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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

This is page 89 out of 227

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VAERS ID: 1873551 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-13
Onset:2021-11-12
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312840 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain lower, Blood urine present, Cardio-respiratory arrest, General physical condition abnormal, Pain, Pelvic pain, Resuscitation, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   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: Atorvastatin Calcium Tablet 40 MG, Azilect Tablet 1 MG, buPROPion HBr ER Tablet Extended Release 300 mg, Cholecalciferol Tablet 25 MCG, Esomeprazole Magnesium Tablet Delayed Release 20 MG, Furosemide Tablet 20 MG, Linzess Capsule 290 MCG, M
Current Illness: Patient was a 67 yo who admitted to nursing home on 8/4/2021. He was being treated for Parkinson''s Disease, Reiter''s syndrome, and incarcerated inguinal hernia. He had an indwelling foley catheter d/t urinary retention d/t BPH.
Preexisting Conditions: Multiple myeloma in remission, hyperlipidemia, diverticulitis, GERD, depression, anxiety, irritable bowel syndrome
Allergies: No Known Allergies
Diagnostic Lab Data: None- the vital signs ceased prior to transfer to ER
CDC Split Type:

Write-up: He experienced a change of condition on 11/12/21 with frank bleeding in catheter bag, pain in LLQ and worsening tremor. He reported feeling achy all over and pain in left pelvic area. The resident had a telehealth visit in the nursing home with the PA. His blood pressure was 153/99. He pending transfer to ER when his vital signs ceased and he was unable to be resuscitated with CPR.


VAERS ID: 1873570 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-29
Onset:2021-11-11
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Resuscitation, Sudden 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: 2021-11-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Full autopsy pending
CDC Split Type:

Write-up: Sudden death due to heart event while at the beach at 7:00 am in the morning. CPR performed for an hour. Heart could not be restarted as my husband had the event in the water.


VAERS ID: 1873588 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2020-12-31
Onset:2021-11-03
   Days after vaccination:307
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 011J20A / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 025J20-2A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Altered state of consciousness, Bronchitis chronic, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Dyspnoea, Emphysema, General physical condition abnormal, Hypoxia, Lung infiltration, Patient uncooperative, Pneumonia aspiration, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 2
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: Coronavirus 19 dated 11/02/2021: Detected.
CDC Split Type:

Write-up: PT ADMITTED ON: 11/03/2021: The patient is admitted to the Palliative care service. HISTORY OF PRESENT ILLNESS: Patient is an 86-year-old man who had a change in level of consciousness and became dyspneic and hypoxic at the nursing home today. He is a resident at Nursing Home. He was sent to the emergency room where he has been found to certainly be hypoxic and has evidence of pneumonia on chest x-ray with a positive COVID test. The patient himself is unable to give the history. REVIEW OF SYSTEMS: The patient is unable to complete review of systems. PAST MEDICAL HISTORY: Patient is unable to cooperate. SOCIAL HISTORY: His sister has arrived today. Additional information for Item 18: (con''t): EXPIRED DATE: 11/05/2021: The patient expired on 11/05/2021. ADMISSION DIAGNOSIS: COVID-19 virus infection. FINAL DIAGNOSES: 1. Pneumonia due to COVID-19 virus. 2. Chronic obstructive bronchitis with pulmonary emphysema. 3. Aspiration pneumonia. 4. Encounter for palliative care. HISTORY OF PRESENT ILLNESS: Patient is an 86-year-old man who presented to the hospital from a local nursing home with dyspnea. He was evaluated in the emergency room where he was found to have right-sided pneumonia or right-sided infiltrate on chest x-ray. He had a positive COVID test. He had changes of emphysema on his chest x-ray. His sister arrived in the emergency room and made it clear that she wants the care focused on his comfort. He looked very ill in the emergency room the night that I arrived and I just did not think it was fair to put the sisters through all the hospice procedures to get the patient admitted. I thought his death was imminent. HOSPITAL COURSE: The patient was admitted. He received IV morphine usually about once per shift for shortness of breath. He expired on the morning of 11/05/2021. The first morning after admission he actually was clinically improved and was able to say just a few words and on the morning of 11/05, he said just a few words. He expired that morning. Cause of death was COVID-19 pneumonia. His sister was counseled following this. No autopsy was desired.


VAERS ID: 1873615 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-08-27
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Death, Encephalopathy, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hosp with severe COVID pneumonia, AHRF; on high flow O2; DNR; placed on comfort care; encephalopathy and her condition continued to worsen; no response to verbal or tactile stimuli for 2 days prior to her death in the hospital


VAERS ID: 1873627 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-20
Onset:2021-03-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Cardio-respiratory arrest, Condition aggravated, Death, Hypertensive heart disease
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), Hypertension (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: Unknown
Current Illness: unknown
Preexisting Conditions: hypertensive heart disease (known)
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 73 year-old female patient. The patient received two doses of the Pfizer Vaccine: First: 2/27/2021 Second: 03/20/2021 The patient was found dead at home on 3/27/2021 (7 days post second dose). The immediate cause of death listed on the death certificate is ?cardiopulmonary arrest? (few minutes) secondary to ?arrhythmia? (few minutes) and ?hypertensive heart disease? (few years). I do not have any additional information about other underlying conditions that may have contributed to this person?s death.


VAERS ID: 1873689 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-07
Onset:2021-04-19
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Coronary artery disease, Death
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Coronary Artery Disease, Hypertension, COPD
Preexisting Conditions: Coronary Artery Disease, Hypertension, COPD
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 65 year-old male patient. The patient received two doses of the Pfizer Vaccine: First: 3/17/2021 Second: 4/07/2021 The patient was found dead at home on 4/19/2021 (12 days post second dose). The immediate cause of death listed on the death certificate is ?coronary artery disease.? Other significant conditions contributing to death but not resulting in underlying cause are listed as ?hypertension COPD?. I do not have any additional information about other underlying conditions that may have contributed to this person?s death.


VAERS ID: 1873694 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-09-05
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, General physical health deterioration, Positive airway pressure therapy, Productive cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to hosp with increasing dyspnea and productive cough x 2 wks; positive for COVID; placed on BiPAP, transitioned to Vapotherm 40 L @ 80%; immunocompromised due to being on Neulasta for prostate CA; started on remdesivir, Decadron; pt''s condition worsened; per death certificate, pt expired in the hospital


VAERS ID: 1873734 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-15
Onset:2021-10-17
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received second dose on 04/15 and was hospitalized on 10/17.


VAERS ID: 1873747 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-26
Onset:2021-10-29
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-02
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of pneumonia, Stage 3a chronic kidney disease, emphysema, GERD, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received her booster on 08/26, and was hospitalized on 10/29 for hypoxia, COVID-19 and sepsis.


VAERS ID: 1873779 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-04-20
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood loss anaemia, COVID-19, Condition aggravated, Death, Gastrointestinal haemorrhage, Haematemesis, Hepatic cirrhosis, SARS-CoV-2 test positive
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: limited medical records received on this pt; pt admitted to the hospital with coffee-ground emesis and vomiting bright red blood; positive for COVID; PMH: cirrhosis and esophageal varices; per death certificate pt died of GI bleed, COVID, blood loss anemia and cirrhosis


VAERS ID: 1873812 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-16
Onset:2021-11-15
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cerebrovascular disease, HTN, DM2, CKD3
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid death


VAERS ID: 1873830 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-09-19
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   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: limited medical records received on this pt; pt in ED for cough and SOB; COVID pneumonia; DNR status; per medical records and death certificate, pt died in the hospital of COVID


VAERS ID: 1873836 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-18
Onset:2021-11-05
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Decreased appetite, Fatigue, Haemoptysis, Hypoxia, Malaise, Myalgia, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: 2021-11-11
   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: aspirin, budesonide-formoterol, ipratropium-albuteroL, levothy
Current Illness:
Preexisting Conditions: Significant underlying comorbidities including non-small-cell lung cancer, emphysema, OSA on CPAP, home oxygen need at
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A 71 y.o. male with a past medical history significant for oxygen dependent COPD, CHF, bronchiectasis, NSCLC, prostate cancer, hypothyroidism, TBI, and seizure disorder who presents to with worsening cough and known Covid infection. Mr. stated that he didn''t feel well on 10/31 and was tested for Covid the following day, returning positive. On 11/2, he felt worse with myalgias, fatigue, poor appetite, and weakness. He was started on Dexamethasone for both the Covid infection +/- COPD exacerbation. Unfortunately, his cough has worsened over the last two days. He has appreciated episodes of hemoptysis. No fever, chills, or sweats. He doesn''t


VAERS ID: 1874137 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-11-10
Onset:2021-11-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pyrexia, Restlessness, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-11-14
   Days after onset: 7304
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra 180 mg tab PO QD; Glucerna 1.5 120ml PO TID; Atenolol 50 mg 1 tab PO QD; Hydrochlorothiazide 25mg tab 1 tab PO QD;
Current Illness:
Preexisting Conditions: Type 2 Diabetes Mellitus, Iron-deficiency anemia, Pain, Left arm, Generalized weakness, unsteadiness on feet, abnormal gait, feeding difficulty, peripheral vascular disease, Hypertention, Pre-retinal hemorrhage right eye, Macular Drusen bilateral eyes, hyperlipidemia, hearing loss, Vitamin B12 deficiency, onychomycosis, s/p cataract extraction 2006, arthroscopic right knee surgery 2000, hx of tonsillectomy, history of falls.
Allergies: Bactrim, ACE Inhibitors (cough)
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: First dose of Moderna given 1/7/2021. Second dose given 2/4/2021. Booster dose given 11/10/2021. No adverse reaction noted immeadiately after vaccination. Restlessness noted 11/12/2021. Resident with low grade fever, tachycardia and tachypnea on 11/13/2021. Resident expired on 11/14/2021. Weakness, poor PO intake and weight loss noted since October 2021. Resident was enrolled in hospice care on 11/1/2021.


VAERS ID: 1874377 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-09
Onset:2021-11-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Brain oedema, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Hemiplegia, Laboratory test
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   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: Eliquis, Diltiazem Hydrochloride, Metoprolol, Potassium, Tamsulosin, Furosemide (Lasix), Atorvastatin
Current Illness:
Preexisting Conditions: A-Fib, Newly diagnosed CHF
Allergies:
Diagnostic Lab Data: All tests and labs are in patient''s medical records- which we are unable to obtain until we have a death certificate.
CDC Split Type:

Write-up: Patient received his COVID "booster" shot on 11/09/2021 on the advice of his cardiologist who diagnosed him with new onset CHF. Two days later, on 11/11/2021, patient suffered a stroke caused by a clot in his brain. Patient was taken by ambulance to Hospital. In the Emergency Room, a number of tests- including a CT scan and angiogram were performed. At this point, patient was experiencing complete left side paralysis but was able to speak and to understand speech. One day later- on 11/12/2021 patient''s brain began to swell. He was put on comfort care because his family and medical team did not think that patient''s heart and body would be able to withstand the surgery. Patient passed away on 11/13/2021- just 4 days after his last COVID shot.


VAERS ID: 1874394 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-19
Onset:2021-03-09
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: see below
Preexisting Conditions: AFIB dementia urinary catheter
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death (Found dead in bed on 03-09-2021 by staff).


VAERS ID: 1875748 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-17
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: USJNJFOC20211122133

Write-up: DEATH; This spontaneous report received from a health care professional concerned multiple patients of an unspecified age, sex, race and ethnic origin. No past medical history or concurrent conditions were reported. The patients'' received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration, batch number and expiry were not reported) dose, start therapy date were not reported, 01 total administered, for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch numbers. No concomitant medications were reported. It was reported that the patients from died of unknown cause of death after taking the johnson and johnson, moderna and pfizer vaccine jabs. It was unspecified if an autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211122133 -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: 1875756 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211131451

Write-up: A VERY RARE REACTION; This spontaneous report received from a consumer via a company representative concerned 5 patients of unspecified sex, race and ethnicity. The patient''s height, and weight were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 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. The reporter stated that "5 people died from a very rare reaction to the vaccine out of millions vaccinated". It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211131451- COVID-19 VACCINE AD26.COV2.S- A very rare reaction. 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: RARE REACTION


VAERS ID: 1875842 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 948548 / UNK - / OT

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: USMODERNATX, INC.MOD20213

Write-up: Death; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 948548) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: This case concerns a patient, with no details on age, gender, or medical history, who experienced the unexpected fatal event of death. The date of death was not reported, neither vaccination date. The event occurred after receiving an unknown dose number of mRNA-1273 Moderna vaccine. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Sender''s Comments: This case concerns a patient, with no details on age, gender, or medical history, who experienced the unexpected fatal event of death. The date of death was not reported, neither vaccination date. The event occurred after receiving an unknown dose number of mRNA-1273 Moderna vaccine. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. The benefit-risk relationship of mRNA-1273 Moderna vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1876073 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-12
Onset:2021-11-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211D21A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Death, Hyperhidrosis, Hypoxia, Influenza A virus test negative, Influenza B virus test, Respiratory arrest, Respiratory distress, Respiratory syncytial virus test negative, Resuscitation, SARS-CoV-2 test negative, Tachycardia, Troponin I increased, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), 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 (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Obesity
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data: Troponin I: 0.20 (H) Cepheid GeneXpert PCR: (post-mortem) SARS-Co-V-2: negative Influenza A: negative Influenza B: negative RSV: negative
CDC Split Type:

Write-up: Report made to agency 11/16/2021 @ 17:45: Severe respiratory distress, profuse diaphoresis, hypoxia, tachycardia 11/16/2021 @ 18:06: Respiratory arrest 11/16/2021 @ 18:10: Ventricular fibrillation, cardiac arrest. Unsuccessful resuscitation. Time of death 18:52 on 11/16/2021


VAERS ID: 1876559 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-26
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Death, Dyspnoea, Fall, Metastatic renal cell carcinoma
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presented to ED after a fall @ home; c/o generalized weakness, SOB x 1wk; dyspneic; recent metastatic renal cell carcinoma; treated with O2 supplementation, antibiotics, steroids, vitamin supplements; pt''s condition declined in spite of therapy; comfort care measures; pt died in the hospital


VAERS ID: 1876560 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-26
Onset:2021-09-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Endotracheal intubation, Intensive care, Mechanical ventilation, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   Days after onset: 51
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 48 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Amldipine
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever began 6 days following vaccine and progressed to shortness of breath by day 10. Tested positive for COVID on day 11, admitted to ICU on day 12, intubated and placed on ventilator on day 15, and died on day 57.


VAERS ID: 1876584 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-08-02
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Unknown       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: 2021-08-08
   Days after onset: 6
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: limited medical records received on this pt; pt presents to hospital being positive for COVID; HX of A Fib, CAD, CKD stage III, HTN; pt actively dying in the hospital; comfort care measures; family agrees to reduce O2 by mask; pt died in the hospital


VAERS ID: 1876598 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-10-20
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diclofenac (VOLTAREN) 75 MG EC tablet DULoxetine (CYMBALTA) 30 MG capsule DULoxetine (CYMBALTA) 60 MG capsule levothyroxine (SYNTHROID) 100 MCG tablet nitrofurantoin, macrocrystal-monohydrate, (MACROBID) 100 MG capsule oxyCODONE-acetam
Current Illness: Rotator cuff tear
Preexisting Conditions: Musculoskeletal and Integument Osteoarthritis of right knee, unspecified osteoarthritis type Medial meniscus tear Primary osteoarthritis of right knee Primary osteoarthritis of knee Chondromalacia, patella Greater trochanteric bursitis of left hip Genitourinary Uterovaginal prolapse, incomplete Other Fibromyalgia Impingement syndrome of right shoulder Encounter for gynecological examination Health care maintenance
Allergies: Penicillin V PenicillinsRash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1876609 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-09-18
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 2.5 MG tablet aspirin 81 MG chewable tablet Cholecalciferol (VITAMIN D) 1000 units tablet lisinopril (PRINIVIL) 40 MG tablet Omega-3 Fatty Acids (FISH OIL) 1000 MG capsule simvastatin (ZOCOR) 40 MG tablet spironol
Current Illness: "Brain Bleed"
Preexisting Conditions: Cardiovascular and Mediastinum HTN (hypertension) Atrial fibrillation CAD in native artery Respiratory OSA on CPAP Digestive Gastric polyp Other History of right thalamic and right occipital stroke Pure hypercholesterolemia Routine general medical examination at a health care facility
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brain bleed resulting in death


VAERS ID: 1876615 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-08-06
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8727 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, Hypoxia, SARS-CoV-2 test positive
SMQs:, Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-15
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: limited medical information received on patient; pt to ED with a positive COVID test and hypoxic; hx of renal transplant on systemic immunosuppression; COVID pneumonia; required intubation; pt''s condition worsened and he died in the hospital


VAERS ID: 1876630 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-10-13
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-11-17
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: Condition aggravated, Death, Intestinal perforation
SMQs:, Gastrointestinal perforation (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline (ELAVIL) 50 MG tablet apixaban (ELIQUIS) 5 MG tablet (Expired) atorvastatin (LIPITOR) 80 MG tablet AURYXIA 1 GM 210 MG(Fe) tablet busPIRone (BUSPAR) 30 MG tablet (Expired) carvedilol (COREG) 12.5 MG tablet cetirizine (ZY
Current Illness: perforated viscus
Preexisting Conditions: Cardiovascular and Mediastinum HTN, goal below 130/80 Severe peripheral arterial disease (CMS/HCC) Arterial insufficiency (CMS/HCC) Demand ischemia (CMS/HCC) PSVT (paroxysmal supraventricular tachycardia) (CMS/HCC) NSVT (nonsustained ventricular tachycardia) (CMS/HCC) Hypotension Peripheral vascular disease (CMS/HCC) Hypertensive urgency Acute deep vein thrombosis (DVT) of axillary vein of right upper extremity (CMS/HCC) SVC syndrome Superior vena cava compression syndrome Hypertension, uncontrolled Hypertensive emergency Cardiopulmonary arrest (CMS/HCC) Digestive GERD (gastroesophageal reflux disease) Diabetic gastroparesis (CMS/HCC) Chronic diarrhea Perforated abdominal viscus Endocrine Diabetes mellitus type 2 in obese (CMS/HCC) Type I diabetes mellitus with complication (CMS/HCC) Diabetes (CMS/HCC) Hypoglycemia Diabetic foot ulcer associated with type 1 diabetes mellitus (CMS/HCC) Hyperglycemia due to type 1 diabetes mellitus (CMS/HCC) Nervous and Auditory Seizure disorder (CMS/HCC) Musculoskeletal and Integument Eschar of finger Abrasion of both knees Genitourinary ESRD (end stage renal disease) on dialysis (CMS/HCC) ESRD needing dialysis (CMS/HCC) End stage renal disease on dialysis (CMS/HCC) Anxiety and Depression Depression Other Infection Dry gangrene (CMS/HCC) Hyperkalemia Abdominal pain History of left MCA stroke s/p TPA and thrombectomy 8/2018 Status post placement of implantable loop recorder Elevated brain natriuretic peptide (BNP) level Anemia of chronic disease Aphasia Hand pain, left Sleep disorder Volume overload and uremia due to missed dialysis Blood blister Allergic reaction Elevated troponin Severe allergic reaction Facial swelling ASCUS with positive high risk HPV cervical Sepsis (CMS/HCC)
Allergies: AdhesiveHives, Itching Banana LatexItching
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed r/t perforated viscus


VAERS ID: 1876660 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-09-21
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Craniocerebral injury, Death
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: latanoprost (XALATAN) 0.005 % ophthalmic solution simvastatin (ZOCOR) 10 MG tablet triamcinolone (KENALOG) 0.1 % cream Vitamin D, Cholecalciferol, 400 units CAPS
Current Illness: none
Preexisting Conditions: Cardiovascular and Mediastinum Hypertension Hypertension, benign essential, goal below 140/90 Other Hyperlipidemia Glaucoma Hyperglycemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt deceased r/t closed head injury


VAERS ID: 1876675 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-20
Onset:2021-09-18
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (ACCUNEB) 1.25 MG/3ML nebulizer solution albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin EC 325 MG tablet carvedilol (COREG) 12.5 MG tablet carvedilol (COREG) 25 MG tablet carvedilol (COREG) 25 MG tablet clo
Current Illness: Chronic gout Tinea corpus T2DM
Preexisting Conditions: Cardiovascular and Mediastinum HTN (hypertension) White coat hypertension Benign essential hypertension Endocrine DM type 2, goal A1C 7-8 Nervous and Auditory Impacted cerumen Anxiety and Depression Anxiety Other S/P cervical spinal fusion Insomnia Hyperlipidemia, mixed Vitamin D deficiency disease Arthrodesis status Dyspnea Gout Mycosis Neck pain
Allergies: Hydroxyzine Valsartan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unsure of reason for death


VAERS ID: 1876697 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-09
Onset:2021-11-16
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chronic obstructive pulmonary disease, Condition aggravated, Death, Failure to thrive
SMQs:, Neonatal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   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:
Current Illness:
Preexisting Conditions: COPD, HF, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid vaccine #1 given 2/9/2021 Moderna, lot # n/a patient died in the hospital from COPD, failure to thrive, not a covid infection


VAERS ID: 1876715 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-24
Onset:2021-11-16
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW01741 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine dose #1 given 4/3/2021 Lot # EW0151 Pfizer Patient had a cardiac arrest at home at died in the ED. Not a covid related death.


VAERS ID: 1876720 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-09-11
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Hypoxia, Positive airway pressure therapy
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 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 hospital for hypoxia; dx with COVID pneumonia; Vapotherm and BiPAP; in spite of aggressive measures, pt continued to be hypoxic; DNR/DNI; comfort care was instituted and pt died in the hospital


VAERS ID: 1876748 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-05
Onset:2021-10-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet, aspirin 81 MG EC tablet, atorvastatin (LIPITOR) 40 MG tablet, Cholecalciferol (VITAMIN D3) 125 MCG (5000 UT) TABS, ciclopirox (PENLAC) 8 % solution, clopidogrel (PLAVIX) 75 MG tablet, cyclobenzaprine (
Current Illness: None
Preexisting Conditions: Cardiovascular and Mediastinum CAD (coronary artery disease) Peripheral vascular disease with claudication Digestive Chronic idiopathic constipation Musculoskeletal and Integument Rectus diastasis Other S/P PTCA (percutaneous transluminal coronary angioplasty)-2008 x3 Dyslipidemia, goal LDL below 70 Vitamin D insufficiency Chronic bilateral low back pain without sciatica Leukocytosis Eosinophilia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt death. Unsure of cause of death


VAERS ID: 1876756 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-17
Onset:2021-08-04
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 - / -

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

Life Threatening? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt in hospice; respiratory failure due to COVID 19; PMH breast CA, HTN, DM, leukemia, dementia; DNR/DNI; on BiPAP; pt continued to decline; family wanted to take pt home; comfort care measures; pt died @ home shortly after arriving


VAERS ID: 1876761 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-05-22
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   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: allopurinol (ZYLOPRIM) 100 MG tablet aspirin EC 81 MG EC tablet atorvastatin (LIPITOR) 80 MG tablet benazepril (LOTENSIN) 5 MG tablet Bimatoprost 0.01 % SOLN brinzolamide (AZOPT) 1 % ophthalmic suspension budesonide-formoterol (SYMBIC
Current Illness: none
Preexisting Conditions: Cardiovascular and Mediastinum Chronic atrial fibrillation Essential hypertension Chronic systolic heart failure Coronary artery disease involving native coronary artery of native heart without angina pectoris Respiratory Sleep apnea Digestive Intestinal malabsorption, unspecified GI bleed Radiation proctitis Musculoskeletal and Integument Osteoarthritis of left hip Genitourinary Chronic renal failure, stage 4 (severe) Prostate cancer Other Essential familial hypercholesterolemia History of colon cancer Status post left hip replacement Anemia, iron deficiency Symptomatic anemia Anemia due to chronic blood loss S/P right colectomy
Allergies: Nitroglycerin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient deceased. Unsure of cause of death


VAERS ID: 1876764 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-01
Onset:2021-03-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrial flutter, Cardiac failure congestive, Death, Seizure
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 240
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coumadin
Current Illness: None
Preexisting Conditions: Aortic Valve Replacement (Age 31 of Implant)
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Congestive Heart Failure Shortly After Booster 3/20 Seizure 10/20/21 AtrialFlutters 10/26/21 Died 10/28/21


VAERS ID: 1876775 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F214 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), 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), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg qd Amlodipine 5 mg qd Vit D3 Sodium Bicarbonate 650 mg 2 tabs bid Metoprolol 25 mg qd Simvastatin 20 mg qd
Current Illness: None
Preexisting Conditions: DJD of bilateral knees Obesity Bicuspid valve replaced in 2015 with bovine graft HTN under control with diet
Allergies: NKA
Diagnostic Lab Data: No labs or further evaluation completed after EMT?s initial assessment.
CDC Split Type:

Write-up: Immediate loss of consciousness/death at 3 pm on 11/16. No symptoms leading up to event. Husband of patient witnessed the event and said it was immediate. Patient was laying down when event occurred. Asystolic when checked by EMTs 10 minutes after. Declared dead.


VAERS ID: 1876785 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-20
Onset:2021-11-01
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Blood urea increased, Cardio-respiratory arrest, Cardiomegaly, Chest X-ray abnormal, Cough, Death, Endotracheal intubation, Fatigue, Glomerular filtration rate decreased, Haemodialysis, Haemoglobin decreased, Hypervolaemia, Lung opacity, Resuscitation, SARS-CoV-2 test negative, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Non
Current Illness: CKD; hypokalemia; hypothyroidism; UTI; erythropoietin deficiency anemia;
Preexisting Conditions: Cardiovascular and Mediastinum Hypertension Acute on chronic diastolic CHF (congestive heart failure) Coronary artery disease Carotid artery stenosis Benign essential HTN Arrhythmia Acute on chronic diastolic congestive heart failure Vagal autonomic bradycardia Diastolic congestive heart failure Stricture of artery Cardiopulmonary arrest with successful resuscitation Respiratory Chronic obstructive pulmonary disease Sleep apnea OSA on CPAP HCAP (healthcare-associated pneumonia) Acute hypoxemic respiratory failure Sepsis due to pneumonia Acute on chronic respiratory failure with hypoxia Pneumonia of right lower lobe due to infectious organism Digestive GERD (gastroesophageal reflux disease) GI bleed Chronic diarrhea Esophagitis due to ASA of 2020 Adenoma of ascending colon of 2019 Endocrine Diabetes Hypothyroid Diabetes mellitus Type 2 diabetes mellitus, uncontrolled Hyperprolactinemia Type II or unspecified type diabetes mellitus without mention of complication, uncontrolled Hypothyroidism Hypothyroidism (acquired) Diabetic polyneuropathy associated with type 2 diabetes mellitus Type 2 diabetes mellitus with stage 4 chronic kidney disease Type 2 diabetes, HbA1c goal < 7% Nervous and Auditory Acute metabolic encephalopathy Musculoskeletal and Integument Alopecia Genitourinary BPH (benign prostatic hyperplasia) End-stage renal disease Renal cell carcinoma of right kidney of 2017 Acute on chronic renal failure ATN (acute tubular necrosis) Contrast dye induced nephropathy Acute kidney failure, unspecified Erythropoietin deficiency anemia Stage 5 chronic kidney disease Malignant neoplasm of kidney Chronic kidney disease, stage IV (severe) Other Hyperlipemia Hypercholesterolemia Carotid bruit Family history of colonic polyps Hx of colonic polyps Diarrhea Hypomagnesemia Acute blood loss anemia Lactic acidosis Perinephric hematoma Severe anemia Hypovolemic shock Leukemoid reaction Hematoma, right perihepatic and right perinephric hematoma Syncope and collapse Stroke-like symptoms Anemia requiring transfusions Cancer related pain Iron deficiency anemia due to chronic blood loss Acute on chronic blood loss anemia Anemia in chronic kidney disease Edema Hypocalcemia Proteinuria Vitamin D deficiency Enlarged prostate
Allergies: Hydromorphone
Diagnostic Lab Data:
CDC Split Type:

Write-up: HOSPITAL COURSE: The patient was a 77 yr/o-year-old male with a history of CKD, COPD and OSA who presented to hospital 10/20/21 with cough, fatigue, and overall decline. Labs showed WBC 11.3; Hg 7.1; BUN/Cr 71/5.03, eGFR 11; COVID negative. Chest xray showed cardiomegaly and multifocal airspace disease bilaterally. He was treated for volume overload and was initiated on hemodialysis. His hospital course was further complicated by acute cardiopulmonary arrest requiring ACLS with ROSC after 6 minutes. He was intubated as part of post-arrest care. He was extubated 10/28/21 but failed to improve. His family ultimately opted for comfort-focused care. He was transferred to the Inpatient Care Center for continued care. Upon admission to the Hospital the pt had a PPS of 10% and prognosis judged to be limited to hours to days. Parenteral medications including fentanyl were ordered for comfort. The interdisciplinary team provided ongoing pt and family support. The pt continued to decline and died on 11/1/21 @ 12:33.


VAERS ID: 1876807 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-18
Onset:2021-10-03
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 210918079 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspiration pleural cavity, Blood lactic acid increased, Confusional state, Death, Endotracheal intubation, General physical health deterioration, Haemoglobin, Hypotension, Intensive care, Pleural effusion, Positive airway pressure therapy, Respiratory failure, Shock haemorrhagic, Transfusion, Upper gastrointestinal haemorrhage
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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 (narrow), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: furosemide (LASIX) 40 MG tablet Lactobacillus TABS (Expired) pantoprazole (PROTONIX) 40 MG tablet sertraline (ZOLOFT) 100 MG tablet spironolactone (ALDACTONE) 100 MG tablet
Current Illness: GI hemorrhage; anemia; dyspnea
Preexisting Conditions: Cardiovascular and Mediastinum Esophageal varices (CMS/HCC) Respiratory Pleural effusion on right Digestive Cirrhosis of liver with ascites (CMS/HCC) Alcoholic cirrhosis of liver with ascites (CMS/HCC) GI bleed Hematopoietic and Hemostatic Coagulopathy (CMS/HCC) Anxiety and Depression Major depressive disorder, recurrent episode, moderate (CMS/HCC) OCD (obsessive compulsive disorder) Other Hyponatremia Alcohol abuse Edema of both lower extremities Anemia Elevated TSH Enlargement, spleen History of hypertension Sepsis, suspected due to intradbominal source/SBP Elevated bilirubin Acute anemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 54M presented with respiratory failure secondary to pleural effusion. The patient was admitted to medsurg and started on diuretics. Plans were made for us guided thoracentesis and likely paracentesis, as well. The patient decompensated, requiring emergent thoracentesis. He was placed on bipap at that time and started on zosyn. When I arrived to hospital day after admission, stat response was called to patient''s room and he was rapidly transported to the ICU for intubation and to be started on vasopressors as he had become confused and hypotensive. It was not clear why. In the ICU, he was intubated and started on vasopressors. Central line was placed. He was transfused two units, but lactic started climbing and his hgb did not improve appropriately. Massive transfusion protocol was initiated. Patient''s family was contacted by intensivist, and ultimately they decided to withdraw life sustaining treatment. The patient expired on 10/3 @ 1650 due to hemorrhagic shock secondary to upper GI bleeding in the context of chronic decompensated cirrhosis of the liver.


VAERS ID: 1876808 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-08
Onset:2021-07-20
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Chest discomfort, Death, Dyspnoea, Hyperhidrosis, Intensive care, Nausea, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (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), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: 2021-08-10
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to ED with chest tightness, SOB, nausea, diaphoresis; scheduled for heart catherization; positive for COVID; placed on BiPAP; transported to ICU; pt''s condition worsened and she experienced cardiac arrest and died in the hosp


VAERS ID: 1876814 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-10-14
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Angioplasty, Anticoagulant therapy, Arteriosclerosis, Atelectasis, Bladder catheterisation, Cardio-respiratory arrest, Computerised tomogram abdomen, Computerised tomogram abdomen abnormal, Coronary artery disease, Death, Echocardiogram abnormal, Fall, General physical health deterioration, Iliac artery occlusion, Intensive care, Left ventricular hypertrophy, Mass, Pain in extremity, Peripheral artery bypass, Peripheral artery occlusion, Peripheral artery stenosis, Peripheral coldness, Peripheral endarterectomy, Right ventricular ejection fraction decreased, Skin discolouration, Ultrasound kidney abnormal, Urinary retention
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Accidents and injuries (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin EC 81 MG EC tablet Calcium Carbonate-Vitamin D (CALCIUM + D) 600-200 MG-UNIT TABS carvedilol (COREG) 12.5 MG tablet docusate sodium (COLACE) 100 MG capsule furosemide (LASIX) 40 MG tablet insulin aspart (NOVOLOG) 100 UNIT/ML in
Current Illness:
Preexisting Conditions: Cardiovascular and Mediastinum Arterial occlusion Critical lower limb ischemia Cardiac arrest Endocrine Diabetes mellitus Nervous and Auditory Hereditary spastic paraplegia Musculoskeletal and Integument Humeral head fracture Genitourinary Kidney disease, chronic, stage III (GFR 30-59 ml/min) Hyperlipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospital Course: Patient with significant past medical history of diabetes 83 spastic paraplegia neuropathy hypertension CAD presented to Hospital with severe worsening pain of the right foot. Patient apparently 3 weeks back due to her neuropathy and spastic paraplegia tripped and fell. She normally uses a walker which got caught in a rug and she fell down. She had some difficulty getting up but otherwise did not feel bad for a few days about a week back she started having some pain in the right foot then she noticed some coldness and discoloration of the right foot last 2 days she has been having unbearable pain in the right foot. She presented to the ER where CT angiogram of the abdomen showed 1. Occlusion of the right external iliac artery just distal to the inferior hypogastric origin with reconstitution at the level of the knee. There is distal occlusion of the right posterior tibial artery as well. 2. High-grade atherosclerotic stenosis of the proximal left femoral artery with segmental distal femoral artery occlusion associated with reconstitution of the distal popliteal artery above-the-knee. There is also diminished three-vessel runoff involving primarily posterior tibial artery. 3. 4.5 cm region of consolidation at the left lung base, potentially pneumonia, rounded atelectasis or a peripheral mass, not fully imaged. When clinically feasible a standard CT scan of the chest would be of benefit. Patient is now admitted to the hospital for further treatment with IV heparin and vascular surgery has already evaluated patient and plans for surgery today. We will start patient on IV Rocephin for possible pneumonia. Patient was started on IV heparin. 2D echo was done which showed left ventricular hypertrophy dilated right ventricle ejection fraction 34%. On 10/12/2021 she underwent right iliofemoral endarterectomy right profunda femoral endarterectomy and patch angioplasty right lower extremity angiogram with runoff right femoral renal to below-knee popliteal arterial bypass with graft. Patient was treated with IV Rocephin and Zithromax for possible pneumonia. Patient had urinary retention and bump in the creatinine nephrology for the patient and a Foley catheter was placed she received bolus of normal saline and renal ultrasound was done. Patient''s condition got worse. Patient coded and was transferred over to ICU on 10/14/2021. Patient was made DNR. Patient had multiple codes and expired around 16 00.


VAERS ID: 1876829 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-04-16
Onset:2021-08-25
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO0164 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Back pain, Chemotherapy, Clostridium difficile colitis, Condition aggravated, Constipation, Fatigue, Feeling abnormal, Malaise
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   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: albuterol HFA 108 (90 Base) MCG/ACT inhaler allopurinol (ZYLOPRIM) 300 MG tablet baclofen (LIORESAL) 10 MG tablet Calcium Carb-Cholecalciferol (CALCIUM-VITAMIN D) 600-400 MG-UNIT TABS Lactobacillus (FLORANEX) lidocaine (LIDODERM) 5 %
Current Illness:
Preexisting Conditions: Respiratory COPD (chronic obstructive pulmonary disease) with emphysema (CMS/HCC) Cancer of upper lobe of left lung (CMS/HCC) Small cell lung cancer, stage IV(CMS/HCC) Digestive Liver metastasis (CMS/HCC) C. difficile colitis Musculoskeletal and Integument DDD (degenerative disc disease), lumbar Primary osteoarthritis of both hips Closed fracture of sixth thoracic vertebra (CMS/HCC) Closed fracture of fourth lumbar vertebra (CMS/HCC) Metastasis to bone (CMS/HCC) Closed T6 spinal fracture (CMS/HCC) Other Cigarette smoker History of adenomatous polyp of colon History of skin cancer Daily consumption of alcohol Gout Followed by palliative care service Tobacco abuse Alcohol dependence (CMS/HCC) Dehydration Nausea
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 68 yr/o male with a history of small cell lung cancer with bone and liver mets, seizure disorder, COPD, who presents to the emergency department complaining of abdominal pain, bloating, acute on chronic back pain, constipation. Wife at bedside supplements most of the history. Patient is a poor historian. He is in palliative care being followed by Dr and on palliative chemo. They deny fever or vomiting. Indicates his last bowel movement was on Saturday, continue treatment for C. difficile. He indicates generalized fatigue and feeling of unwellness. In triage he was noted to "which she was dead ". He has not here for SI denies SI now. He mearly indicates that he is miserable in his state of health. Symptoms started Saturday and have been constant. Symptoms are worsened by nothing and made better by nothing. Pt denies tobacco, alcohol or drug use.


VAERS ID: 1876848 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-12
Onset:2021-11-04
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bradyarrhythmia, COVID-19, Death, Endotracheal intubation, Fall, Haemofiltration, Hyperkalaemia, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Angioedema (broad), Accidents and injuries (narrow), Bradyarrhythmia terms, nonspecific (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN) 650 MG SR tablet atorvastatin (LIPITOR) 20 MG tablet carvedilol (COREG) 25 MG tablet Cholecalciferol (VITAMIN D3) 2000 UNIT CAPS citalopram (CELEXA) 20 MG tablet clopidogrel (PLAVIX) 75 MG
Current Illness: none known
Preexisting Conditions: 05/22/19 Abnormal CT scan 05/22/19 Preoperative cardiovascular examination 2019 Paroxysmal atrial fibrillation (HCC) 04/05/2016 Aortic stenosis 4/5/2016 Bilateral carotid bruits 6/2010 Prophylactic antibiotic Date Unknown Arthritis Date Unknown Asthma 1/20/2010, 7/13/2010 Breast cancer (HCC) Date Unknown Bruxism (teeth grinding) Date Unknown Cardiomegaly Date Unknown Chronic kidney disease Date Unknown COPD (chronic obstructive pulmonary disease) (HCC) Date Unknown Depression Date Unknown Diverticulosis Date Unknown Emphysema Date Unknown GERD (gastroesophageal reflux disease) Date Unknown Heart disease Date Unknown Heart murmur Date Unknown HTN (hypertension) Date Unknown Hyperlipidemia Date Unknown Hypothyroid Date Unknown Sleep apnea Date Unknown Syncope
Allergies: no know allergies
Diagnostic Lab Data: test positive for covid-19 at Healthcare on 11/4/21
CDC Split Type:

Write-up: patient presented to emergency department on 11/4/21 after falling patient tested positive for covid-19 after testing in the emergency room on 11/4/21 patient was admitted to hospital and received treatment for symptoms associated with covid-19 infection. treatment included dexamethasone, oxygen patient required intubation on 11/7/21 and was put on a covid-19 unit patient expired on 11/12/21 due to continuous renal replacement therapy hyperkalemia and bradyarrhythmia


VAERS ID: 1876896 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-13
Onset:2021-11-05
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN PO) Blood Glucose Monitoring Suppl (FREESTYLE LITE) DEVICE FREESTYLE LITE test strip HYDROcodone-acetaminophen (NORCO) 5-325 MG per tablet hydrOXYzine (ATARAX) 25 MG tablet levothyroxine (SY
Current Illness: Malignant melanoma of scalp
Preexisting Conditions: Cardiovascular and Mediastinum Hypertension complicating diabetes Essential hypertension PVC''s (premature ventricular contractions) Digestive Adenomatous colon polyp Endocrine Hyperlipidemia associated with type 2 diabetes mellitus Controlled type 2 diabetes mellitus with complication, without long-term current use of insulin Hypothyroidism Musculoskeletal and Integument Primary osteoarthritis involving multiple joints Genitourinary Benign non-nodular prostatic hyperplasia with lower urinary tract symptoms Other Cataract Statin intolerance Macular degeneration Mixed hyperlipidemia Diverticulosis of large intestine without hemorrhage S/p total knee replacement, bilateral Parotid mass Sinus tachycardia Undifferentiated pleomorphic sarcoma Atypical fibroxanthoma Elevated PSA Malignant melanoma Encounter for antineoplastic immunotherapy Encounter to discuss x-ray results Hyponatremia Intracranial hemorrhage
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 83 yo M with large L thalamic IPH with intraventricular extension; family made it clear they would not want intubation, CSF diversion, or artifical feeding. Patient was transitioned to Hospice scattered bed on 11/1 -he was treated with prn IV morphine, Ativan, and Robinul -continue prn IV Ativan and Robinul - he passed away at 08:39 on 11/5. Cause of death was left thalamic IPH


VAERS ID: 1876897 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-07
Onset:2021-10-25
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, COVID-19, Cough, Electrocardiogram, Exposure to SARS-CoV-2, Fatigue, Full blood count, Hunger, Hypoxia, Inappropriate schedule of product administration, Intensive care, Metabolic function test, Nausea, Pain, Rhinorrhoea, SARS-CoV-2 test positive, Scan with contrast normal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-11
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hemorrhoids hearing loss myopia OU w/astigmatism + presbyopia vaginal candidiasis obesity osteoarthritis of knee hyperthyroidism hypertension, benign uncontrolled type 2 diabetes w/polyneuropathy chronic lymphocytic leukemia
Allergies: lisinopril - unknown hydrocodone - unknown penicillin - unknown
Diagnostic Lab Data: 10/28/2021: CBC, general chemistry panel, CT angiogram w/IV contrast, electrocardiogram
CDC Split Type:

Write-up: Pt is a 75 year old female with pmedhx significant for CLL, uncontrolled DM2, HTN, hyperthyroidism, OA, hearing loss, and arthritis. Pt presented to the ER after 3 days of fatigue, non productive cough and runny nose. Pt states she had been cleaning the house and believed she had allergies from dust but then continued to feel fatigued and developed body aches. She admits to hunger as well as nausea, denies vomiting, diarrhea, change in sense of taste or smell. SQ PCR COVID + from 10/25 when she first developed symptoms. Hypoxic in ER on arrival SpO2 of 83%, initially required 5L, able to titrate down to 3L NC. Pt states her sister who is the caretaker to her husband and cooks and cleans for them was contact to sister''s son who is COVID + and did not tell pt and her husband until she had been there for a day or two after exposure. Pt believes she contracted COVID from her sister. Pt states her husband is in ER bay next door also with COVID. WBC noted to be 109,000 in ER, appears to be chronic. Discussed with oncology, pt has never required tx, no intervention needed at this time. CTA negative for PE. Pt admitted to RCU with COVID related hypoxia


VAERS ID: 1876991 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-11-17
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Coronary artery bypass, Coronary artery disease, Dyspnoea exertional, Electrocardiogram abnormal, Positron emission tomogram abnormal, Road traffic accident
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   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: Outpatient Medications albuterol HFA 108 (90 Base) MCG/ACT inhaler atorvastatin (LIPITOR) 40 MG tablet blood glucometer system carBAMazepine (TEGRETOL XR) 100 MG 12 hr tablet DULoxetine (CYMBALTA) 60 MG capsule gabapentin (NEURONTIN)
Current Illness:
Preexisting Conditions: Cardiovascular and Mediastinum Hypertension Coronary artery disease involving native coronary artery of native heart without angina pectoris Coronary artery disease involving native coronary artery of native heart with angina pectoris CAD in native artery PAF (paroxysmal atrial fibrillation) Respiratory Acute respiratory failure Endocrine Type 2 diabetes mellitus with complication, without long-term current use of insulin Secondary diabetes mellitus without complications Musculoskeletal and Integument Patellofemoral arthritis Genitourinary Pyelonephritis Renal insufficiency Other Renal colic Chest pain Abnormal stress test Dyslipidemia Morbid obesity with BMI of 40.0-44.9, adult Hernia of abdominal wall Abnormal nuclear stress test
Allergies: MorphineAnaphylaxis Vitamin CNausea And Vomiting Citric Acid-potassium Citrate [Potassium Citrate]Nausea And Vomiting Orange Juice [Orange Oil] Pcn [Penicillins]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 61 yr/o female who presents today for cardiac evaluation for chest pain, abnormal EKG and prior history of coronary artery disease. Conference for discussion of abnormal PET scan imaging and recommendationsShe has chest pain and shortness of breath on exertion cardiac cath on 6/29/2016 showed the left main 30 to 40% stenosis distally LAD 40 to 60% segmental stenosis and normal LV function at that time. 61 yo woman previously evaluated in office for CAD, who was involved in a MVA. She was seen and cleared by NS to have CABG. She has not been in a neck brace since initial visit. Patient denies any issues or changes since last visit.


VAERS ID: 1877057 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-08-13
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO LOT # AVAILA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, COVID-19, Death, Dyspnoea, Hypoxia, Positive airway pressure therapy, SARS-CoV-2 test positive, Sepsis
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), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 19
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt diagnosed positive for COVID 19 on 8/13/21; to ED on 8/15 with increasing SOB; hypoxic with O2 sats 70%; on BiPAP; Hx of lung CA, currently not taking chemotherapy or radiation; treated with dexamethasone, tocilizumab, remdesivir, therapeutic anticoagulation; DNR; TPN; became septic with increasing weakness; made comfort care; inpatient hospice; pt died in hospice


VAERS ID: 1877085 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-07
Onset:2021-07-15
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Abscess drainage, Adenocarcinoma metastatic, Anticoagulant therapy, Atrial fibrillation, Atrial natriuretic peptide normal, Bacterial infection, Biopsy liver abnormal, Biopsy lung abnormal, Blood potassium increased, Blood sodium decreased, Blood test abnormal, Bronchoscopy, Cardiac arrest, Catheter placement, Chemotherapy, Chest X-ray abnormal, Chest tube insertion, Computerised tomogram thorax abnormal, Death, Device leakage, Diarrhoea, Drain placement, Dyspnoea, Electrocardiogram normal, Fatigue, Gastrointestinal tube insertion, Haemoglobin normal, Ileus, Immunochemotherapy, Incomplete course of vaccination, Intensive care, Laboratory test, Lung adenocarcinoma stage IV, Magnetic resonance imaging, Metastases to bone, Metastases to liver, Metastases to lymph nodes, Pericardial drainage, Pericardial effusion, Platelet count decreased, Pleural effusion, Pneumonia, Positron emission tomogram, Pulmonary mass, Pulmonary oedema, Scan with contrast, Total lung capacity decreased, Ultrasound Doppler normal, Ultrasound scan, Vaccine associated enhanced disease, White blood cell count decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Interstitial lung disease (broad), Systemic lupus erythematosus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-16
   Days after onset: 93
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: Lipitor Amlodipine
Current Illness: None
Preexisting Conditions: High Blood Pressure, High Cholesterol However, we were completely unaware of an underlying severe health condition: Inoperable, Stage 4 Adenocarcinoma that had metastasized to his liver, lymph nodes, bones, blood. The Moderna Shot triggered the cancer to become aggressive resulting in rapid atrial fibrillation and subsequent pleural effusion. After two rounds of chemotherapy (the second round included immunotherapy) and a mismanagement of meds, patient died of cardiac arrest during a routine NG tube insertion procedure one Saturday, October 16, 2021.
Allergies: None
Diagnostic Lab Data: Wednesday, July 7, 2021 First dose of Moderna COVID-19 vaccination Saturday, August 4, 2021 Scheduled for second dose of Moderna but did not have bc of shortness of breath and fatigue Visited Urgent Care - Took Xray - lungs were pure white, sent to ER Visited ER - took CTScan - lungs were pure white - mass in upper left lobe suspected Sent home with 10 days of antibiotics - said he has pneumonia even though he had no phelgm, or cough Over 10 days, symptoms worsened Saturday, August 14, 2021 Admitted for rapid atrial fibrillation Tuesday, August 17, 2021 Surgery to drain fluid from pericardial sac Put in drain and port into sac Bronchial scope for biopsy Friday. August 20, 2021 Bleomycin put in pericardial sac to prevent fluid from building up again Drained left lung - removed 2 liters of fluid Drained right lung and put in pigtail drain - removed at least 1 liter of fluid "Pathology came back confirming Adenocarcinoma Lung - metastatic to liver suspected Testing of Pericardial fluid showed no malignancy" Monday, August 23, 2021 Liver biopsy Tuesday, August 24, 2021 Removed pigtail drain and installed Plurex catheter Thursday, August 26, 2021 Discharged Request for medical records fax by staff and handed hard copy to person in admitting Sunday, August 29, 2021 10:00 AM Visited ER - catheter leaking blood and fluid Xray showed catheter was in proper place Dressing changed - sent home at noon 11:45 PM ER - catheter leaking blood and fluid more heavily We denied Xray because it was not productive to give him so much radiation They concluded the catheter was leaking around the tubing due to the blood thinner Dressing changed to a zeroscape? And a tegaderm placed over the gauze. Sent home at 3:30am Monday, August 30, 2021 New dressing is proving to be effective - no evidence of additional bleeding Dr. confirmed results of pathology show suspected Adenocarcinoma travelled from the primary location of the lung to the liver via lymph nodes Tuesday, August 31, 2021 9:00 AM Visiting Nurse scheduled - drained catheter (<150ml), changed dressing, other 12:00 PM Follow up with Dr. - Breathing test - determined 50% lung capacity - signed disability parking permit app. Wednesday, September 1, 2021 Dr. - 11:45 AM - EKG - determined heart is strong. Still in Afib. Thursday, September 2, 2021 "Consultation visit - noon Need additional testing -PTScan, MRI w/ contrast, Labwork" Friday, September 3, 2021 10:00 AM Visiting Nurse - Drained lung catheter and changed dressing 3:00 PM PET Scan - Saturday, September 4, 2021 11:15 AM Labwork 12:30 PM MRI with Contrast Tuesday, September 7, 2021 RN - 10:00 AM - BP: 120/70, Thursday, September 9 Follow Up visit - 12:20 PM Monday, September 13, 2021 Chemo Treatment - No. 1 Wednesday, September 15, 2021 Follow up with Dr. - 9:30 AM Follow Up with Dr. 4:00 PM - did EKG/Sono - no Blood Clots Friday, September 17, 2021 Radiation - Sono on legs - no blood clots Saturday, September 18, 2021 Went to ER - Rapid Afib 186 - Left lung filling with fluid Admitted Monday, September 20, 2026 Medicine updated to stop Digoxin and start Amiodarone Installed a left lung plurex catheter Tuesday, September 21, 2021 Discharged Thursday, September 23, 2021 Dr. called and indicated they saw gram-negative rods in the blood. Highly recommended we bring back to hospital to give him IV antibiotics. Admitted Monday, September 27, 2021 Dr. said they think there may not have been and infection and sent us home with oral antibiotics. Discharged around 8:00 PM Wednesday, September 29, 2021 RN visited and drew 600ml - left and 500ml right Friday, October 1, 2021 RN visited. Drew 500ml per lung Monday, October 4, 2021 2nd Chemo Treatment - Pemetrexed, Carboplatin, Keytruda Labwork showed dangerously low levels of sodium - 123 - possible need to go to hospital Tuesday, October 5, 2021 Went back for labwork - sodium level now at 128 - prescribed sodium chloride Wednesday, October 6, 2021 110/60 BP Visiting RN - drained both lungs - LL: 550ml RL: 400ml Thursday, October 7, 2021 Return for labwork to check sodium levels. 11:00 AM Admitted to Hospital for low sodium, high potassium. 1:30 PM Friday, October 8, 2021 Drained both catheters - LL: 550ml RL: 350ml Saturday, October 9, 2021 Discharged 2:00 PM - Levels stabilizing - S: 128 P: <5.7 Tuesday, October 12, 2021 Visited for urgent care and blood work because of distended belly, water poop, and pain in belly Discovered his WBC was 0.04 - normal range is 4.0-6.0 Admitted to Hospital late in evening - moved to a room at 6:00 AM Heart AFIB was high again... they have gotten it under control Hemoglobin is normal Platelet count was normal at admission but has now dropped to 65,000? normal is 150-400,000 ? was at 260,000 when he was admitted. This could be from bone marrow or antibiotic that can cause drop ? Protonix. WBC ? ANP ? Atrial Natriuretic Peptide normalizing Sodium is still low 122-126 - Now again limiting fluid intake Renal specialist coming to see him Holding off on Eliquis for now to see how numbers fare. They may consider administering a single agent of immunotherapy for his October 25 treatment? they will not administer chemo if there is an active infection. Dr. feels it is too soon to take a PTScan as it may not show enough progress. Weighing the risks and benefits of the cancer treatment. Saturday, October 16, 2021 Sodium levels still low. .04 white blood cell count Gave platelet infusion. CTScan revealed Ileus NG Tube insertion Cardiac arrest was cause of death.
CDC Split Type:

Write-up: We were completely unaware of an underlying severe health condition: Inoperable, Stage 4 Adenocarcinoma that had metastasized to his liver, lymph nodes, bones, blood. The Moderna Shot triggered the cancer to become aggressive resulting in rapid atrial fibrillation and subsequent pleural effusion progressively getting worse until on August 14, 2021 patient was admitted to Hospital. A drain port was installed and a right lung catheter and later after his first round of chemo a left lung catheter was installed. After two rounds of chemotherapy (the second round included immunotherapy) and a mismanagement of meds, patient died of cardiac arrest during a routine NG tube insertion procedure one Saturday, October 16, 2021.


VAERS ID: 1877251 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-21
Onset:2021-11-04
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Contusion, Cough, Death, Dyspnoea, Fall, Hypoxia, Loss of consciousness, SARS-CoV-2 test positive, Walking aid user
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: 2021-11-13
   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: Allbuterol MDI PRN, Furosemide 20 mg QD, Gabapentin 300 mg TID, Olmesartan 40 mg QD, Potassium Chloride 8 meq QD, Viroptic 1 drop Q4H, Preservision Vitamin QD, Carvedilol 6.25 mg BID, Symbicort QD
Current Illness:
Preexisting Conditions: H/O Breast Cancer, COPD, Hypertenison, Macular degeneration, arthritis
Allergies: Codeine
Diagnostic Lab Data: COVID-19 Positive on 11/4/2021 using 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 2/28/2021 and 3/21/2021. Presented to ED on 11/4/2021 complaining of passing out at daughters house around 9am today. Patient said it lasted for a few seconds. + previous in rehab 3 weeks ago. Had a fall and did rehab recently where she left on October 1st. Lives with daughter. SOB all the time due to COPD. Uses walker. Bruised on her left knee and right ankle but improving. Patient treated with remdesivir, baricitinib, antibiotics. Patient began to experience more cough on 11/7, patient developed hypoxia on 11/9 started on oxygen NC. Patient expired on 11/13/2021.


VAERS ID: 1877255 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-05
Onset:2021-11-06
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cellulitis, Death, Dyspnoea, Fatigue, Oxygen saturation decreased, Pain in extremity, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-11
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRN, Diphenhydramine PRN, Albuterol PRN, Augmentin 500 mg BID, Apixaban 5 mg BID, Arformoterol BID, Azelastine Nasal QD, Budesonide Nebs BID, Carvedilol 3.125 mg BID, Cetirizine 10 mg QD, Furosemide 40 mg QD, Gabapentin 100 mg
Current Illness:
Preexisting Conditions: Cellulitis, Hypertension, Osteoarthritis, Asthma, COPD, OSA, Atrial Fibrillation, Interstitial Lung disease, Anemia
Allergies: Adhesive
Diagnostic Lab Data: COVID Positive on 11/6/2021 using Cepheid GeneXpert, 10/1/2021 using the Hologic Panther System, 9/25/2021 using Cepheid GeneXpert
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/14/2021 and 5/5/2021. Covid-19 + in September, 2021. Patient presented to ED on 11/6/2021 for leg pain and diagnosed with severe cellulitis, denies injury to leg, found to be Covid-19 + upon admission. On 11/10/2021 patient began to complain of fatigue and increased dyspnea with increased oxygen requirements. Family elected for palliative care due to declining oxygen saturations despite NIPPV. Patient expired on 11/11/21.


VAERS ID: 1877258 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-11-02
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase increased, Anticoagulant therapy, Aspartate aminotransferase increased, COVID-19, Cerebral infarction, Compartment syndrome, Death, Dysarthria, Endotracheal intubation, Fasciotomy, Hypoaesthesia, Lactic acidosis, Lung assist device therapy, Magnetic resonance imaging head abnormal, Oliguria, Paraesthesia, SARS-CoV-2 test positive, Transaminases increased, Ventricular assist device insertion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Angioedema (broad), Lactic acidosis (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Ischaemic central nervous system vascular conditions (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-10
   Days after onset: 8
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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/14/2021 and 6/04/2021. Presented to an ED on 11/2/21 with right hand numbness and tingling and transient slurred speech. Admitted and diagnosed with left parietal lobe infarct per MRI and received TPA. In the early am of 11/6 he decompensated and requiring intubation. Taken to cath lab where an Impella CP was placed in the right femoral site. Required extreme high doses of inotropes and pressors with fever spikes. Diagnosed with COVID- PCR + on 11/5/2021. Transferred to another Medical Center for ECMO. Patient noted to have lactic acidosis up to 20 on 11/5/2021, AKI with oliguria requiring CRRT, transaminitis with AST and ALT $g 7000, and development of compartment syndrome requiring fasciotomies of RLE. Patient required continued support of ECMO. Code status was changed to DNAR-AND and he expired 11/10 am.


VAERS ID: 1877261 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-19
Onset:2021-10-18
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Bacterial infection, Bronchoalveolar lavage abnormal, COVID-19, Death, Diarrhoea, Haemofiltration, Malaise, Mechanical ventilation, Pseudomonas infection, Pyrexia, Renal impairment, SARS-CoV-2 test positive, Sepsis, Sputum culture positive, Thrombosis in device, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-11
   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: Aspirin 81mg daily, atorvastatin 40 mg daily, B complex 1 capsule daily, cinacalet 30 mg, estradiol 0.01% 0.5 g vaginally twice weekly, glipizide XL 10 mg, melatonin 3 mg, cellcept 500 mg twice daily, omeprazole 20 mg, ondansetron 4 mg, pre
Current Illness:
Preexisting Conditions: Diabetes, stroke, thyroid disease, kidney transplant
Allergies: Adhesive, aztreonam, benzoin, clarithromycin, erythromycin,gentamicin, iodine, latex, levofloxacin, linezolid, penicillins, sulfamethoxazole-trimethoprim, vancomycin, anecream, tetracycline
Diagnostic Lab Data: COVID-19 positive on 10/19/2021, Sputum positive for pseudomonas aeruginosa on 10/29/2021; BAL positive for pseudomonas aeruginosa on 11/9/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 5/22/2021 and 6/19/2021. Patient presented to ED on 10/18/2021 with complaints of general malaise, diarrhea, and fever. Hospitalized for sepsis, Covid-19 + upon admission. Received: dexamethasone, remdesivir, baricitinib, broad spectrum antibiotics, paralytics, methylprednisolone, prednisone, and vasopressors. Required mechanical ventilation on 10/24/2021 with continued respiratory decompensation. Patient developed bacterial infection with pseudomonas aerugenosa. Patient''s renal function also continued to decline requiring CRRT. On 11/10/2021, CRRT clotted off and patient unstable. Patient receiving norepinephrine and vasopressin with maxed ventilator settings and episodes of V tach. Patient was changed to DNR per husband''s wishes and patient expired on 11/11/2021 at 0003.


VAERS ID: 1877266 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-23
Onset:2021-10-19
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 UN / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Anticoagulant therapy, Asthenia, COVID-19, Chest X-ray abnormal, Chest pain, Chest tube insertion, Cough, Death, Diarrhoea, Endotracheal intubation, Hypotension, Hypoxia, Intensive care, Lung opacity, Mechanical ventilation, Nausea, Pneumonia, Pneumothorax, Pulmonary oedema, SARS-CoV-2 test positive, Shock, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (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: 2021-10-28
   Days after onset: 9
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: atorvastatin Take 1 tablet (20 mg total)by mouth daily,
Current Illness:
Preexisting Conditions: Kidney transplant, allergic rhinitis, anemia, Autonomic nervous system disorder, thrombocytopenia, benign prostatic
Allergies: Flomax
Diagnostic Lab Data: COVID positive 10/19/2021 and 10/20/2021; CXR: Patchy bibasilar opacities compatible with edema or pneumonia on 10/20/2021.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/8/2021, 3/29/2021, and 9/23/2021. Patient tested for COVID at clinic on 10/19/2021 which resulted positive. Presented to ED on 10/20/2021 with complaints of cough, nausea, vomiting, diarrhea and weakness for 10 days. Admitted for acute kidney injury and requiring oxygen supplementation 3-4 L nasal cannula. Received: dexamethasone, full anticoagulation, remdesivir, broad spectrum antibiotics, paralytics, pressors, and nitric oxide. Transferred to ICU for chest pain and hypoxia. Developed pneumothorax, chest tube placed and intubated.


VAERS ID: 1877292 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-03-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Death, Dyspnoea, Fall, Hypertension, Lung infiltration, Lung opacity, Pneumoconiosis, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Accidents and injuries (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Black lung,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: MRG: Report as COVID 19 death as Xray support the COVID 19 death. Not LTCF; PCR positive 3/2/2021, (-) 3/22/21; S/S: shortness of breath, worsening chest X-rays, diffuse ground-glass infiltrates similar to that of Coronovirus, admitted for managing shortness of breath post fall several week priorl; C/M: CVD - A-fib, heart failure, gout, HTN, COPD - black lung; Dx: ARF with hypoxemia, pneumonia, paroxysmal A-fib, HTN, black lung, acute exacerbation of chronic obstructive airways disease, history of COVID-19, heart failure, Moderna vaccines on 1/12 and 2/8


VAERS ID: 1877325 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-04
Onset:2021-09-16
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 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: Apixaban Aspirin Atorvastatin Budesonide Cyanocobalamin Ergocalciferol Fluticasone furoate-vilanterol
Current Illness: Unknown
Preexisting Conditions: Acute on Chronic Anemia Atrial Fibrillation Morbid Obesity COPD CAD Chronic Anticoagulation
Allergies: Hibiciens Sulfa Zithromax
Diagnostic Lab Data: Positive COVID-19 lab on 9/13/2021.
CDC Split Type:

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


VAERS ID: 1877338 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-02
Onset:2021-11-08
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray abnormal, Dyspnoea, Endotracheal intubation, Lung infiltration, Positive airway pressure therapy, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: End stage renal disease, coronary artery disease, CVA, Diabetes, HTN
Allergies: NKA
Diagnostic Lab Data: CXR with infiltrates and edema bilaterally 11/8
CDC Split Type:

Write-up: Hospitalized with shortness of breath, oxygen saturation less than 80%, BP 220/123 on admission. Trialed BiPap but failed and was intubated. Extubated 11/9.


VAERS ID: 1877357 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-04
Onset:2021-10-25
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute pulmonary oedema, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Chest pain, Condition aggravated, Death, Dyspnoea, Hypotension, Intensive care, Lung opacity, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-27
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 1300 mg BID, gabapentin 600 mg BID, hydrochlorothiazide 50 mg daily
Current Illness:
Preexisting Conditions: Anemia, anxiety, aortic stenosis, arthritis, cervical cancer, congestive heart failure, complete heart block, chronic pain, depression, diabetes mellitus, Gastroesophageal reflux disease, hyperparathyroidism, hypertension, nephrolithiasis, obesity, ostearthritis, peripheral neuropathy, peripheral vascular disease, cardiac pacemaker, transcatheter aortic valve replacement, valvular disease, vitamin D deficiency, pulmonary hypertension, obstructive sleep apnea,
Allergies: No known allergies
Diagnostic Lab Data: COVID positive 10/25/2021; CXR: patchy bibasilar opacities on 10/20/2021.
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen (J&J) Vaccine on 5/4/2021. Per patient chart, patient had COVID in Jan. 2021. Presented to ED on 10/25/2021 with complaints of chest pain and shortness of breath for approximately 1 week. Admitted for COVID pneumonia and acute hypoxemic repiratory failure. Throughout hospitalization patient received: dexamethasone, broad spectrum antibiotics, and pressors. On 10/26/2021, patient was transferred to ICU for tachycardia and tachypnea. Overnight patient''s respiratory status continued to decompensate.Patient became hypotensive with flash pulmonary edema. Went into cardiac arrest and expired at 0050 on 10/27/2021.


VAERS ID: 1877360 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-06
Onset:2021-10-21
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest X-ray abnormal, Chest pain, Death, Dyspnoea, Gastrostomy, Interstitial lung disease, Lung opacity, Mechanical ventilation, SARS-CoV-2 test positive, Staphylococcal infection, Tracheal aspirate culture, Tracheostomy
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-11
   Days after onset: 21
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 80 mg daily, duloxetine 60 mg daily, gabapentin
Current Illness:
Preexisting Conditions: Hypertension, diabetes, obesity, hypothyroidism, fibromyalgia, hyperlipidemia
Allergies: Penicillin
Diagnostic Lab Data: COVID positive 10/21/2021; CXR: increased interstitial markings with associated bilateral airspace opacification on 10/21/2021. Tracheal aspirate positive for MRSA on 11/10/2021
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Janssen (J&J) Vaccine on 3/6/2021. Presented to ED on 10/21/2021 with complaints of chest pain and shortness of breath for approximately 1 week. Per patient she tested positive with a COVID home test on the prior Thursday. Hospitalized for COVID pneumonia and acute respiratory failure. Developed ARDS and required mechanical ventilation. Unable to wean off vent and received trach and PEG. Throughout hospitalization patient received: dexamethasone, baricitinib, broad spectrum antibiotics, paralytics, remdesivir, and pressors. Suffered cardiac arrest on 11/10/2021 with ROSC. Expired on 11/11/2021.


VAERS ID: 1877361 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-09-12
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
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: 2021-09-19
   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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dyspnea c/o. Pt is on 2 liters at home. COVID positive recently. Hypoxia concerns with exertion. Pt is currently on 6 liters via NC, but plan to place on Bipap. patient was a transfer to our facility. one dose of the vaccine was administered on 2/1/2021 but no record of lot number


VAERS ID: 1877363 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-14
Onset:2021-09-16
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 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: 2021-09-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol/pratropium Potassium Chloride
Current Illness: Unknown
Preexisting Conditions: COPD Hypertension
Allergies: Sulfa
Diagnostic Lab Data: Positive COVID-19 lab test on 9/01/2021 and 9/03/2021.
CDC Split Type:

Write-up: Patient had breakthrough infection and expired.


VAERS ID: 1877369 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-01-15
Onset:2021-11-16
   Days after vaccination:305
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 2 UN / IM

Administered by: Pharmacy       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: 2021-11-17
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: AICD, arthritis, A-fib, HTN, CAD, COPD, chronic anticoagulation, CKD stage 3, dementia, GERD, MI in last year, heart failure, tobacco dependence
Allergies: Lisinopril
Diagnostic Lab Data: Positive for covid 11/16/21
CDC Split Type:

Write-up: Pt tested positive for covid and died during hospitalization.


VAERS ID: 1877391 (history)  
Form: Version 2.0  
Age: 101.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-16
Onset:2021-11-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Death, Pallor, Protrusion tongue, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   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: Booster dose given. Waited 15 minutes in lobby before leaving. Family came back inside after getting her in the car to leave, for help. She was ash color with tongue protruding from mouth. Opened her eyes upon shaking and breathing noted. 911 called and Oxygen applied via face mask. Ambulance then arrived and transported to Hospital for medical treatment where she expired later the same afternoon.


VAERS ID: 1877414 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-20
Onset:2021-03-30
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Fall, Loss of consciousness, SARS-CoV-2 test positive, Subdural haemorrhage, Vaccine breakthrough infection
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), Haemorrhagic central nervous system vascular conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   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: prior Covid infection 118 days earlier
Preexisting Conditions: DM type 2, CVD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough case. Patient tested positive while receiving treatment for multiple falls. Expired 04-14-2021, Traumatic subdural hemorrhage with loss of consciousness of unspecified duration.


VAERS ID: 1877452 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-02-17
Onset:2021-10-31
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chemotherapy, Chest X-ray abnormal, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Electrocardiogram, Full blood count, Hepatocellular carcinoma, Hypotension, International normalised ratio, Mental status changes, Metabolic function test, Pneumonia bacterial, Radiotherapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Liver malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-11
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pramipexole spironolactone potassium chloride 20mEq daily cetirizine furosemide 40mg daily
Current Illness: unknown
Preexisting Conditions: liver masses bilateral knee pain liver hematoma bradykinesia obesity tremor polyarthralgia
Allergies: NKA
Diagnostic Lab Data: 10/31/2021: CBC, CMP, INR, chest and head CT w/o contrast positive for bacterial pneumonia, EKG
CDC Split Type:

Write-up: 10/31/2021 ED visit: past medical history significant for Parkinson''s disease followed by Dr. and on pramipexole, recent diagnosis of highly advanced hepatocellular carcinoma not amenable to either chemotherapy or XRT followed by oncology here, who presents to the emergency department with acutely altered mental status this evening. She is afebrile and is essentially hemodynamically normal although her blood pressures are little soft. CT scan of the head does not show any acute process. X-ray of the chest revealed lung markings consistent with COVID-19 pneumonia. CT scan of the chest redemonstrates this finding. Abbott rapid coronavirus test is negative and the patient is afebrile and fully vaccinated. I am somewhat skeptical of this finding although I have sent confirmatory Cephied PCR coronavirus test. Although patient''s Abbott rapid coronavirus test was negative, her Cephied coronavirus test which I sent is positive. Admitted due to altered mental status likely related to her neoplastic disease.


VAERS ID: 1877500 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-10-26
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-04
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: hypertension, chronic renal disease, chronic lung disease, diabetes , severe obesity, former smoker
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed COVID-19 on 10/26/2021 and died on 11/4/2021. Patient admitted to long term care facility 5/24/2021. Required VAERS reporting for fully vaccinated patient with COVID death.


VAERS ID: 1877549 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-12
Onset:2021-08-30
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Acute respiratory distress syndrome, Alanine aminotransferase increased, Atrial fibrillation, Back pain, Bacterial test, Bicytopenia, Biopsy bone marrow, Biopsy skin normal, Blood bilirubin increased, Blood creatinine increased, Blood culture negative, Blood immunoglobulin G, Blood test normal, Bronchoalveolar lavage normal, Bronchoscopy, CSF glucose increased, CSF lymphocyte count increased, CSF protein normal, CSF white blood cell count increased, Chest X-ray normal, Chest pain, Clostridium test, Computerised tomogram abdomen abnormal, Computerised tomogram head normal, Computerised tomogram normal, Computerised tomogram spine, Condition aggravated, Cryoglobulinaemia, Cryoglobulins present, Death, Dialysis, Disseminated intravascular coagulation, Drug screen positive, Echocardiogram, Ejection fraction normal, Encephalopathy, Endotracheal intubation, Fungal test, Gastrointestinal wall thickening, Generalised oedema, Gram stain, Haemofiltration, Haemophagocytic lymphohistiocytosis, Heparin-induced thrombocytopenia test, Hepatic steatosis, Hepatitis B virus test, Hepatitis C virus test, Herpes simplex test negative, Hyperferritinaemia, Hyperkalaemia, Hypocomplementaemia, Hypotension, Hypoxia, Infection, Inflammation, Laboratory test abnormal, Leukocytosis, Lumbar puncture normal, Lung opacity, Mental status changes, Metabolic acidosis, Multiple organ dysfunction syndrome, Myoclonus, Platelet transfusion, Pleural effusion, Polymerase chain reaction, Positive airway pressure therapy, Procalcitonin increased, Pulmonary alveolar haemorrhage, Pulmonary haemorrhage, Pyrexia, Rash, Renal failure, Renal fusion anomaly, Respiratory failure, Rheumatological examination, Sepsis, Serum ferritin increased, Shock, Skin discolouration, Transfusion, Troponin increased, Ultrasound Doppler abnormal, Ultrasound abdomen abnormal, Urine analysis normal, Urine output decreased, Varicella virus test negative, Vasculitis, Ventilation/perfusion scan, Ventilation/perfusion scan normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Drug abuse and dependence (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vasculitis (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Malignant lymphomas (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 19
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rizatriptan Benzoate (MAXALT) 5 MG Tab buprenorphine-naloxone (SUBOXONE) 8-2 mg SL Tab busPIRone (BUSPAR) 5 MG Tab butalbital-acetaminophen-caffeine (FIORICET, ESGIC) 50-325-40 MG Tab citalopram (CELEXA) 40 MG Tab gabapentin (NEURONTIN) 300
Current Illness: "not had a bowel movement for several days" at time of ED admission
Preexisting Conditions: Back pain, chronic Chronic headache - 4/21/2017 Osteomyelitis of arm - 09/2001 OM, left forearm Raynaud''s disease
Allergies: Meloxicam - Vomiting Tramadol Hcl - Vomiting
Diagnostic Lab Data: 9/13 BCX: NGTD 9/13 BAL: unrevealing. Includes Bacterial and fungal cx, AFB Stain, PJP PCR/Stain, fungal PCR, RVP 9/14 Bone marrow biopsy: Remains in progress 9/14 CSF studies: Lymphocytic pleocytosis with 20 WBCs (100% lymphs). Portein 43, glucose 84, HSV/VZV PCRs negative. Autoimmune encephalitis panel and bacterial/fungal cx remain in progress 9/17 Enteric pathogen panel: negative 9/17: Skin biopsy: NGTD 9/17 BAL: Gram stain without PMNs or orgs, cx in progress
CDC Split Type:

Write-up: From admission H&P dated 9/12/21 by Doctor: "History per chart and collateral given patient''s encephalopathy. The patient was reportedly in USOH when she began experiencing abdominal pain. She reportedly started a short course of penicillin as an outpatient for this abdominal pain. She presented to the Hospital with worsening abdominal pain, worsening of her chronic low back pain, and chest pain. Mild leukocytosis with elevated ALT and bilirubin on admission. Troponin was elevated to 0.44, but down-trended and deemed to be non-cardiac after evaluation by cardiology. CXR, UA not concerning for infection. CT-AP showed diffuse colonic wall thickening, mild pulmonary interstitial opacities, small bilateral pleural effusions, and a horseshoe kidney. V/Q scan without PE, ultrasound of LE showed patents. TTE with normal EF, RUQUS without biliary dilation, only mild fatty infiltration of the liver. Stool-filled colon - had pain relief with aggressive bowel regimen and bowel movement. Due to persistent fevers and back pain with elevated procalcitonin, the patient was started empirically on ceftriaxone and vancomycin. Negative CT-spine for infection. Course complicated by 2x episodes of afib with RVR, the second one requiring amiodarone and beta blocker. She also developed an AKI with Cr rising to peak of 3.56 over the course of days. Intermittent hypotension requiring pressors. Renal consulted, workup concerning for glomerulonephritis, revealed hypocomplementemia, ferritin $g80,000, and monoclonal IgG kappa. She refused a bone marrow biopsy. Her urine output dropped to near-anuric, and she became encephalopathic with myoclonus. At this point, she was started on every other day dialysis. No head imaging performed. Other diagnostic studies included utox (positive for morphine and oxycodone), APAP level (undetectible), Hep C, HepB, C.Diff, Due to the elevated ferritin and concern for HLH, he was evaluated by hematology, started on dexamethasone. She had hypoxemic respiratory failure requiring bipap that was ultimately weaned to nasal cannula. Past medical history of major depressive disorder and chronic lower back pain. Notably, she had severe osteomyeletis of the LUE, LLE requiring extensive surgery" HOSPITAL COURSE: Patient had an unfortunately complicated hospital course. As above, she was transferred from an outside facility with a constellation of clinical and lab abnormalities including fever of unknown origin, abdominal/chest pain, anuric renal failure requiring iHD, respiratory failure, and encephalopathy as well as cryoglobulinemia, hypocomplementemia and hyperferritniemia ($g80K) and developing bicytopenia with concern for, though not diagnosis of, HLH from unclear trigger. While pursuing workup for unifying diagnosis she developed progressive multiorgan failure as will be discussed below. In regards to diagnostics for underlying diagnosis, with the assistance of multiple consulting services (infectious diseases, heme/onc, rheumatology, nephrology) she underwent broad workup for diagnosis of and trigger of HLH v. Alternative inflammatory/rheumatologic process including bone marrow biopsy (in progress) , rheumatologic workup (notable for low complement levels and reported cryoglobulinemia at OSH), infectious workup via blood/BAL/LP (negative/in progress). Realization that cryoglobulins + at OSH as well as development of chest/abdomen rash and discolored toes raised question of cryoblobulinemic vasculitis. She was empirically treated with 1g IV methylpred then 40mg IV dex/day while awaiting results and diagnostics which unfortunately were not complete prior to her death and remains a question, hopefully to be answered by pending autopsy. Despite gradual improvement in several body systems (hemodynamics, hypoxemia), she developed DIC and pulmonary hemorrhage on the day of her death which ultimately led to her death as described below. Multiorgan failure will be described below by system: # Hypoxemic respiratory failure: Intubated for airway protection and hypoxemia upon admission to UWMC. Treated for ARDS with LPV possibly secondary to infection, though notably BAL and other infectious workup remained unremarkable throughout her stay. Hypoxemia improved enough with UF for volume removal and empiric ABX to move towards SBT pt was not able to be extubated. On the day of Patient''s death, she developed bloody secretions from ETT so underwent repeat bronchoscopy. BAL diagnostic of alveolar hemorrhage with progressively bloody lavage aliquots. She was re-pulsed with IV methylpred and provided platelet replacement with concern for DAH or pulmonary vasculitis on 9/17 though developed severe pulmonary hemorrhage early on 9/18. Despite MTP and DDAVP to try and stabilize coagulopathy/hemorrhage, she ultimately lost $g3L blood from ETT and died following this significant pulmonary hemorrhage (see code note and death note from today''s date). # Shock: Developed distributive shock requiring 3 vasopressors for support early in her stay. She received empiric antimicrobials, high dose steroids and ID workup with no revealing cause for sepsis. Hemodynamics showed signs of improvement leading up to day of death with vasopressors nearly weaned off. #anuric renal failure- Complicated by anascarca, hyperkalemia and metabolic acidosis. By microscopy related to tubular injury, considered possibly related to cryoglobulinemia v. Vasculitis though unable to pursue renal biopsy due to instability. Required intermittent SLED/SCUF while admitted. # Encephalopathy: Again, unclear etiology of altered mental status. Initially considered related to sedation and metabolic abnormalities and initial CT head WNL and LP without clear infectious cause (though some studies remain in progress), though remained profoundly encephalopathic following wean of sedatives. Other considerations have included CNS involvement of primary underlying diagnosis (cryoglobulinemic vasculitis), undiagnosed infection, NCSE, etc. # DIC # Bicytopenia Likely related to underlying unifying diagnosis. Other considerations included MAHA though no evidence of hemolysis, negative HIT assay, HLH. Progressive throughout stay requiring cryo transfusion and multiple PLT transfusions on day of death.


VAERS ID: 1877553 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-20
Onset:2021-04-30
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ataxia, Encephalitis
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 120
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: Ataxia, encephalitis.


VAERS ID: 1878025 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, 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? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   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: Furosemide Tablet 20 MG DilTIAZem HCl Tablet 120 MG Januvia Tablet 50 MG (SITagliptin Phosphate) Lisinopril Tablet 20 MG Insulin Tylenol AmLODIPine Besylate Tablet 2.5 MG
Current Illness: No acute illnesses at time of vaccination and up to one month prior.
Preexisting Conditions: Chronic illnesses: Atrial fibrillation ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS VITAMIN D DEFICIENCY, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION ESSENTIAL (PRIMARY) HYPERTENSION SCHIZOAFFECTIVE DISORDER, UNSPECIFIED ALZHEIMER''S DISEASE, UNSPECIFIED
Allergies: No known allergies to medications, food, or other products.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Resident was observed to be unresponsive at 5 pm. CPR and emergency called, pronounced dead. Resident was not observed with any noted adverse reactions to vaccine prior to being found unresponsive . No definite evidence that death was directly related to administration of vaccine.


VAERS ID: 1878047 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-01
Onset:2021-10-21
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Diarrhoea, Encephalopathy, Productive cough, SARS-CoV-2 test positive
SMQs:, Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested at Health Center on 10/21/2021- positive COVID-19 BioFire.
CDC Split Type:

Write-up: Wet cough, diarrhea, 88% on RA, encephalopathic, DNR patient- expired, etc.


VAERS ID: 1879616 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-05-03
Onset:2021-06-14
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angioplasty, Cardiac arrest, Cardiac electrophysiologic study, Cardiac stress test, Chest discomfort, Dyspnoea, Echocardiogram, Fatigue, Heart rate increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-09
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes (Other medical history: diagnosed with diabetes while in hospital)
Allergies:
Diagnostic Lab Data: Test Name: angioplasty; Result Unstructured Data: Test Result:no blockage; Test Name: epstudy; Result Unstructured Data: Test Result:Unknown Results; Test Name: stress test; Result Unstructured Data: Test Result:Unknown Results; Test Name: echocardigram; Result Unstructured Data: Test Result:Unknown Results
CDC Split Type: USPFIZER INC202101558535

Write-up: Patient died / Cause of Death Cardiac Arrest; racing heart rate; started having shortness of breath; heaviness in chest; fatigue; This is a spontaneous report from a contactable consumer. This consumer reported for a 50-year-old male patient that, A 50-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: ER8735) via an unspecified route of administration on 03May2021 (at the age of 50-years-old), as DOSE 2, SINGLE for COVID-19 immunisation. Medical history included diabetes mellitus and Other medical history: diagnosed with diabetes while in hospital. Patient had no Known allergies.The patient''s concomitant medications were not reported. Historical vaccine included the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EW0150) on 12Apr2021 as DOSE 1, SINGLE for COVID-19 immunisation. On 14Jun2021, patient died due to cardiac arrest, shortness of breath, racing heart rate, fatigue, heaviness in chest. Date of death: 09Jul2021. Autopsy was not performed. He was hospitalized for 15 days. Patient received treatment included medication. He did not have covid prior to vaccination. He was not tested for covid post vaccination. He was on other medicines in two weeks which included multivitamins. Patient did not take any other vaccine in four weeks. The patient underwent lab tests and procedures which included angioplasty: no blockage on, cardiac electrophysiologic study: unknown results on, cardiac stress test: unknown results on, echocardiogram: unknown results on.The outcome for the events was fatal. The lot number for the vaccine, BNT162B2 was not provided and will be requested during follow up.; Reported Cause(s) of Death: Cardiac arrest


VAERS ID: 1879617 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-18
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 INC202101563043

Write-up: Caller stated that she has seen death as being an adverse event of the Pfizer Covid-19 vaccine (did not specify how many patients or demographic information).; This is a spontaneous report from a contactable consumer. The consumer reported that unknown number of patient (unknown age and gender) received BNT162b2 (COMIRNATY,COVID 19 Vaccine, mRNA), on an unspecified date, via an unspecified route of administration as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunization. The reporter mentioned that she has seen death as being an adverse event of the Pfizer Covid-19 vaccine (did not specify how many patients or demographic information). Reporter asking if there was any information about seizures being a side effect of the Pfizer Covid-19 vaccine and what are the side effects for the orange cap Pfizer Covid-19 vaccine. The outcome of the event was fatal. No follow-up attempts are possible; information about lot/batch number not available. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101557104 Same reporter/ drug, different patients/ events.; Reported Cause(s) of Death: Caller stated that she has seen death as being an adverse event of the Pfizer Covid-19 vaccine (did not specify how many patients or demographic information).


VAERS ID: 1879797 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-02
Onset:2021-11-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-07
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient passed away; This spontaneous case was reported by a nurse and describes the occurrence of DEATH (Patient passed away) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Nov-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 07-Nov-2021 The patient died on 07-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. Reporter reported that patient passed away on 07 Nov 2021 and it could be due to age and comorbidities. Company comment: This case concerns a 83-year-old, female patient with no reported medical history, who experienced the unexpected fatal event of death. Death occurred on 07-NOV-2021, 5 days after receiving the first dose of mRNA-1273. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. Patient?s age could be a confounding factor. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 83-year-old, female patient with no reported medical history, who experienced the unexpected fatal event of death. Death occurred on 07-NOV-2021, 5 days after receiving the first dose of mRNA-1273. The rechallenge is not applicable considering the outcome of the event. No autopsy results were provided; the cause of death was not reported. Patient?s age could be a confounding factor. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1879843 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-03-12
Onset:2021-03-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Death; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 010A21A) for COVID-19 vaccination. No Medical History information was reported. On 12-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 14-Mar-2021 The patient died on 14-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No treatment information was provided. Patient did not show symptoms before dying. Reporter did not give precise information on HCP and vaccination site and did not know which concomitant medication patient was taking. Company comment: This fatal spontaneous case concerns a 72-year-old male patient with no relevant medical history who experienced serious unexpected event of death The event occurred 3 days after the second dose of mRNA-1273 vaccine. Rechallenge is not applicable The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report; Sender''s Comments: This fatal spontaneous case concerns a 72-year-old male patient with no relevant medical history who experienced serious unexpected event of death The event occurred 3 days after the second dose of mRNA-1273 vaccine. Rechallenge is not applicable The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1880071 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-17
Onset:2021-10-27
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute left ventricular failure, Acute respiratory distress syndrome, Acute respiratory failure, Anticoagulant therapy, Aspergillus test, Blood beta-D-glucan, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Chronic left ventricular failure, Condition aggravated, Death, Echocardiogram normal, Ejection fraction, Endotracheal intubation, Fibrin D dimer increased, General physical health deterioration, Intensive care, Polyuria, SARS-CoV-2 test positive, Sputum culture positive, Ultrasound Doppler normal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (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 (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See VAERS #706111
Current Illness: See VAERS #706111
Preexisting Conditions: See VAERS #706111
Allergies: See VAERS #706111
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is Deceased. Date of Death: 11/15/21 Time of Death: 7:40 PM Preliminary Cause of Death: COVID-19 See VAERS #706111 for initial hospitalization reporting. DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute on chronic diastolic congestive heart failure (HCC) [I50.33] Pneumonia due to COVID-19 virus [U07.1, J12.82] COVID-19 [U07.1] Acute respiratory distress [R06.03] HOSPITAL COURSE: This is a 72 y/o male with past medical history significant for AL amyloidosis on active chemo, diastolic CHF, AS s/p bioprosthetic AV replacement 5/2021, diastolic CHF, CKD 3b, CAD, Paroxysmal afib, and OSA. He was admitted on 10/31 with acute hypoxic respiratory failure secondary to COVID PNA and has been under the oncology service. Patient developed symptoms around 10/19 and tested positive on 10/25. He is fully vaccinated and is s/p both booster vaccination. Patient was started on decadron and completed treatment with Remdesivir. He also received monoclonal Ab infusion. He was started on empiric heparin gtt for rising d-dimer. Dopplers were negative for DVT. CTA has been avoided in the setting of his chronic kidney disease. He has been aggressively diuresed and was started on empiric CAP coverage 11/3. Sputum culture 11/4 positive for MSSA. ID was consulted and ordered BDG and aspergillus Ag which are pending. Cardiology was consulted for decompensated diastolic CHF exacerbation. Echo was performed noting EF of 71% and was without critical valve disease. Work up with RHC was not recommended. Nephrology was also following for assistance with diuresis management in the setting of his kidney disease. Lasix was placed on hold 11/6 due to improvement in fluid status/ Pt is also s/p albumin infusions. Despite this, worsening respiratory status continued and pt was transferred to ICU 11/9 and intubated 11/11 after reconfirming code status with him and his wife. There is no desire for prolonged efforts at resuscitation in this regard however. Patient''s condition declined. Wife wished to proceed with comfprt care measures on 11/15/2021. Patient passed away peacefully at 1940 on 11/15/2021 with wife and ster daughter at bedside.


VAERS ID: 1880333 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-22
Onset:2021-10-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0186 / 3 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EW0158 / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EN6199 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hyperkalaemia, Hypocalcaemia, Low lung compliance, Pneumomediastinum, Pneumonia, Pneumothorax, SARS-CoV-2 test positive, Type 2 diabetes mellitus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient now deceased. Date of Death - 11.12.21 See VAERS #705326 report which covers initial hospitalization DISCHARGE DIAGNOSES 1. ARDS. 2. Severe acute hypoxic respiratory failure secondary to COVID pneumonia. 3. COVID pneumonia. 4. Pneumothorax and pneumomediastinum. 5. Ventilator-associated pneumonia. 6. Permanent atrial fibrillation. 7. Type 2 diabetes mellitus. 8. Hyperkalemia. Resolved. 9. Hypocalcemia. Resolved. HOSPITAL COURSE 70-year-old patient presented to the ER on 10/28 with complaints of shortness of breath. She tested positive for COVID. She was treated with Decadron, then Solu-Medrol, and remdesivir. Unfortunately, the patient''s clinical course deteriorated and she required intubation on 10/30. Despite maximal efforts in treating underlying conditions, which included ventilator associated pneumonia and pneumothorax/pneumomediastinum, the patient continued to decompensate. After she developed a pneumomediastinum, she required nearly 100% FiO2 as well as ongoing paralytics and deep sedation for multiple days. It was determined that her lung compliance was so poor that it was a near certainty that she would never get off the ventilator and would require likely weeks of oral intubation before she could have a tracheostomy. Discussions were held with the family at length and they all agreed that she would not want to be kept alive in this state. They agreed that care was futile. They agreed to remove life support on 11/12 and the patient succumbed to her disease process. She passed and was pronounced at 5:46 p.m. on 11/12/2021.


VAERS ID: 1880450 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-04
Onset:2021-09-15
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Ageusia, Blood pressure abnormal, COVID-19, Cardio-respiratory arrest, Chest X-ray abnormal, Cough, Death, Decreased appetite, Dyspnoea, Oxygen saturation abnormal, Pain, Pneumonia, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASPIRIN, AZELASTINE, COREG, SYMBICORT, ZYRTEC, VITAMIN D3, ARICEPT, FLONASE, ADVAIR, LASIX, HYDRODIURIL, ATARAX, SYNTHROID, SINGULAIR, MINIPRESS, CRESTOR, ENTRESTO, ZOLOFT, JANUVIA, SPIRIVA, DESYRELL
Current Illness:
Preexisting Conditions: CHF, ANEMIA, ANXIETY, CKD, COPD, CAD, DIABETES MELLITUS, GERD, GALLSTONES, HYPERLIPIDEMIA, HYPERTENSION, HYPERTHYROIDISM, IBS, OSA ON CPAP, OSTEOARTHRITIS, PNEUMONIA, PTSD, THROMBOCYTOPENIA
Allergies: NKDA
Diagnostic Lab Data: CXR SHOWED BILATERAL PNEUMONIA 9/30/21 & 10/8/21.
CDC Split Type:

Write-up: PATIENT ADMITTED TO HOSPITAL 9/30/21 WITH PROGRESSIVE SOB, COUGH, POOR APPETITE, BODY ACHES, LOSS OF TASTE. DIAGNOSED WITH CVODI19 DURING ADMISSION. ISSUES WITH MAINTIANING BP AND OXYGENATION DURING HOSPITALIZATION. CODE BLUE CALLED 10/10/2021, ACLS INITITATED, NO ROSC AFTER 18 MINUTES, FAMILY ASKED TO STOP RESUSCITATION EFFORTS. DIED 10/10/2021 AT HOSPITAL.


VAERS ID: 1880482 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-14
Onset:2021-09-22
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Blood culture positive, Cardio-respiratory arrest, Chest X-ray abnormal, Death, Dyspnoea, Endotracheal intubation, Intensive care, Lung infiltration, Malaise, Mechanical ventilation, Renal failure, Salmonellosis
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METFORMIN, ZOLOFT
Current Illness:
Preexisting Conditions: HYPERTENSION
Allergies: NKDA
Diagnostic Lab Data: CXR SHOWS DIFFUSE BILATERAL PULMONARY INFILTRATES
CDC Split Type:

Write-up: COVID SSX BEGAN 9/22/21 WHILE PATIENT INCARCERATED. TRANSFERRED TO HOSPITAL DUE TO WORSENING SHORTNESS OF BREATH. ADMITTED TO ICU, PUT ON PRESSORS. INTUBATED ON 10/4/21. DEVELOPED WORSENING KIDNEY FAILURE AND BLOOD CULTURES + FOR SALMONELLA. MAXED OUT ON VENT AND PRESSORS. PATIENT MADE DNR BY FAMILY, CODED & DIED 10/12/2021.


VAERS ID: 1880526 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-11-14
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: AFIB, hypertension, vertigo, hysterectomy, appendectomy
Allergies: Penicillin, Sulfa
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unknown at time of vaccine. This person was fully vaccinated against Covid-19 and is deceased.


VAERS ID: 1880560 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-09-20
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-26
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to ED with increasing SOB, cough, fever, chills; home sats on RA were in the 70s; placed on O2 supplementation; Acute on chronic HRF secondary to COVID pneumonia; treated with dexamethasone, and remdesivir; condition deteriorated; encephalopathy; DNR; with worsening condition, pt was changed to comfort measures; pt died in the hospital


VAERS ID: 1880619 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Asthenia, COVID-19, Death, Dialysis related complication, Hypotension, Hypoxia, SARS-CoV-2 test positive, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: 2021-10-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt to ED with increasing weakness; positive for COVID; CA pt on chemotherapy; septic shock; AHRF; ARF; started on remdesivir, dexamethasone, barcitinib; unable to tolerate dialysis, became hypotensive and hypoxic; DNR; pt died in the hospital


VAERS ID: 1880626 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-11-14
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   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: HCTZ 25 mg daily
Current Illness: HTN
Preexisting Conditions: HTN
Allergies: NKA
Diagnostic Lab Data: Hospital 11/14/21
CDC Split Type:

Write-up: Increased fatigue and SOB 1 week after receiving vaccine, Acute MI 4 weeks after vaccine administration


VAERS ID: 1880706 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-09-30
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN NO LOT # AVAILA / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cardio-respiratory arrest, Cough, Death, Decreased appetite, Dyspnoea, Endotracheal intubation, Fatigue, Mechanical ventilation, Nausea, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), 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), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: 2021-10-08
   Days after onset: 8
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: PMH: HTN, DM, morbid obesity; pt c/o SOB, fatigue, cough, nausea, anorexia x2wks, worsening past 3 dys; positive for COVID; COVID pneumonia with HRF; placed on BiPAP, remdesivir, dexamethasone, baricitinib; eventually required intubation with mechanical ventilation; pt coded and died in the hosp


VAERS ID: 1880715 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-29
Onset:2021-11-15
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Patient was in hospice care at time of death. Patient received booster dose of Pfizer Covid-19 vaccine on 09/23/2021.
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Unknown


VAERS ID: 1880735 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-08-30
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NO LOT # AVAILA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea, Oxygen saturation decreased, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-12
   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: PMH: HTN, DMT2, prostate CA; to ED with increasing weakness, SOB, cough (x8dys); Positive for COVID; taking antibiotics and steroids from PCP; initially on NRB; AHRF; O2 sats decreased and pt placed on BiPAP; given broad-spectrum antibiotics and baricitinib; DNR/DNI; pt''s condition worsened; family declined hospice; pt died in the hosp


VAERS ID: 1880771 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-09-28
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Cardiac arrest, Cough, Death, Dyspnoea, Endotracheal intubation, Haemofiltration, Oxygen saturation decreased, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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 (broad), Pulmonary hypertension (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 (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-16
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt presents to ED with c/o dyspnea and dry cough; pt with intellectual disability; PMH: HTN, hyperlipidemia, depression; placed on Vapotherm; dexamethasone; remdesivir; O2 sats declined requiring intubation; developed ARF requiring CRRT; experienced cardiac arrest; CPR administered and medications per protocol; pt died in the hospital


VAERS ID: 1880780 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-01
Onset:2021-10-06
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, COVID-19 pneumonia, Cardiac arrest, Chest tube insertion, Condition aggravated, Death, Deep vein thrombosis, Echocardiogram abnormal, Ejection fraction decreased, Fraction of inspired oxygen, Gastrostomy, Mechanical ventilation, Pneumonia necrotising, Pneumonia pseudomonal, Pneumothorax, Positive end-expiratory pressure, Pulmonary embolism, Pulseless electrical activity, Renal tubular necrosis, Resuscitation, SARS-CoV-2 test positive, Sepsis, Tidal volume, Tracheostomy
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), 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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Renovascular disorders (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), 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: 2021-11-12
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 36 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, Pulmonary Embolism, Hyperlipidemia, Gastroesophageal Reflux Disease, Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 74yr old male admitted on 11/3/2021 from Medical Center. The patient had a past medical history of COPD, PE, Hyperlipidemia, Gastroesophageal reflux disease, Hypothyroidism, Cholecystectomy, R knee replacement, PEG on 10/29/2021 and a Percutaneous tracheostomy on 10/27/2021. Pt was vaccinated with Johnson and Johnson vaccine in May 2021. Pt''s son passed away from COVID-19 infection. The patient tested positive on 10/5/2021. The patient was transferred to bigger hospital from smaller Hospital with COVID-19 pneumonia and sepsis. When the patient arrived to bigger hospital the patient had a pulseless electrical activity cardiac arrest requiring chest compressions and 1 dose of epinephrine prior to returning to spontaneous circulation. The patients post cardiac echocardiogram showed an ejection fraction decreased to 23%, the pt. also developed acute kidney injury related to acute tubular necrosis. The patient was given tocilizumab, remdesivir and steroids. The patient''s hospital course was further complicated by DVT and pulmonary embolism. Pt was noted to also have right upper lobe necrotizing pneumonia due to Pseudomonas. Pt was seen and was on Meropenem. Pt was unable to be weaned off of the ventilator and underwent a tracheostomy on 10/27/2021 and a PEG placement on 10/29/2021. The patient''s family met with palliative care and they wanted to continue current care. On admission to Select the patient was on assit-control mode of ventilation with a tidal volume of 380, PEEP of 5, respiratory rate of 14 and FiO2 of 40%. The pt. had also had pneumothoraxes and on admission to Select the pt. had 2 right sided chest tubes and a chest tube on the left. Pt''s condition worsened and on 11/12/2021 Pulmonary noted that he had a long discussion with the family, discussed with them the surgical additional chest tube placement needed, but family decided on comfort cares at that time. Pt was placed on comfort cares and expired on 11/12/2021 at 1500.


VAERS ID: 1880787 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Death less than 24 hours after vaccine.


VAERS ID: 1880901 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-26
Onset:2021-11-16
   Days after vaccination:294
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Alanine aminotransferase increased, Anion gap, Aortic dilatation, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bicarbonate increased, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood pH decreased, Blood potassium increased, Blood sodium normal, Blood urea increased, Bradycardia, Bundle branch block right, COVID-19, COVID-19 pneumonia, Cardiomegaly, Creatinine renal clearance increased, Death, Depressed level of consciousness, Dyspnoea, Electrocardiogram QRS complex abnormal, Electrocardiogram abnormal, Fibrin D dimer increased, Full blood count abnormal, General physical health deterioration, Glomerular filtration rate decreased, Gram stain positive, Haematocrit normal, Haemoglobin decreased, Hypercapnia, Intensive care, Lung opacity, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Metabolic function test abnormal, Myocardial infarction, Oxygen saturation decreased, PCO2 increased, Platelet count decreased, Pleural effusion, Pleural thickening, Positive airway pressure therapy, Protein total normal, QRS axis abnormal, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width normal, Respiratory failure, SARS-CoV-2 test positive, Scoliosis, Serum ferritin increased, Staphylococcus test positive, Supraventricular tachycardia, Tracheal deviation, Unresponsive to stimuli, Ventricular extrasystoles, Ventricular fibrillation, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (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), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 1
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: tylenol 1000 mg every 6 hrs prn, proventil 2.5 mg/3ml -2.5 mg by neb every 4 hrs prn, maalox 30 ml QID, lac-hydrin 12% lotion, prn, eliquis 5 mg BID, ASA 81 mg daily, lipitor 80 mg nightly, atorvastatin 80 mg nightly, dulcolax 10 mg supposi
Current Illness:
Preexisting Conditions: Pre-Existing Active Problems Diagnosis Date Noted POA Acute CHF (congestive heart failure) 02/18/2020 Unknown Abscess of hip, right 02/18/2020 Unknown NSTEMI (non-ST elevated myocardial infarction) 08/08/2018 Unknown BPH without urinary obstruction 08/08/2018 Unknown Pulmonary embolism/infarction Unknown Hyperlipidemia Unknown Carotid artery occlusion without infarction Unknown Atherosclerosis of native coronary artery Unknown Congestive heart failure 03/04/2016 Unknown
Allergies: peaches
Diagnostic Lab Data: Peripheral Blood Culture Collected: 11/16/21 1107 Order Status: Completed Specimen: Blood, Venous Updated: 11/18/21 1202 Cult Blood Peripheral No Growth 48 hours Peripheral Blood Culture (Abnormal) Collected: 11/16/21 1051 Order Status: Completed Specimen: Blood, Venous Updated: 11/18/21 1014 Cult Blood Peripheral Staphylococcus hominis Abnormal Comment: (Coagulase-negative Staphylococcus) This is an edited result. Previous organism was Gram positive cocci in clusters on 11/17/2021 at 0350. Electrocardiogram, Complete Collected: 11/16/21 1202 Order Status: Completed Updated: 11/17/21 1424 Narrative: Ventricular Rate 198 BPM Atrial Rate 214 BPM QRS Duration 112 ms Q-T Interval 274 ms QTC Calculation(Bazett) 497 ms Calculated R Axis -75 degrees Calculated T Axis 90 degrees Diagnosis Supraventricular tachycardia with premature ventricular complexes or fusion complexes Left axis deviation Incomplete right bundle branch block Septal infarct (cited on or before 30-OCT-2017) Abnormal ECG When compared with ECG of 19-FEB-2020 17:22, Significant changes have occurred Confirmed by MD, on 11/17/2021 2:23:56 PM DR CHEST SINGLE VIEW Resulted: 11/17/21 1050 Order Status: Completed Updated: 11/17/21 1052 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/17/2021 10:42 AM TECHNIQUE: Single view chest INDICATION: covid pneumonia with pleural effusion COMPARISON: November 16, 2021 ENCOUNTER: Subsequent _________________________ FINDINGS: Chronic aortic ectasia and effacement of the trachea. The heart is enlarged. Chronic bilateral apical pleural thickening. Pleural effusions and hazy lung opacities persist however there has been improvement since the prior days exam. No pneumothoraces. Chronic scoliosis and cardiac postsurgical hardware _________________________ Impression: 1. Persistent effusions and airspace opacities however the chest is improving. Complete Blood Count without Differential (Abnormal) Collected: 11/17/21 0947 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1051 White Blood Cell 7.00 4.00 - 10.80 x10*3/uL Red Blood Cell 4.16 Low 4.60 - 6.00 x10*6/uL Hemoglobin 13.2 Low 14.0 - 18.0 g/dL Hematocrit 43.7 42.0 - 52.0 % Mean Cell Volume 105.0 High 80.0 - 100.0 fL Mean Cell Hemoglobin 31.7 27.0 - 33.0 pg NRBC Absolute Count 0.02 High 0.00 - 0.01 x10*3/uL NRBC Automated 0.3 High 0.0 - 0.1 %WBC Mean Cell Hemoglobin Concentration 30.2 Low 32.0 - 37.0 g/dL Red Cell Diameter Width 13.7 11.0 - 16.0 % Platelet 109 Low 140 - 400 x10*3/uL Mean Platelet Volume 11.1 High 7.4 - 11 fL Ferritin, Blood Level (Abnormal) Collected: 11/17/21 0948 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1041 Ferritin 3,581 High 24 - 336 mcg/L Comprehensive Metabolic Panel (CMP) (Abnormal) Collected: 11/17/21 0948 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1032 Sodium Level 145 134 - 146 mmol/L Potassium Level 6.4 High Panic 3.4 - 5.0 mmol/L Chloride 101 98 - 112 mmol/L HCO3 34 High 21 - 29 mmol/L Anion Gap 10 9 - 18 mmol/L Glucose Level 213 High 70 - 99 mg/dL Blood Urea Nitrogen 83 High 8 - 20 mg/dL Creatinine 2.64 High 0.60 - 1.30 mg/dL MDRD eGFR 24 Low $g=60 mL/min/1.73 m2 CG eCrCl 27 mL/min/1.73 m2 Calcium Level Total 8.8 8.6 - 10.4 mg/dL Protein Total 7.1 6.0 - 8.0 g/dL Albumin Level 2.6 Low 3.5 - 5.0 g/dL Bilirubin Total 0.4 0.2 - 1.0 mg/dL Alkaline Phosphatase 164 High 40 - 129 IU/L Alanine Aminotransferase 66 High 10 - 40 IU/L Aspartate Aminotransferase 146 High 10 - 40 IU/L D-Dimer (Abnormal) Collected: 11/17/21 0948 Order Status: Completed Specimen: Blood, Venous Updated: 11/17/21 1031 D-Dimer Quant 1,380 High 0 - 500 ng/mL FEU
CDC Split Type:

Write-up: "Deceased (11.17.21); Hospitalized (11.16.21); COVID-19 positive (11.13.21); Fully vaccinated. x2 Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: CO2 narcosis [R06.89] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] COVID-19 [U07.1] Acute respiratory failure with hypoxia and hypercapnia [J96.01, J96.02] HOSPITAL COURSE: 73 yo male who is a resident of facility. Patient presented to the emergency room with several days of worsening dyspnea and decreased responsiveness. He had had a positive COVID-19 test on November 13. In the emergency department he had a blood gas demonstrating a pH of 7.16 with a P CO2 of 104. He was do not resuscitate and do not intubate status. He was treated with BiPAP in the emergency department and had improvement in his blood gas to a pH of 7.26 and pCO2 of 75, with resulting improved alertness. He was admitted to intensive care unit and started on IV remdesivir and IV Decadron and was continued on BiPAP. A repeat blood gas at 1:55 a.m. showed pH 7.04 and a pCO2 of 120, and was associated with decreased responsiveness.. He subsequently had oxygen desaturation and became completely unresponsive. In the morning repeat arterial blood gas showed a pH of 6.83 with a pCO2 greater than 150. I contacted his legal guardian and reported his declining condition with a grave prognosis. He subsequently developed bradycardia followed by ventricular fibrillation and expired at 10:56 a.m..


VAERS ID: 1880917 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-10-06
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Cancer surgery, Death, Post procedural complication, SARS-CoV-2 test positive, Surgery, Vaccine breakthrough infection
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), 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: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Post Vaccine Breakthrough. Was seen in clinic on 10/06/2021 for failing surgical site following surgery for cancer. Surgeon admitted tot the hospital for failing surgical site and was found to be positive for Covid 19 on admission due to routine swab. During hospital stay resident continued to require multiple surgical interventions and did pass away on 10/26/21 at hospital. Does not appear that death was related to Covid but likely due to Cancer diagnosis with poor surgical outcome.


VAERS ID: 1880937 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-08-22
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Mental disorder, Metabolic encephalopathy, Positive airway pressure therapy, SARS-CoV-2 test positive, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-31
   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: PMH: ESRD, CHF, seizure disorder; hypothyroidism; hypercoagulable state, on chronic Coumadin; to ED due to altered mental state; AFR and positive for COVID; placed on BiPAP; condition worsened; to ICU; COVID protocols followed; metabolic encephalopathy; DNR; sepsis and shock; pt died in the hosp


VAERS ID: 1881100 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-16
Onset:2021-10-29
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / N/A UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Ascites, Atrial fibrillation, Cholecystitis, Condition aggravated, Death, Endocarditis, Hepatic cirrhosis, Intestinal perforation, Mental status changes, Sepsis, Streptococcal bacteraemia
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Gastrointestinal perforation (narrow), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: olmesartan-hydrochlorothiazide 20-12.5 mg daily metoprolol succinate 25 mg daily eplerenone 25 mg daily cyclobenzaprine 5 mg tid anastrazole 1 mg daily lasix 20 mg daily methimazaole 5 mg
Current Illness:
Preexisting Conditions: Aortic stenosis s/p TAVR Atrial fibrillation Hypertension Diastolic heart failure History of brain tumor (unknown type) s/p resection x 15 years History of breast cancer Alzheimer''s disease
Allergies: codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found down at her assisted living facility. Admitted to hospital with altered mental status, severe sepsis secondary to cholecystitis, atrial fibrillation, new diagnosis of cirrhosis with ascites (unknown etiology), streptococcal bacteremia from infective endocarditis. Hospitalization then complicated by bowel perforation, patient transitioned to comfort care and passed away.


VAERS ID: 1881203 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-14
Onset:2021-11-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Death, Dyspnoea, Feeling of body temperature change, Lethargy, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: High blood pressure
Preexisting Conditions: In good health prior to death
Allergies: Unknown
Diagnostic Lab Data: A COVID nasopharyngeal was obtained at examination on 11/18/2021, and has been sent to the Lab for testing.
CDC Split Type:

Write-up: The decedent received his Johnson and Johnson COVID 19 vaccine on 11/14/2021. After receiving the vaccine, the decedent started to experience difficulty breathing, chest pain, hot and cold flashes, fevers and lethargy. The decedent did not receive any treatment prior to death.


VAERS ID: 1881209 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-11-11
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Breath sounds abnormal, COVID-19, Carotid pulse abnormal, Death, Endotracheal intubation, Extubation, Heart sounds abnormal, Lower gastrointestinal haemorrhage, Pupillary light reflex tests abnormal, Restlessness, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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 (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Akathisia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (broad), Glaucoma (narrow), Retinal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   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 (TYLENOL) 325 MG tablet aluminum, magnesium & simethicone 200-200-20 MG/5ML SUSP suspension atorvastatin (LIPITOR) 80 MG tablet bisacodyl (DULCOLAX) 10 MG suppository calcium carbonate (TUMS) 500 MG chewable tablet cyanocobala
Current Illness:
Preexisting Conditions: Macular atrophy, retinal - Both Eyes Seasonal allergic rhinitis due to pollen Arthritis Mild episode of recurrent major depressive disorder Type 2 diabetes mellitus without complication Neuromyositis Gastroesophageal reflux disease without esophagitis Pure hypercholesterolemia Benign essential HTN Acquired hypothyroidism Chronic bilateral low back pain with bilateral sciatica Mitral valve insufficiency Thyroid nodule Heart murmur Spinal stenosis of lumbar region with neurogenic claudication Gait abnormality Hypomagnesemia Vitamin D deficiency Vitamin B 12 deficiency Esophageal dysphagia Late onset Alzheimer''s disease without behavioral Subarachnoid hemorrhage Subdural hematoma Hypertension Hyperlipidemia Diabetes mellitus
Allergies: Red Dye Cephalexin Diazepam Latex Methylprednisolone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased 11/13/2021; Hospitalized 11/11/2021; COVID-19 positive 11/11/2021; fully vaccinated. BRIEF OVERVIEW: Admission Date: 11/11/2021 Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Lower GI bleed COVID-19 HOSPITAL COURSE: 88 year old female that presented on 11/11/21 for severe covid-19 infection. Patient was initially intubated in the ED for Acute hypoxic respiratory failure 2? COVID. However during the day 11/12/21 family meeting was held and patient''s family decided to withdraw care. Patient was initially placed on Venti mask after extubation. However during the night of the 13th to 14th patient developed terminal restlessness. Morphine drip was started and family was contacted. Patient passed away on 11/13/21 at 9:29pm. Daughter was at bedside. Patient had no response pain, no heart/lung sounds over 2 mins, no carotid pulse over 2 minutes, and no pupillary reaction to light. Time of death was called at 9:29 pm.


VAERS ID: 1881210 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-09-30
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
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: Positive COVID test 9/14/21
CDC Split Type:

Write-up: Patient death 9/30/2021


VAERS ID: 1881273 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-21
Onset:2021-05-17
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death - Symptoms unknown


VAERS ID: 1881307 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-04-14
Onset:2021-11-08
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Cerebral haemorrhage, Death, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (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: 2021-11-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100 My bid Maxalt 10 MGqd prn migraine Carafate 1 gm po bid Coumadin 7.5 MG po qd Desyrel 100 mg po qd Wellbutrin XL 300 mg po qd Pepcid 40 mg po bid Synthroid 175 mcg po qd Indocin 50 mg po tid
Current Illness: Acid reflux Adenomatous polyp and FHx Colon Ca: repeat 5 yrs Back injury non surgical candidate per Dr Breast cancer screening she states yearly at Advanced Imaging and completed in 2013 and declines having my office set up another mammogram (OV 2/10/14) Degenerative arthritis of left knee s/p arthroscopy for meniscal tear (2014) Depression Diarrhea resolved/ negative colon biopsies DVT (deep venous thrombosis) (HCC) right common femoral to saphenous vein- Coumadin lifelong H/O Hashimoto thyroiditis dx''d by Bx by Dr; not on supplements Hx of bronchitis Immunization due tDAP 2009; receives yearly flu vaccines (OV 2/10/14) Lactose intolerance Migraine normal MRI/MRA CMC Multinodular goiter s/p thyroidectomy (2017) Neck pain Obesity negative overnight oximetry 3/2001; but continues to respectfully decline further sleepeval/study (OV 2/10/14) Pulmonary emboli (HCC) multiple PE''s (2012); w/ h/o prior DVT: life long Coumadin Sinusitis Superficial phlebitis left leg Tubulovillous adenoma polyp of colon negative random bx for colitis
Preexisting Conditions: Acid reflux Adenomatous polyp and FHx Colon Ca: repeat 5 yrs Back injury non surgical candidate per Dr Breast cancer screening she states yearly at Advanced Imaging and completed in 2013 and declines having my office set up another mammogram (OV 2/10/14) Degenerative arthritis of left knee s/p arthroscopy for meniscal tear (2014) Depression Diarrhea resolved/ negative colon biopsies DVT (deep venous thrombosis) (HCC) right common femoral to saphenous vein- Coumadin lifelong H/O Hashimoto thyroiditis dx''d by Bx by Dr; not on supplements Hx of bronchitis Immunization due tDAP 2009; receives yearly flu vaccines (OV 2/10/14) Lactose intolerance Migraine normal MRI/MRA CMC Multinodular goiter s/p thyroidectomy (2017) Neck pain Obesity negative overnight oximetry 3/2001; but continues to respectfully decline further sleepeval/study (OV 2/10/14) Pulmonary emboli (HCC) multiple PE''s (2012); w/ h/o prior DVT: life long Coumadin Sinusitis Superficial phlebitis left leg Tubulovillous adenoma polyp of colon negative random bx for colitis
Allergies: PRoton pump inhibitors
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Status: Final Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX Specimen Collection Date/Time: 2021-11-08 05:07:00.0 Results: * Resulted Test: SARS-CoV-2 RNA Resp Ql NAA+probe Coded Result: DETECTED Numeric Result: Units: Text Result: Reference Range From: Not Detected Reference Range To: Performing Facility Details: Date/Time: 2021-11-08 06:21:00.0 Performing Facility: HOSPITAL Interpretation: Very abnormal Result Method: LAB DEVICE: CEPHEID GENEXPERT DX SYSTEM Status: Final
CDC Split Type: 1338988

Write-up: Case suffered massive brain bleed and cardiac arrest while Covid positive 6 months after completing the Covid vaccine. Case died.


VAERS ID: 1881316 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-10-30
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test 10/10/2021
CDC Split Type:

Write-up: Patient death 10/30/2021


VAERS ID: 1881317 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-08
Onset:2021-10-30
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Acute left ventricular failure, Acute pulmonary oedema, Acute respiratory failure, Alanine aminotransferase normal, Albumin globulin ratio decreased, Alcohol abuse, Anion gap normal, Anticoagulant therapy, Arteriosclerosis, Ascites, Aspartate aminotransferase normal, Atrial fibrillation, Basophil count decreased, Basophil percentage decreased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood culture negative, Blood glucose increased, Blood magnesium normal, Blood phosphorus normal, Blood potassium normal, Blood sodium decreased, Blood thyroid stimulating hormone normal, Blood urea increased, Blood urea nitrogen/creatinine ratio increased, Carbon dioxide decreased, Cardiac failure congestive, Cardiac ventricular thrombosis, Cardiogenic shock, Cardiomegaly, Chronic left ventricular failure, Computerised tomogram abdomen abnormal, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Condition aggravated, Death, Differential white blood cell count abnormal, Diverticulum, Eosinophil count decreased, Eosinophil percentage decreased, Full blood count, Globulins increased, Glomerular filtration rate increased, Glycosylated haemoglobin normal, Haematocrit decreased, Haemoglobin decreased, Hyponatraemia, Hypothyroidism, Intensive care, Leukocytosis, Liver function test abnormal, Lymphocyte count increased, Lymphocyte percentage increased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Mental status changes, Metabolic acidosis, Metabolic encephalopathy, Monocyte count normal, Monocyte percentage decreased, Neutrophil count increased, Neutrophil percentage decreased, Oedema, Platelet count decreased, Protein total normal, Pulmonary congestion, Red blood cell count decreased, Red cell distribution width increased, SARS-CoV-2 test negative, Thrombocytopenia, Ultrasound kidney normal, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Agranulocytosis (broad), Angioedema (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (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) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypothyroidism (narrow), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-03
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ampicillin-sulbactam 3 g Intravenous Q6H o aspirin 81 mg Oral Daily o digoxin 125 mcg Intravenous Every Other Day o furosemide 80 mg Intravenous Q8H o LORazepam o mupirocin 0.5 g Nasal BID o tamsulosin
Current Illness:
Preexisting Conditions: 1. Acute on chronic systolic CHF (congestive heart failure) (8/11/2021) 2. Metabolic acidosis, 3. Leukocytosis (10/30/2021) 4. Metabolic encephalopathy (10/30/2021) 5. Acute respiratory failure with hypoxia (11/2/2021) 6. Acute pulmonary edema with congestive heart failure (11/2/2021) 7. Elevated alkaline phosphatase level (8/11/2021) 8. Hyponatremia (10/30/2021) 9. Abnormal LFTs (10/30/2021) 10. New onset atrial fibrillation (10/31/2021) 11. History of alcohol abuse (8/11/2021) 12. Left ventricular thrombus (8/15/2021) 13. Chronic anticoagulation with Eliquis (8/21/2021) 14. Alcohol abuse (10/30/21) 15. Thrombocytopenia (10/30/2021) 16. Hypothyroidism (11/2/2021)
Allergies: No known allergies
Diagnostic Lab Data: Results for patient as of 11/18/2021 17:58 11/3/2021 10:34 Sodium: 118 (LL) Potassium: 4.5 Chloride: 86 (L) CO2: 13 (L) Glucose: 326 (H) BUN: 61 (H) Creatinine: 1.97 (H) BUN/Creat Ratio: 31.0 Total Protein: 6.5 Albumin: 2.7 (L) Globulin: 3.8 Albumin/Globulin Ratio: 0.7 (L) Calcium: 7.5 (L) Bilirubin-Total: 5.3 (H) ALT/SGPT: 33 AST/SGOT: 28 Alkaline Phosphatase: 338 (H) Estimated GFR: 36 (L) Estimated GFR: 44 (L) Phosphorus: 3.4 Magnesium: 1.8 Anion Gap: 19 (H) PTT: 63.2 (H) WBC: 24.41 (H) RBC: 3.70 (L) HGB: 11.1 (L) HCT: 35.3 (L) MCV: 95.4 MCH: 30.0 MCHC: 31.4 Platelet Count: 89 (L) MPV: 13.0 (H) Differential Type: Hospital CBC w/AutoDiff NEUT%: 46.6 LYM%: 51.2 (H) Mono%: 1.5 EOS%: 0.1 BASO%: 0.2 IG%: 0.4 EOS#: 0.02 NRBC%: 0 Absolute Neutrophil Count: 11.38 (H) Baso#: 0.04 Red Cell Distribution Width-CV: 17.3 (H) Absolute Lymphocyte Count: 12.50 (H) Monocyte Absolute: 0.37 Immature Granulocyte Abs: 0.10 10/30/21 COVID-19 RESULT Not Detected Not Detected
CDC Split Type:

Write-up: 11/3/21 Altered Mental Status Per EMS, neighbors called for altered mental status, unknown last known well. Per neighbors, pt is usually A&Ox4. Per EMS, pt follows commands, unable to answer any questions. Cardiogenic shock Procedures: 1. CT head: No acute disease 2. CT chest noncontrast: Acute on chronic pulmonary vascular congestion. Marked cardiomegaly. 3. CT abdomen/pelvis: Perihepatic and upper abdominal and pelvic ascites with moderate body wall edema. Advanced atherosclerosis. Mild diverticular disease 4. Renal ultrasound: Normal 5. Blood cultures: No growth 6. COVID-19: Negative 7. Hemoglobin A1c: 8.4 8. TSH: 6.8 10/30/21: This patient was a 49-year-old male with a past medical history significant for chronic systolic CHF with EF 14%, type II poorly controlled diabetes mellitus, LV thrombus on Eliquis, hypertension, chronic kidney disease, history of alcohol abuse, and a history of medical noncompliance who presented to hospital secondary to an altered mental status. She was admitted to the intensive care unit for cardiogenic shock secondary to an acute on chronic systolic CHF and metabolic encephalopathy. The patient was seen and evaluated by the heart failure group at which time it was noted that this patient has remained noncompliant in the outpatient setting as well. Over the course of his hospitalization, multiple discussions took place regarding his status. He eventually agreed to DNR status. He did require multiple continuous drips that included dopamine, Neo-Synephrine, Levophed, vasopressin, milrinone, heparin, amiodarone, Bumex, Precedex, and dopamine drips during the hospitalization. Unfortunately, given his noncompliance, there was little that could be done. Despite multiple continuous drips, the patient eventually expired on November 3, 2021 at 1924.


VAERS ID: 1881335 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-03
Onset:2021-10-10
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test 10/2/2021
CDC Split Type:

Write-up: Patient death 10/10/2021


VAERS ID: 1881373 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-10-25
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN) 650 MG o atorvastatin (LIPITOR) 80 MG tablet, Take 80 mg by mouth nightly. o clopidogrel (PLAVIX) 75 MG tablet, Take 75 mg by mouth nightly. o fexofenadine (ALLEGRA) 180 MG tablet, Take 1
Current Illness:
Preexisting Conditions: AAA (abdominal aortic aneurysm) states had 4 aneurysms - has had surgery o Bruises easily o CHF (congestive heart failure) 10/04/2021 o Diabetes mellitus Type II o Full dentures o HOH (hard of hearing) o Hyperlipidemia o Hypertension o Lymphoma current o Osteoarthritis o Stroke 2003 o Subdural hematoma 01/2018 right hand weakness
Allergies: No Known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10/25/21-Patient listed as deceased as of this date, no records of where or why


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