10/14/21 the resident had a change of condition and was unresponsive. He was pale and lethargic. He had hypoxia and sats were 58% and supplemental oxygen was increased. Resident was transferred to the ER. The resident was treated at the hospital for pulmonary infiltrates, cellulitis LUE, aspiration pneumonia, hypokalemia, hypomagnesis.


VAERS ID: 1828986 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-02
Onset:2021-10-21
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 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: 2021-10-21
   Days after onset: 0
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: Atorvastatin, lisinopril, omeprazole, oxybutynin
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data: Positive COVID-19 PCR test on 10/15/2021.
CDC Split Type:

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


VAERS ID: 1828993 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-17
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-17
   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: cloNIDine HCl Tablet 0.1 MG Vitamin D3 Tablet ,Centrum Silver Tablet ,Fish Oil Capsule 1200 MG ,Valsartan Tablet 160 MG,hydrALAZINE HCl Tablet 50 MG,Carvedilol Tablet 12.5 MG,Atorvastatin Calcium Tablet 20 MG ,ARIPiprazole Tablet 2 MG,AmLOD
Current Illness: Prostate Cancer, Old MI, HTN ,GOUT, Hyperlipidemia
Preexisting Conditions: Dementia
Allergies: No known allergies
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Resident passed away on 10/17/21


VAERS ID: 1828998 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-03-17
Onset:2021-08-24
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-10
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: contrast media, sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID


VAERS ID: 1829051 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-15
Onset:2021-10-08
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Chest X-ray abnormal, Cough, Death, Effusion, Generalised oedema, Lung infiltration, Lung opacity, Malaise, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: 2021-10-22
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Clonidine Iodinated Contrast Media
Diagnostic Lab Data: PCR COVID-19 test
CDC Split Type:

Write-up: Patient was admitted to the hospital on 09/27/2021. Patient tested COVID positive on 10/08/2021 after cough initiated. He was placed in isolation, On 10/11/2021 CXR was suggestive of infiltrates and became very symptomatic on 10/12/2021 requiring oxygen treatment. Treatment was started on Decadron and remdesevir. On 10/14/2021, baricitinib was added; on 10/16/2021 his pneumonia worsened and theres was small to moderate effusion; Vancomycin and zosyn IV were added as well. It was noted that he had anasarca and treated with lasix which didn''t help his respiratory status. On 10/18/2021, CXR showed continued opacities and RT lung atelectasis; 10/19/2021 he was coughing uncontrollably. Palliative care was recommended and patient transferred to hospice on 10/21/2021 and passed away on 10/22/2021.


VAERS ID: 1829067 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-10
Onset:2021-09-03
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest pain, Death, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt tested positive for COVID 10 dys prior to hosp admission; presents to hosp with increase in SOB and chest pain; O2 sats at home were 60% on O2 3 LPM; placed on 100% NRBM; hx of COPD and OSA with CPAP; treated with dexamethasone and redisivir; pt''s condition worsened and she requested a DNR/DNI; pt expired in the hosp; COVID pneumonia


VAERS ID: 1829072 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-19
Onset:2021-06-05
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none. He DIED
CDC Split Type:

Write-up: He DIED


VAERS ID: 1829098 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-26
Onset:2021-10-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus - was sick for a week after receiving. Date of last Tetanus injection unknown.
Other Medications: Fenofibrate, Synthroid, Flonase, Fish Oil, Ibuprofen
Current Illness: Have not seen patient in office since 03/11/2020. Has only been in for vaccinations.
Preexisting Conditions: hypothyroidism, hyperlidemia, renal insufficiency, polycythemia vera, neuropathy, atherosclerosis of both iliac arteries, idiopathic skeletal hyperostosis
Allergies: Sulfa, Tetanus, Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away on 10/27/2021 from a heart attack.


VAERS ID: 1829128 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-02-10
Onset:2021-08-31
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Statins, cipro, iron
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was hospitalized after testing positive for COVID


VAERS ID: 1829151 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-03-08
Onset:2021-03-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / UNK - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthropathy, Cardiac failure, Death, Fall, Gait disturbance, Head injury, Hepatic failure, Loss of consciousness, Renal failure, Syncope, Walking aid user, Wheelchair user
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (narrow), Arthritis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 65
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: First shot was February 8, 2021. A day later he started to lose control of his nerves. He was constantly shaking. He couldn''t hold a glass with water without it flying out of his hand accidentally. He needed someone behind him to walk anywhere because he would faint. The second shot was March 8, 2021. The symptoms got worse. He was not able to walk without a walker, which quickly led him to a wheelchair. There was one day he felt to confident and tried to sit at the counter barstool. His legs gave out, or he fainted, we''re not sure, but he landed on the ground and hit his head so hard he was unconscious and he brought him to the hospital. A week later he was on his way out from discharge and he fell again. He did not leave the hospital again. His kidneys failed, then his liver, and then his heart. He died on May 14, 2021.


VAERS ID: 1829189 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-02-12
Onset:2021-09-30
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized after testing positive for COVID.


VAERS ID: 1829223 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-08-23
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with hypoxic respiratory failure and sepsis due to positive for COVID 19; treated with antibiotics, steroids, breathing treatments; remdesivir, Baracitinib; overall condition and oxygenation worsened; pt experienced respiratory arrest in the hospital


VAERS ID: 1829230 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-10-27
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aortic valve replacement, Cardiac pacemaker insertion, Death
SMQs:

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? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: PAST MEDICAL HISTORY: Notable for aortic stenosis with the patient having undergone a TAVR and PPM on 07/15/2021. He was being treated with Brilinta and transitioning to clopidogrel. Other history is notable for pulmonary fibrosis, non-insulin dependent diabetes mellitus, hypertension, post-transplant lymphoproliferative disorder, chronic kidney disease, stage 3A, hypothyroidism, anxiety, Barrett esophagus, and benign prostatic hypertrophy.
Allergies: Levofloxacin, spironolactone, lisinopril
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient expired 10/27/2021.


VAERS ID: 1829244 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-08-08
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, GERD, HIV, hypercholesterolemia, SOB
Allergies: Benadryl, codeine, PCN
Diagnostic Lab Data: Covid test, labs, cxr.
CDC Split Type:

Write-up: Pt came to ER c/o SOB.


VAERS ID: 1829253 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-08-09
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchopleural fistula, COVID-19, Death, Dyspnoea, Endotracheal intubation, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 30
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to ED with 3 days of increasing SOB; positive for COVID in ED; treated with dexamethasone, remdisivir, tocilizumab; on 15 L O2 via NC; oxygenation worsened requiring ICU and intubation; bronchopleural fistula secondary to heavy hx of vaping and cigarette use; was eventually made a DNR; comfort measures; extubated and patient expired in the hosp


VAERS ID: 1829274 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-11
Onset:2021-08-28
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   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: Amlodipine, atorvastatin, aspirin, clopidogrel, nexium 24 hr, levothyroxine
Current Illness: Unknown
Preexisting Conditions: CVA, vertigo, B12 deficiency. iron deficiency, osteoarthritis, GERD, hyperlipidemia, depression, anxiety, panic
Allergies: no known allergies
Diagnostic Lab Data: Positive COVID Antigen on 8/17/2021 Positive COVID PCR on 8/24/2021
CDC Split Type:

Write-up: Unknown


VAERS ID: 1829276 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-22
Onset:2021-08-30
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chronic obstructive pulmonary disease, Coma, Cough, Death, Dyspnoea, Encephalopathy, Extubation, Mechanical ventilation, Multiple organ dysfunction syndrome, Pyrexia, Respiratory failure, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-13
   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: pt admitted to hosp after 3 days of fever, cough, SOB; positive for COVID 19; hypoxic respiratory failure; septic shock - treated with Levophed; acute encephalopathy; remained in coma; exacerbated episode of COPD; placed on ventilator 100% FiO2; multiorgan system failure; pt was made a DNR and comfort measures; extubated and pt died at the hospital


VAERS ID: 1829320 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-10-25
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dehydration, Neck pain, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Arthritis (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: MEDICAL CANNABIS amoxicillin-pot clavulanate (AUGMENTIN) 875-125 mg oral tablet ascorbic acid, vitamin C, 500 mg oral tablet aspirin 81 mg Oral TbEC baclofen (LIORESAL) 10 mg oral tablet buPROPion XL (WELLBUTRIN XL) 150
Current Illness:
Preexisting Conditions: Congestive heart failure Anemia Atherosclerotic coronary vascular disease Atrial flutter Depression Hyperlipidemia Hypertension Inguinal hernia Multiple sclerosis Osteomyelitis Renal disease Spasticity Transient ischemic attack Hypotension Cellulitis Coronary artery disease Paroxysmal atrial tachycardia Chronic kidney disease Warfarin induced coagulopathy Lower extremity edema
Allergies: Hydralazine Adhesive Tape-Silicones Amiodarone Aricept [Donepezil] Hydrochlorothiazide Latex
Diagnostic Lab Data: POSITIVE COVID TEST 10/25/2021
CDC Split Type:

Write-up: NECK PAIN AND DEHYDRATION


VAERS ID: 1829361 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-09-24
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Death, Endotracheal intubation, Positive airway pressure therapy, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-24
   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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EMS brought pt to ED; O2 sats on room air are 50%; placed on CPAP; pt unresponsive; tested positive for COVID; intubated; went into cardiac arrest x 10 mins and a second time for 7 mins; family states they do not want CPR or medication to be used on patient; pt''s condition worsened and he expired in the ED


VAERS ID: 1829391 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dizziness, Dyspnoea at rest, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Respiratory failure (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, HLD, DM, CKD,
Allergies:
Diagnostic Lab Data: 10/28/21 Covid-19 positive
CDC Split Type:

Write-up: Symptoms: n/v, dizziness and SOB at rest for the last 7 days, Treatment: Remdesivir, and Dexamethasone


VAERS ID: 1829423 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-09-22
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Cyanosis, Death, Fall, Respiratory tract congestion, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: pt was found at home by family unresponsive and with facial cyanosis after an apparent fall; EMS called; no CPR done due to cyanosis and unresponsiveness; family states he had cough and congestion past 5 - 6 days; pronounced dead at home; COVID test was positive.


VAERS ID: 1830620 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-07
Onset:2021-08-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, COVID-19, Chest discomfort, Chills, Cough, Death, Dyspnoea, Fatigue, Gait inability, Hyperhidrosis, Pain, Pain in extremity, Pyrexia, SARS-CoV-2 test positive, Urinary retention
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 16
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: He went to go get test for Covid 19 August 18,2021 because he wasn?t feeling better the results were positive. He took a Covid 19 test before vaccine and it was negative.
CDC Split Type:

Write-up: From the date of his vaccine til the date he went to the hospital (August 22, 2021) he felt these symptoms more and more. Soar arm, chills, body aches, fatigue, fever, lost of taste, cough, shortness of breath, excessive sweating, heavy chest, couldn?t walk or use legs, couldn?t urinate after drinking water. He took Advil(red pill). He died August 23, 2021


VAERS ID: 1830681 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Death, Injury
SMQs:, Accidents and injuries (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211057445

Write-up: DEATH; SEVERELY INJURED; This spontaneous report received from a consumer concerned multiple patients with unspecified age, gender, race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. It was reported that on an unspecified date multiple patients had died and were severely injured as a direct result of vaccine. The cause of death was unknown. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of severely injured was not reported. This report was serious (Death).; Sender''s Comments: V0: 20211057445-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1831095 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-24
Onset:2021-03-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6302 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   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:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101438499

Write-up: Cardiac arrest one week later, on 03Mar died 3 months later; Cardiac arrest one week later, on 03Mar died 3 months later; This is a spontaneous report from a contactable consumer. A 73-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 24Feb2021 02:00 (at the age of 73-years-old) (Batch/Lot Number: En6302) as DOSE 1, SINGLE for covid-19 immunisation. The patient''s medical history was not reported. The patient has no known allergies. The patient did not have covid prior vaccination and was not covid tested post vaccination. On 03Mar2021 07:00, the patient experienced cardiac arrest one week later, on 03Mar2021 died 3 months later. Therapeutic measures were taken as a result of the events. The patient died on 03Mar2021. It was not reported if an autopsy was performed. The outcome of the event cardiac arrest was not recovered. Follow-up attempts are completed. No further information is expected.; Reported Cause(s) of Death: Cardiac arrest one week later, on 03Mar died 3 months later


VAERS ID: 1831098 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101441253

Write-up: COVID; COVID; This is a spontaneous report from a contactable consumer reporting same events under the same suspect product for 3 patients. This is the first of 3 reports. A patient of unspecified age and gender received unknown dose number of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE, solution for injection) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. Medical history and concomitant medications were not reported. It was reported that 3 people died from COVID after getting Pfizer''s Vaccine. Three (3) individuals had the Pfizer''s shot and died from COVID. 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-202101441264 same reporter/drug/event, different patient;US-PFIZER INC-202101441268 same reporter/drug/event, different patient; Reported Cause(s) of Death: COVID; COVID


VAERS ID: 1831099 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101441264

Write-up: COVID; COVID; This is a spontaneous report from a contactable consumer reporting same events under the same suspect product for 3 patients. This is the second of 3 reports. A patient of unspecified age and gender received unknown dose number of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE, solution for injection) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. Medical history and concomitant medications were not reported. It was reported that 3 people died from COVID after getting Pfizer''s Vaccine. Three (3) individuals had the Pfizer''s shot and died from COVID. 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-202101441253 same reporter/drug/event, different patient;US-PFIZER INC-202101441268 Same reporter/vaccine/event, different patient; Reported Cause(s) of Death: COVID; COVID


VAERS ID: 1831100 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101441268

Write-up: COVID; COVID; This is a spontaneous report from a contactable consumer reporting same events under the same suspect product for 3 patients. This is the third of 3 reports. A patient of unspecified age and gender received unknown dose number of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE, solution for injection) via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunisation. Medical history and concomitant medications were not reported. It was reported that 3 people died from COVID after getting Pfizer''s Vaccine. Three (3) individuals had the Pfizer''s shot and died from COVID. 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-202101441253 Same reporter/vaccine/event, different patient;US-PFIZER INC-202101441264 Same reporter/vaccine/event, different patient; Reported Cause(s) of Death: covid; covid


VAERS ID: 1831101 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101451919

Write-up: 5 people she knew were vaccinated and died; This is a spontaneous report received from Pfizer sponsored program from a non-contactable consumer. This consumer reported same event for 5 patients. This is the 1st of 5 reports. A female patient of unspecified age received bnt162b2 (COMIRNATY), via unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. The relevant medical history and concomitant medications were not reported. The consumer stated during conversation that 5 people she knew were vaccinated and died. She did not have any other information. The patient died on an unspecified date. It was unknown if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER_INC-202101451923 same reporter/drug/event, different PTs;US-PFIZER_INC-202101451924 same reporter/drug/event, different PTs;US-PFIZER_INC-202101451925 same reporter/drug/event, different PTs;US-PFIZER_INC-202101451926 same reporter/drug/event, different PTs; Reported Cause(s) of Death: 5 people she knew were vaccinated and died.


VAERS ID: 1831102 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101451923

Write-up: 5 people she knew were vaccinated and died; This is a spontaneous report received from Pfizer sponsored program. A Non-contactable female consumer reporting same event(s) under the same suspect product(s) for 5 patients. This is the second of five reports: A patient of unspecified age and gender 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 medical history and concomitant medications were not reported. She also stated during conversation that 5 people she knew were vaccinated and died. She did not have any other information. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER_INC-202101451919 same reporter/drug/event, different PTs; Reported Cause(s) of Death: 5 people she knew were vaccinated and died.


VAERS ID: 1831103 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101451924

Write-up: 5 people she knew were vaccinated and died; This is a spontaneous report received from Pfizer sponsored program from a non-contactable consumer. This consumer reported same event for 5 patients. This is the 3rd of 5 reports. A patient of unspecified age and gender received BNT162B2 (COMIRNATY), via unspecified route of administration on an unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The consumer stated during conversation that 5 people she knew were vaccinated and died. She did not have any other information. The patient died on an unspecified date. It was unknown if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER_INC-202101451919 same reporter/drug/event, different PTs; Reported Cause(s) of Death: 5 people she knew were vaccinated and died


VAERS ID: 1831104 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101451925

Write-up: 5 people she knew were vaccinated and died; This is a spontaneous report received from Pfizer sponsored program. A Non-contactable consumer reporting same event under the same suspect product for 5 patients. This is 4 of 5 reports. A patient of unspecified age and gender received bnt162b2 (COMIRNATY) on an unspecified date as single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. Reporter stated that she had J & J vaccine in March. She wanted to start over with the Pfizer Covid vaccines but her Provider was saying she could only have Pfizer Covid Booster. Wondering if there are any clinical trials she could get in to. Also wondering if steroids affect the Pfizer Covid vaccine. She would call back the day after reporting to speak with them. She also stated during conversation that 5 people she knew were vaccinated and died. It was unknown if Autopsy Done. The outcome of the event was fatal. No follow-up attempts are needed; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER_INC-202101451919 same reporter/drug/event, different patient.; Reported Cause(s) of Death: 5 people she knew were vaccinated and died


VAERS ID: 1831105 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
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 INC202101451926

Write-up: 5 people she knew were vaccinated and died; This is a spontaneous report received from Pfizer sponsored program from a non-contactable consumer. This consumer reported same event for 5 patients. This is the 5th of 5 reports. A patient of unspecified age and gender received bnt162b2 (COMIRNATY), via an unspecified route of administration on an unspecified date as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The reporter stated during conversation that 5 people she knew were vaccinated and died. She did not have any other information. The patient died on an unspecified date. It was unknown if an autopsy was performed. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER_INC-202101451919 same reporter/drug/event, different PTs; Reported Cause(s) of Death: 5 people she knew were vaccinated and died


VAERS ID: 1831106 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Metastatic lymphoma
SMQs:, Malignant lymphomas (narrow), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101452565

Write-up: Diagnosed with metastatic lymphoma after first vaccine; This is a spontaneous report from a contactable consumer (daughter). A 60-years-old male patient (father) received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient had injection site pain in his shoulder with redness, he was tired, he had a headache, and muscle pain in his shoulder. He also was not feeling well, had swollen lymph nodes and his eye and part of his face was swollen. He went to the hospital and was admitted, and he was diagnosed with metastatic lymphoma. The patient died on 14Jul2021. 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: Diagnosed with metastatic lymphoma after first vaccine


VAERS ID: 1831721 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-06
Onset:2021-05-25
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Deep vein thrombosis, Intracardiac thrombus, Pulmonary embolism, Sudden death, Superficial vein thrombosis, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   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: Remicade, Amitriptyline, Hydroxyzine, Oxycodone, Duloxetine.
Current Illness: Chrohn''s Disease
Preexisting Conditions: Fibromyalgia
Allergies: None
Diagnostic Lab Data: Bilateral pulmonary thromboemboli extending deeply into both lungs. Adherent thromboli in right atrium Deep vein thromboli of superficial veins of Left Lower leg. Lead to instantaneous death on 5-25-2021.
CDC Split Type:

Write-up: Blood clot induced death.


VAERS ID: 1832044 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-15
Onset:2021-10-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FHF020 / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram abnormal, Death, Endotracheal intubation, Loss of consciousness, Mechanical ventilation, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: 2021-10-27
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found unconsious, vomiting in bed following a very normal day CT scan revealed catastrophic cerebral hemhorrage on both sides of the brain Intubated at hospital, withdrew care from ventilator the next day due to unrecoverable diagnosis Booster vaccine given 9 days prior to incident. Died 10/27/2021


VAERS ID: 1832218 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-05-10
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chills, Cough, Death, Diarrhoea, Dyspnoea, Fatigue, Headache, Loss of personal independence in daily activities, Malaise, Nausea, Paranasal sinus discomfort, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-19
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 05/10/2021 SARS-CoV-2 (COVID-19)
CDC Split Type:

Write-up: 05/10/2021 presents w/ SOB; "Roughly 10 days ago started to not feel well. Went on vacation 5/2 and states she could not do anything because of how sick she felt. Had fever, chills, fatigued, sinus pressure, congestion, headache, nauseous, overtime developed a cough, sob and diarrhea"; PMH HTN, CKD, CLL.; Pt. passed away on 05/19/2021; D/C Dx. "Acute hypoxemic respiratory failure".


VAERS ID: 1832228 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-02
Onset:2021-04-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood albumin decreased, Blood urea increased, Coma, Death, Drainage, Dyspnoea, Dyspnoea exertional, Haematocrit decreased, Haemoglobin decreased, Loss of consciousness, Mechanical ventilation, Monocyte count increased, Protein total decreased, Pulmonary oedema, Red blood cell count decreased, Tooth extraction
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 182
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: statin, thyroid, actonel, tumeric, magnesium
Current Illness: None
Preexisting Conditions: stable COPD, rarely used inhaler
Allergies: unknown
Diagnostic Lab Data: 09-24-21: low RBC, low HGB, low HCT, high monocytes, high BUN, low total protein, low albumin,
CDC Split Type:

Write-up: 04-07-21 reported fluid in L lung, SOB taking stairs, 1st ER visit 04-12-21 difficulty breathing, fluid drained twice bet. April 12 and May 14, tooth pulled at one point in between lung procedures, 06-25-21 reported that fluid drained 3 times total since onset in April, hospitalized July 19 - 26, dr. office to ER by ambulance, reported August 16 more fluid drained, hospitalized prior to Labor Day (Sept 6) O2 was 52 at a dr. office, hospitalized Sept 15 or 16 for five days, 09-27-21 reported O2 of 70 at doctor office, first day out of breath since last hospital stay, pulmonary and cardiac specialists were still conferring, patient was seeking a donation for a portable O2 unit, needing O2 more often throughout the day and night. Tried to drive to hospital again Oct 4, found unconscious on side of road, in a coma on ventilator until October 11 when family removed ventilator and she passed away.


VAERS ID: 1832259 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High BP, Gout
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s sister, called to inform us that patient received her Pfizer booster vaccine on 10/5/21. Patient did not experience any symptoms/side effects (sister) on 10/5/21; however, patient had a heart on 10/6/21 and later passed away on 10/7/21.


VAERS ID: 1832300 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-17
Onset:2021-07-30
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cardiac arrest, Death, Headache
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), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hyalgan injection to bilateral knees
Current Illness: none
Preexisting Conditions: knee pain
Allergies: none
Diagnostic Lab Data: Cardiac Arrest Protocal
CDC Split Type:

Write-up: weakness, head ache-DEATH


VAERS ID: 1832855 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-05
Onset:2021-10-13
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 UN / IM

Administered by: Senior Living       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: 2021-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: Renal Failure, Diabetes, CAD
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died after testing positive for COVID-19 8/2/2021


VAERS ID: 1833007 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-08-28
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood culture negative, Brain natriuretic peptide normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest discomfort, Chest pain, Computerised tomogram thorax normal, Cough, Death, Dyspnoea, Electrocardiogram normal, Endotracheal intubation, Hypoxia, Lung opacity, Mechanical ventilation, Mental status changes, Pain, Procalcitonin increased, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Tachycardia, Troponin normal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-23
   Days after onset: 56
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftirizine 10 mg QD, Cholecalciferol 2000 units QD,
Current Illness:
Preexisting Conditions: Lupus, RA, Sjogren''s, GERD, Fibromyalgia, IBS, Seasonal Allergies
Allergies: Penicillin''s (Hives), Ondansetron (Hives), Nuts (unspecified)
Diagnostic Lab Data: Positive COVID-19 tests on 9/24/2021 using the Biofire Torch system using PCR or equivalent Nucleic Acid Amplification (NAA)technology, and 10/8/2021 using the Hologic Panther System
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/22/2021 and 5/13/2021. On 8/28/2021 patient presented to a outside facility with complaints of worsening shortness of breath and chest tightness with patient report of positive COVID test on August 20th. On 9/1/2021 patient presented to ED with chest pain and shortness of breath. VS stable; minimally tachycardia. Physical exam overall reassuring. The pt is well appearing, nontoxic, in NAD. Lungs CTAB, no respiratory distress. Labs overall reassuring. No leukocytosis to concern for sepsis. Troponin negative. BNP normal. ECG w/o ST elevation;


VAERS ID: 1833052 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-27
Onset:2021-10-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension acute and combined systolic and diastolic heart failure history of myocardial infarction
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her booster vaccine on 10/27/2021. Was found on the floor on 10/28/2021 at the facility at that moment her heart rate was 142. Patient was transferred to the hospital and from there to Larger hospital and went into cardiac arrest and could not get her back. Patient passed away on 10/29/2021 at 11:44am. We discussed with the facility medical director and was advised to let Pharmacy know. As per medical director he doesn''t know if the cause of death was due to booster vaccine or patient medical history since cardiac arrest has been reported previously with covid vaccine. Patient had history of some cardiac disease hypertension disease, heart failure acute on combined systolic and diastolic heart failure, and history of MI.


VAERS ID: 1833084 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-10-20
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT#007M20A, # / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Acute kidney injury, Alanine aminotransferase increased, Anion gap normal, Anticoagulant therapy, Aspartate aminotransferase increased, Atrial fibrillation, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood glucose abnormal, Blood lactate dehydrogenase increased, Blood phosphorus decreased, Blood potassium increased, Blood sodium normal, Blood urea increased, Brain natriuretic peptide increased, COVID-19, Carbon dioxide decreased, Cardiac failure congestive, Chest X-ray, Chronic kidney disease, Differential white blood cell count, Eosinophil percentage decreased, Full blood count, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Hypoxia, Laboratory test, Laboratory test abnormal, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count, Monocyte percentage, Myocardial injury, Neutrophil count, Neutrophil percentage increased, Platelet count normal, Protein total decreased, Red blood cell count decreased, Red cell distribution width increased, Renal failure, SARS-CoV-2 test positive, Troponin I increased, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Hypertension, hyperlipidemia, diabetes, COPD, TIA, TBI.
Allergies: no known allergies
Diagnostic Lab Data: Lab Results: Other Chemistry: 24-Oct-21 11:50, Chemistry 14 Profile Estimated GFR 25.39 [60.00 - 130. ml/ min] Estimated Glomerular Filtration Rate 20.98 [60.00 - 130. ml/ min] Estimated GFR Value <60 ml/min/1.73 sq meters is indicative of chronic kidney disease <15 ml/min/1.73 sq meters is indicative of kidney failure The Estimated GFR is calculated by the four variable MDRD equation. Limitations of this calculation include: Decreased accuracy for values $g60 Decreased accuracy in the hospitalized/severely ill patient populations Disregard EGFR values for infants and children (should not be applied to this age group) 24-Oct-21 11:50, Troponin I Troponin I 12.67 [0.00 - 0.03 ng/mL] Telephone notification of critical result was read back and verified with: 10/24/2021 12:18:23 EDT Normal: <= 0.03 ng/mL Indeterminate: 0.04-0.29 ng/mL Suggestive of Myocardial Damage: $g= 0.30 ng/mL 24-Oct-21 12:24, Brain Natriuretic Peptide Brain Natriuretic Peptide 947 [10 - 100 pg/ml] A cutoff of 100 pg/mL has been demonstrated to provide the maximal combination of sensitivity, specificity, and negative predictive value for contributing to the diagnosis of congestive heart failure (CHF). A BNP value greater than 100 pg/mL is consistent with a diagnosis of CHF in the appropriate clinical setting. Blood concentrations of natriuretic peptides may also be elevated in patients with myocardial infarction and in patients who are candidates for or are undergoing renal dialysis. Coagulation: 24-Oct-21 12:24, PTT PTT 95 [26 - 39 sec] CBC-Differential-Morphology: 24-Oct-21 12:24, CBC White Blood Cell Count 6.5 [4.5 - 11.0 K/cmm] Red Blood Cell Count 3.78 [3.90 - 5.60 M/cmm] Hemoglobin 11.1 [12.0 - 17.3 g/dL] Hematocrit 34.0 [36.0 - 53.0 %] Mean Corpuscular Volume 90.1 [80.0 - 100.0 fl] Mean Corpuscular Hemoglobin 29.4 [26.0 - 34.0 PG] Mean Corpuscular Hemoglobin Concn 32.6 [31.0 - 37.0 %] Red Cell Distribution Width 16.3 [11.5 - 14.5 %] *Platelet Count 169 [140 - 440 K/cmm] Mean Platelet Volume 8.2 [7.4 - 10.4 FL] Automated Neutrophils % 91 [ %] Automated Lymphocytes % 7 [ %] Automated Monocytes % 2 [ %] Automated Eosinophils % 0 [ %] Automated Basophils % 0 [ %] Absolute Neutrophil Count 5.9 [1.0 - 8.0 K/cmm] Absolute Lymphocyte Count 0.5 [1.0 - 5.0 K/cmm] Absolute Monocyte Count 0.1 [0.1 - 0.8 K/cmm] Chemistry Panels & Profiles: 24-Oct-21 11:50, Chemistry 14 Profile Sodium Level, Serum 138 [136 - 144 mmol/L] Potassium Level, Serum 5.3 [3.6 - 5.1 mmol/L] Chloride Level, Serum 113 [101 - 111 mmol/L] Total Carbon Dioxide, Serum 13 [20 - 30 mmol/L] Blood Urea Nitrogen, Serum 61 [8 - 26 mg/dL] Creatinine Level, Serum 2.92 [0.61 - 1.24 mg/dL] Anion Gap 12 [8 - 16 mmol/L] Glucose, Serum 293 [70 - 99 mg/dL] The above reference range for glucose is appropriate for the fasting state. For random specimens, values up to 140 mg/dL are considered normal. Calcium Level, Serum 7.4 [8.4 - 10.2 mg/dL] Albumin Level, Serum 3.0 [3.5 - 5.0 g/dL] Phosphorus Level, Serum 4.3 [2.3 - 4.7 mg/dL] Bilirubin, Total 0.4 [0.3 - 1.0 mg/dL] Protein Total Level, Serum 5.6 [6.5 - 8.1 g/dL] Aspartate Aminotransferase (SGOT) 95 [15 - 41 U/L] Alanine Aminotransferase (SGPT) 59 [17 - 63 U/L] Alkaline Phosphatase, Serum 98 [41 - 150 U/L] Lactic Dehydrogenase (LDH), Serum 357 [125 - 220 IU/L] Chest X ray 1 view
CDC Split Type:

Write-up: 8-year-old male presents as a transfer from an outside facility for new onset atrial fibrillation, acute renal failure and COVID-19. VSS, NAD. Saturating well on 3 L nasal cannula. Previously hypoxic on room air. Received Solu-medrol 125 mg IV PTA. Creat 2.9 (prev. 1.2), trop 1.13. COVID positive. Given 5mg Metoprolol IV for HR 113. New onset afib. Rate controlled 90s. On Heparin gtt,


VAERS ID: 1833098 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-02
Onset:2021-08-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Anion gap increased, Aspartate aminotransferase increased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bicarbonate decreased, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase normal, Blood creatinine increased, Blood glucose normal, Blood lactic acid, Blood magnesium increased, Blood osmolarity normal, Blood pH decreased, Blood phosphorus increased, Blood potassium normal, Blood sodium normal, Blood urea normal, Death, Haematocrit normal, Haemoglobin decreased, Laboratory test, Malaise, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, N-terminal prohormone brain natriuretic peptide increased, PCO2 increased, PO2 increased, Platelet count normal, Protein total decreased, Red blood cell count decreased, Troponin I increased, Unresponsive to stimuli, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of substance abuse
Allergies: None
Diagnostic Lab Data: 8/5/2021: Potassium 5.0 mmol/L pH 6.78 pCO2 87 mm HG pO2 312 mmHG HCO3 13 mm/L APTT 44 seconds Glucose 170 mg/dL Sodium 144 mmol/L Potassium 4.7 mmol/L Chloride 102 mmol?L Anion Gap 26 Osmolality calculated 294 mOsm/kg BUN 19 mg/dL Cr 1.30 mg/dL Calcium 8.6 mg/dL Total protein 6.1 g/dL Albumin 3.9 g/dL Total bilirubin 0.3 mg/dL AST 2167 units/L ALT 2250 units/L Alkaline phosphatase 92 units/L Magnesium 2.9 mg/dL Phosphorous 12.7 mg/dL Troponin I 0.383 ng/ml CPK 114 unit/L NT-proBNP 510.0 pg/mL lactic acid 16.5 mmol/L WBC count 8.3 x 10(3)/mcL RBC count 4.67 x 10(6)/mcL Hemoglobin 13.1 g/dL Hematocrit 45.4 percent MCV 97.2 fL MCH 28.1 pg MCHC 28.9 g/dL Platelet count 234 x 10(3)/mcl *Multiple other laboratory values available since he was hospitalized for 4 days - will be cumbersome to manually write them all in here. I am able to provide them at a later date if necessary.
CDC Split Type:

Write-up: According to his mother, Pt received his second dose of the Moderna COVID-19 vaccine on August 2, 2021. Two days later, on August 4, 2021, he complained of not feeling well. He could not provide specific symptoms, but said that it involved his entire body and was not like anything he had ever experienced before. The following day, on August 5, 2021 he was found unresponsive on a train. He was subsequently hospitalized and pronounced deceased on 08/09/2021.


VAERS ID: 1833104 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-08-22
   Days after vaccination:138
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Bradycardia, COVID-19 pneumonia, Cardiac arrest, Cardio-respiratory arrest, Death, Endotracheal intubation, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   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: pt admitted to hosp and diagnosed with bilateral COVID pneumonia with respiratory failure; treated with remdesivir and Plavix; 15 L O2 on heated high flow; pt coded and was intubated; bradycardic then asystolte; pt pronounced dead in the hospital; acute on chronic hypoxia and respiratory failure due to COVID


VAERS ID: 1833119 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-01
Onset:2021-09-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Death, Fatigue, Hypoaesthesia oral, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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: Metformin 500mg started 9/1/21 Gabapenton 300mg started 9/1/21 Valsartan 80mg started 9/1/21
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: He had the shot on 9/1/21 after his dr recommended he get it following his appointment. He complained of arm pain and some lip numbness the same night. He was more tired than usual for the first couple of weeks and complained once of a slight chest discomfort. On 9/20/21, he went to work, got off and went for a walk/ jog and 10 minutes later called me to say he had pressure/pain in his chest. He died a few minutes later.


VAERS ID: 1833143 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-09-04
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, Dyspnoea, General physical health deterioration, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 6 days prior to hosp admission, pt diagnosed positive for COVID in the ED; left AMA to home; admitted to hosp with increase in weakness and SOB; O2 sats in the 70s; placed on NRB and NC; treated with remdesivir and dexamethasone; PMH renal transplant, HTN, monoclonal gammopathy; DNI/DNR; optiflow therapy for hypoxia; condition worsened; pt transferred to palliative care; pt''s condition continued to decline and she expired in the hosp


VAERS ID: 1833171 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-10-06
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Death, Dyspnoea, End stage renal disease, Endotracheal intubation, Malaise, Nausea, Respiratory failure, SARS-CoV-2 test positive, Urinary tract infection, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-15
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with c/o increasing SOB, malaise, N/V, O2 sats in 30s; placed on 60 L high flow NC; O2 sats in 70s, pt was intubated; diagnosed positive for COVID 19 and UTI; pt eventually extubated and placed on 35 L high flow NC with O2 sats @ 97%; began to wean off of O2 but later condition worsened and required intubation; pt''s condition worsened and family wished to withdraw care; pt died in the hosp; respiratory failure due to COVID pneumonia as well as PE related to CHF and end-stage renal disease


VAERS ID: 1833197 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-14
Onset:2021-09-02
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Atrial fibrillation, COVID-19, Chronic kidney disease, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Nausea, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   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 diagnosed positive for COVID on 8/25; received monoclonal antibody infusion on 8/30; presented to ED on 9/2 with increasing SOB, cough, weakness, N/D, poor appetite; found to have A Fib with RVR; hypoxic respiratory failure due to COVID 19; PMH of liver/pancreatic lesions; pt does not want chemotherapy treatment; started on dexamethasone and remdisivir, 2-3 L O2 via NC; AKI on CKD; pt elects to forego liver bx; comfort care measures were instituted and pt died in the hospital


VAERS ID: 1833236 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-07-26
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cerebral infarction, Chills, Death, Dyspnoea, Hyperglycaemia, Hypoxia, Magnetic resonance imaging head abnormal, Mental status changes, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-08
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt comes to ED and states he was diagnosed positive for COVID 2 days ago; presents to ED with increasing SOB, fever, chills, hypoxic, placed on 3 L O2 via NC; COVID test is positive; pt is hyperglycemic; received insulin, steroids, antibiotics, remdisivir, thromboembolic prophylaxis; eventually switched to BiPAP; mental status worsened; MRI of brain shows widespread, extensive acute infarctions; his condition worsened and he eventually passed away in the hospital


VAERS ID: 1833377 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-08-29
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, Death, Dyspnoea, Positive airway pressure therapy, 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 (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 17
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: pt admitted to hosp after being tested in assisted living for COVID - test was positive; c/o increasing SOB and generalized weakness; placed on O2 therapy, dexamethasone and remdisivir; dc''d remdisivir due to AKI; placed on BiPAP for a period of time, but was able to go back to HFNC; pt not responding well to therapy; palliative care discussed; pt placed on comfort care measures; she passed away in the hospital


VAERS ID: 1833444 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-02
Onset:2021-09-18
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chemotherapy, Cough, Death, Lung cancer metastatic, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-21
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt with metastatic lung CA found after evaluation of a dry cough; pt tool 1 round of chemotherapy and declined any more treatments; asked for hospice care; while in hospice pt expired on 9/21; COVID test performed on 9/21 and reported on 9/23/21, the test was positive for COVID 19


VAERS ID: 1833526 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-02
Onset:2021-09-14
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cardiogenic shock, Cyanosis, Death, Dyspnoea, Endotracheal intubation, Hypotension, Positive airway pressure therapy, SARS-CoV-2 test positive, Septic shock
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt arrived to hosp via EMS; EMS called due to increasing SOB; O2 sats 60s; placed on CPAP; cyanotic and no improvement; pt gave consent to be intubated in the field; pt was positive for COVID 1 wk before arriving at the hosp, completed remdesivir and steroids; PMH: chronic respiratory failure, on 10-12 L O2 via NC and astral device at home; in ED pt was severely hypotensive with septic/cardiogenic shock; pt was made a DNR; he arrested in the ED and died


VAERS ID: 1833633 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-05-21
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Arthralgia, COVID-19, Death, Fall, Mental status changes, Respiratory failure, SARS-CoV-2 test positive, Surgery
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), Dementia (broad), 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), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   Days after onset: 33
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/21/2020 SARS-CoV-2 (COVID-19) detected by PCR; 05/21/2021 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: Pt. presents to facility 05/21/2021 with R hip pain after mechanical fall; underwent surgery and on 06/03/2021 transfered to alternative facility; on 06/22 returns to original facility from secondary with altered mental status. On 06/23/21 pt. passed away due to Acute hypoxic, hypercarbic respiratory failure.


VAERS ID: 1833657 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-20
Onset:2021-04-27
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Cast application, Fall, Gait disturbance, Humerus fracture, Hyperhidrosis, Mental status changes, Upper limb fracture
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 185
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: multiple with each visit
CDC Split Type:

Write-up: 4/27/21 visit to clinic: 74yr old female who has had off balance and leaning way to right and stumbling. This lasted short time. By time sister got to view she was sitting in a chair. Some of these symptoms began 2 days before this visit and have been completely resolved since that time. Patient has tried No medications. 7/9/21 clinic 75yr old female presents for referral to ortho for fracture of elbow and possible wrist. Had fallen 6 days ago. Was seen in ER and pout in posterior cast and told to see ortho when back here. recommends for her to be seen by Specialist. She may need a total elbow replacement. 9/12/21 ED Closed displaced fracture of medial epicondyle of right humerus, unspecified fracture morphology, initial encounter Acute 9/17/21 admit to nursing home H/O: CVA (cerebrovascular accident) Dementia without behavioral disturbance, unspecified dementia type (HCC) Cognitive safety issue Plan: She will be admitted to nursing home on Tuesday, 9/21/2021. We have asked her that the physical therapy would evaluate her for the best cane possible 10/29/21 Patient presents to ED via EMS from nursing home for diaphoresis, altered mental status. She was ''found like this'' by nursing just prior to arrival to ED. Patient has prior history of CVA, recovered. Staff believed she may be having ''another stroke''.


VAERS ID: 1833664 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-29
Onset:2021-05-25
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Decreased appetite, Fatigue, Mobility decreased, SARS-CoV-2 test positive
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (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: 2021-05-27
   Days after onset: 2
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: 05/25/2021 SARS-CoV-2 (COVID-19) by NAA detected
CDC Split Type:

Write-up: 05/25/21 in EC pt. presents with progressive weakness and decreased appetite. Per H&P: "This is a 88y.o. female who lives with son presenting with difficulty getting out of bed. She was walking her dog 3 weeks ago and now states she cannot get out of bed. She is denying associated symptoms she states she was vaccinated for COVID-19. No other sick contacts or recent travel. She has been warned by physicians she needs to increase PO intake. She saw her PCP about 3-4 weeks ago and was given lexapro to start. Pt did have improvement in mood last week, then felt fatigue again."


VAERS ID: 1834252 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-26
Onset:2021-10-23
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, Osteomyelitis, Pleural effusion, Renal graft infection, SARS-CoV-2 test positive, Sepsis, Staphylococcal infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (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), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Hypersensitivity (broad), 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: 2021-10-25
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen PRN, amlodipine, baby aspirin, baclofen, clopidogrel, cyclosporine modified, Novolog pen, Lantus pen, levetiracetam, linezolid, magnesium oxide, metoprolol succinate ER, metronidazole, mycophenolate EC, pantoprazole, PNV plus
Current Illness:
Preexisting Conditions: type 2 diabetes, HFpEF, pulmonary hypertension, CKD status post renal transplant 2011 on immunosuppressive medications, history of CVA, OSA, sensorineural hearing loss, blindness in the right eye
Allergies: Zosyn
Diagnostic Lab Data: COVID status positive on 10/23/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/6/21 and 3/26/21. On 10/23/21, patient admitted for acute hypoxemic respiratory failure due to COVID-19 pneumonia with bilateral pleural effusions. During admission, patient also developed MRSA LLE osteomyelitis and sepsis, AKI, pyelonephritis in transplanted kidney. Patient expired on 10/25/21.


VAERS ID: 1835273 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211100532

Write-up: BRAIN BLEED; This spontaneous report received from a consumer via social media via a company representative concerned a 46 year old female of unspecified race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) 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, patient experienced headache immediately after the vaccination. Patient went to the doctor but doctor was not able to help her. Then patient went to the emergency room (ER) where patient died due to brain bleed (date unspecified). It was unspecified if an autopsy was performed. On an unspecified date, the patient died from brain bleed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211100532-covid-19 vaccine ad26.cov2.s-brain bleed.. 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: BRAIN BLEED


VAERS ID: 1835602 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       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: 2021-10-18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Multiple myeloma (a type of blood cancer that can limit the body''s ability to fight infection); Parkinson''s disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101408205

Write-up: he was fully vaccinated, he got his 2nd dose in February; a high profile figure, died of the covid-19 virus; This is a spontaneous report from contactable consumers. An 84-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as dose 1, single and via an unspecified route of administration on Feb2021 (Batch/Lot number was not reported) as dose 2, single for covid-19 immunisation. Medical history included multiple myeloma - a type of blood cancer that can limit the body''s ability to fight infection and Parkinson''s disease. The patient''s concomitant medications were not reported. The patient who was a high-profile figure, died of the covid-19 virus. He had received the vaccine. From what the reporter had heard, he may have been battling cancer and so was autoimmune compromised. The patient received his second dose of the Pfizer-BioNTech vaccine in February, said his longtime aide. He had been scheduled for a booster last week but before he received it, she said (as reported). The patient died Monday as a result of complications from COVID-19, his family said. He was fully vaccinated against the virus but had been treated over the past few years for multiple myeloma - a type of blood cancer that can limit the body''s ability to fight infection, according to his longtime aide. The patient died on 18Oct2021 due to drug ineffective and suspected COVID-19. 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: he was fully vaccinated, he got his 2nd dose in February; (Name), a high profile figure, died of the covid-19 virus


VAERS ID: 1836114 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Septic shock
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 (narrow), 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), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension; Lymphoma; Obstructive sleep apnea syndrome; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211060043

Write-up: ACUTE KIDNEY INJURY; SEPTIC SHOCK; This spontaneous report was received from literature: This report concerned a 64 year old male. The objective of this study was to describe fatal and non-fatal possible AEs after COVID-19 vaccine administration. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: hypertension, type 2 diabetes mellitus, lymphoma, and obstructive sleep apnea. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 1 total dose, start therapy date were not reported for prophylactic vaccination. The batch numbers were not reported and have been requested. No concomitant medications were reported. On an unspecified date, the patient experienced acute kidney injury, and septic shock. On an unspecified date, the patient died from septic shock, and acute kidney injury. It was unspecified if an autopsy was performed. The action taken with COVID-19 vaccine AD26.CoV2. was not applicable. The authors concluded that Although reported AEs are not necessarily caused by the vaccination, this study provides further information about possible AEs after COVID-19 immunization, especially those requiring hospital admission. This study also supports prior data that serious AEs post vaccination are much lower than primary COVID-19 infections. Further studies are needed to investigate causalities between vaccines and reported AEs across all age groups. This report was serious (Death). This case, from Same Literature article is linked to 20211045466 and 20211048130.; Sender''s Comments: V0- 20211060043? covid-19 vaccine ad26.cov2.s- Acute kidney injury, Septic shock. 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 KIDNEY INJURY


VAERS ID: 1836116 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-10-09
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chest pain, Death, Headache, Hyperhidrosis, Limb discomfort, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 12
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: USJNJFOC20211061610

Write-up: BACK WAS HURTING ON THE RIGHT SIDE; DEATH; CHEST PAIN; SWEATING; ARM TIGHTNESS (LEFT SIDE); HEADACHE; THROWING UP; This spontaneous report received from a consumer concerned a 53 year old male of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, expiry: Unknown, batch number: Unknown) dose was not reported, 1 total, administered at left arm on 24-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 09-OCT-2021, the patient experienced headache, chest pain, arm tightness (left side), sweating, throwing up. Patients back was hurting on the right side. On 21-OCT-2021, the patient died from unknown cause. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of headache, chest pain, arm tightness (left side), sweating, throwing up and back was hurting on the right side was not reported. This report was serious (Death).; Sender''s Comments: V0- 20211061610-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: 1836360 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-12
Onset:2021-10-10
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SHORTNESS OF BREATH with hypoxia, D satting into the 80s when she sleeps at night, now at about the 11th day of illness with COVID-19.Diagnosed with covid on 10/10, presented to outside hospital on 10/12, after having been sick for about 9 days.


VAERS ID: 1836506 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-04
Onset:2021-10-31
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Confusional state, Cough, Delirium, Dyspnoea, Mental status changes, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, Diabetes, metastatic prostate cancer
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested + for COVID via home kit on 10/17. Scheduled for monoclonal antibody but condition worsened. Present to medical center on 10/21 with worsening dyspnea, cough, and fever. Started on dexamethasone and remdesivir. O2 requirements increased and started on baricitinib. Hx DVT on warfarin with D-dimer 0.42 and low risk for DVT. Bridged to enoxaparin. Increased confusion and mental status changes during hospitalization consistent with delirium. Not tolerating po meds secondary to cough and high aspiration risk. Maxed out on Vapatherm with O2 saturations in the 80''s. Family decided to transition to comfort care with DNR.


VAERS ID: 1836638 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-11
Onset:2021-10-25
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Anticoagulant therapy, Asthenia, COVID-19, Cardio-respiratory arrest, Death, Decreased appetite, Dyspnoea, Fatigue, Hypervolaemia, Polyuria, Productive cough, Resuscitation, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin cholecalciferol corlanor ezetimibe farxiga furosemide glipizide jantoven magnesium oxide metformin metoprolol succinate XL multivitamin nitroglycerin pantoprazole semaglutide hepatitis B (Engerix-B)
Current Illness: N/A
Preexisting Conditions: ? CHF (congestive heart failure) ? Coronary artery disease STENTS X 3 ? Hypertension ? Old myocardial infarction History of ST elevation myocardial infarction (STEMI) ? Personal history of other diseases of the circulatory system History of coronary artery disease ? Personal history of other diseases of the circulatory system History of hypertension ? Personal history of other endocrine, nutritional and metabolic disease History of type 2 diabetes mellitus ? Type 2 diabetes mellitus with diabetic chronic kidney disease CKD stage 3 secondary to diabetes
Allergies: statins - rash banana - diarrhea
Diagnostic Lab Data: COVID PCR confirmed positive on 10/25/21
CDC Split Type:

Write-up: a 63 y.o. male has history of HFrEF due to ICM, mod-severe MR, CKD II-III, DMII, MI X2 with PCI and LV thrombus on warfarin. He is currently listed for heart transplant. Patient complaints of loss of appetite, generalized weakness, mild productive cough, and mild dyspnea since Saturday. He denies fever, chills, sore throat, nausea, vomiting, abdominal pain, diarrhea, loss of taste or smell. Patient denies any recent weight gain or weight loss. He initially went to Emergency Room where he was tested positive for COVID 19. He was given Tylenol then was transferred for higher level care. Unknown contact information for provider who cared for the patient. Review of Systems Constitutional: Positive for appetite change and fatigue. Respiratory: Positive for cough and shortness of breath. Pt remained on warfarin, was started on remdesivir and steriods. Pt was diuresed for fluid overload and developed AKI, lasix were held. Pt had worsening oxygen requirements overnight and was re-started on diuresis. Pt coded and underwent about 1 hour of CPR and was pronounced at 11:28 am.


VAERS ID: 1836656 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-26
Onset:2021-10-25
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Amyotrophic lateral sclerosis, Anxiety, Aspiration, Asthenia, Breath sounds abnormal, COVID-19, COVID-19 pneumonia, Cachexia, Condition aggravated, Cough, Death, Disease progression, Dyspnoea, Gastrostomy, General physical condition abnormal, Joint contracture, Motor neurone disease, Muscle spasticity, Peroneal nerve palsy, Positive airway pressure therapy, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Dystonia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (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: 2021-10-27
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin (Lipitor) baclofen (Lioresal) Benzalkonium Chloride 0.1 % liquid clonazePAM (KlonoPIN) dimethicone 1 % cream FLUoxetine (PROzac) guaiFENesin (Mucinex) halobetasol (UltraVATE) 0.05 % cream hydrocortisone 0.5 % cream iprat
Current Illness: N/A
Preexisting Conditions: Past Medical History: ALS/MND Anxiety/depression Dysphagia HLD
Allergies: NKDA
Diagnostic Lab Data: COVID PCR confirmed positive on 10/25/21
CDC Split Type:

Write-up: Patient 59 y.o. male who presents the ED today from Hospital for further evaluation of aspiration shortness of breath. Patient has ALS, states that he feels like he is getting worse slowly, is not having difficulty swallowing, states that he wants to focus on his comfort, and go inpatient hospice route. Patient is currently DNR and has a power-of-attorney currently, who is at bedside with him today. Patient denies any symptoms of fever, endorses coughing episodes and severe anxiety, but no other symptoms at this time. Of note, contact information for provider who cared for the patient at the outside facility not available in our electronic health record. On exam, he is ill appearing, cahectic, in mild respiratory distress, on nasal canula, following commands, has good air entry bilaterally with bilateral rhonchi, normal S1S2, soft abdomen, PEG tube in place, has bilateral feet drop and hands contractures and weakness/spasticity. 1- COVID-19 pneumonia in settings of progressive ALS disease: patient was not hypoxic though he is on some oxygen for comfort. No indication for dexamethasone or remdesivir. He was well determined that he would like to pursue comfort care and not undergo any invasive intervention or active treatment of his disease. We will keep im comfortable, morphine PRN, scopolamine patch, Ativan PRN, and Robinul PRN. We will use CPAP at night as may help to make him more comfortable (recommended by pulmonary as outpatient but did not start using it yet) Presented with shortness of breath in the setting of ALS/MND and concern for aspiration. He was found to have COVID-19 pneumonia but opted for comfort measures. He was provided comfort medications. He passed away prior to transitioning to a nursing facility to pursue hospice care.


VAERS ID: 1836663 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-09-16
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Blood glucose increased, COVID-19, COVID-19 pneumonia, Cardiac arrest, Death, Dyspnoea, Endotracheal intubation, Myocardial infarction, Oxygen saturation decreased, Positive airway pressure therapy, Resuscitation, SARS-CoV-2 test positive, Tracheostomy, Type 2 diabetes mellitus
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), 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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
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: pt told to come to ED due to blood sugars over 500; when got to ED his O2 sats where 59% on RA; increasing SOB; positive for COVID; placed on BiPAP; eventually required intubation and tracheostomy; O2 status continued to worsen and his sats went down; he went into cardiac arrest twice; CPR was done; family decided to stop CPR and pt expired in the hospital; Acute hypoxic respiratory failure secondary to COVID pneumonia; acute renal failure; DMT2; MI.


VAERS ID: 1836674 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-22
Onset:2021-10-27
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute cardiac event, Chest pain, Death, Dyspnoea, Endotracheal intubation, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure med for minor blood pressure issue...not known exactly which medication at this time
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I do not have this information as this time but would be happy to provide this information on request. The issue I am describing began at about 5PM on 27 October and was over (my father was dead) by 7AM on 28 October.
CDC Split Type:

Write-up: My father went to the emergency room at local HCF early on 28 October after suffering from severe chest pain and difficulty breathing. He was completely awake and lucid. After a few hours in the emergency room, they were unable to resolve the issue and lungs were filling with fluid. My father was intubated and shortly had 2 cardiac events. He was dead by 7AM on 28 october. The reason I am reporting this is because there is no way a completely healthy Human being becomes completely dead in the space of a few hours. It is my opinion that something triggered the mRNA instructions and the hospital was unable to stop the spike protein from taking over my father''s system. I am not a doctor, but I have read a lot about Covid and the so called vaccine, and it is my belief that the lack of a ''shut off'' valve related to the mRNA instructions caused the process to overload my father''s system and a cytokine storm that the emergency room was unable to stop. The doctor did not come out and say this, but he implied that he had not seen anything like this and was unsure why it occurred.


VAERS ID: 1836681 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-25
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hypoxia, Multiple organ dysfunction syndrome, Positive airway pressure therapy, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), 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), 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: 2021-10-03
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
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 to ED for increasing SOB over several days; was seen a dr''s office for SOB and hypoxemia and told to come to ED; c/o cough; O2 sats in 70s on RA; started on 6 L O2 via NC; eventually transitioned to BiPAP due to worsening oxygenation; COVID test positive; placed on steroids, antibiotics, remdisivir, baricitinib; eventually required intubation and went into septic shock; condition deteriorated and pt expired in the hosp; acute hypoxic respiratory failure with multiorgan failure secondary to COVID


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