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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 90 out of 227

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VAERS ID: 1881390 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-21
Onset:2021-11-09
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL6201 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Acute kidney injury, Acute respiratory failure, Blood bilirubin increased, Bronchial secretion retention, Bronchoalveolar lavage, Bronchoscopy, Computerised tomogram head, Computerised tomogram spine, Computerised tomogram thorax, Culture positive, Dizziness, Dyspnoea, Echocardiogram, Endotracheal intubation, General physical health deterioration, Gram stain, Haemofiltration, Hypoxia, Intensive care, Legionella test positive, Leukocytosis, Liver function test increased, Pneumonia, Renal impairment, Sepsis, Urine analysis abnormal, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban 5 mg Oral 2 times daily Ascorbic Acid 250 MG
Current Illness:
Preexisting Conditions: 1. Community-acquired pneumonia 2. Severe sepsis 3. Acute respiratory failure 4. Acute on chronic kidney failure
Allergies: No known allergies
Diagnostic Lab Data: 11/8/21 RPP Comment Negative Legionella Antigen Urine POSITIVE Abnormal Culture, Bronchial Washing Status: Final result-Gram stain-rare squamous epithelial cells, WBC
CDC Split Type:

Write-up: 11/8/2021 1. Community-acquired pneumonia 2. Severe sepsis 3. Acute respiratory failure 4. Acute on chronic kidney failure 5. Elevated LFTs and bilirubin


VAERS ID: 1882915 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-22
Onset:2021-11-16
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM

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

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: DM; a-fib; PVD; CAD; HTN; HLD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccincated, complications of covid death


VAERS ID: 1884228 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Immunisation
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 INC202101573681

Write-up: patient may have died due to the Pfizer Booster dose of the covid vaccine; Booster; This is a spontaneous report from Pfizer from a contactable consumer. A male patient of an unspecified age received third booster dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number: Unknown, Expiry date: unknown), via an unspecified route of administration on an unspecified date as a single dose for covid-19 immunization. The patient medical history and concomitant medications were not reported. Historical vaccine included first and second dose of bnt162b2 via an unspecified route of administration on an unspecified date both as a single dose for COVID-19 immunization. On an unknown date it was reported that patient may have died due to the Pfizer Booster dose of the covid vaccine. Cardiologist that may have died was alleged to social media and he would not put too much credibility on that and states the cardiologist did die and the reporter did internet research, and he had no verification from the vaccine, but it was a claim they are after. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for BNT162B2 was not provided and will be request during follow-up. ; Reported Cause(s) of Death: patient may have died due to the Pfizer Booster dose of the covid vaccine


VAERS ID: 1884298 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood test normal, Death, Food refusal, Laboratory test normal, Organic brain syndrome, Pain, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-06
   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: Conjestive Heart Failure, Dementia
Preexisting Conditions: Conjestive Heart Failure, Dependent on oxygen
Allergies:
Diagnostic Lab Data: Lab work was done, blood work done week of Oct. 25. All came back clear, her vitals were good!!
CDC Split Type:

Write-up: My Mother, at 92, almost 93, was given the Booster shot on Oct. 12. Although she had the start of Dementia, Mom was still Mom. After the booster, Mom went into a spiral downfall. The Dr. diagnosed her with Organic Brain Syndrome. My mother passed away Nov. 6, 2021. She had stopped eating, was in pain, could not speak from approximately Oct 22 - Nov 6. Organic Brain Syndrome is triggered by too many toxins in your body. At 92, her body was not equipped to take such a powerful vaccination and my sisters, nurse and I believe the Booster pushed her into a toxic state that escalated her untimely death.


VAERS ID: 1884611 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pancreatic carcinoma
SMQs:, Non-haematological malignant tumours (narrow)

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

Write-up: died of pancreatic cancer; This spontaneous case was reported by a consumer and describes the occurrence of PANCREATIC CARCINOMA (died of pancreatic cancer) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) 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. On an unknown date, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PANCREATIC CARCINOMA (died of pancreatic cancer) (seriousness criteria death and medically significant). The reported cause of death was Pancreatic cancer. It is unknown if an autopsy was performed. Reporter stated that the patient was fine beforehand and used to run marathons. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: This case concerns a male patient of an unknown age with no relevant medical history, who experienced the unexpected event of Pancreatic Cancer. The event occurred approximately 6 months after receiving an unknown dose number of mRNA-1273 Vaccine and had a fatal outcome, with death occurring around the same time. The reported cause of death was Pancreatic cancer. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a male patient of an unknown age with no relevant medical history, who experienced the unexpected event of Pancreatic Cancer. The event occurred approximately 6 months after receiving an unknown dose number of mRNA-1273 Vaccine and had a fatal outcome, with death occurring around the same time. The reported cause of death was Pancreatic cancer. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Reported Cause(s) of Death: pancreatic cancer


VAERS ID: 1884880 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-01
Onset:2021-08-12
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bronchogram abnormal, COVID-19, Cardiomegaly, Chest X-ray abnormal, Cough, Interstitial lung disease, Lung consolidation, Pneumonia, Pulmonary hilar enlargement, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   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: Amlodipine, Neurontin, Hydroxyzine, Loratadine, Lexapro, Atorvastatin, Ezetimbe, Norco, insulin, Linzess, Nexium Levalbuterol, prednisone, losartan, flexeril, spironlactone, Victoza, K-tab, Lyrica, topiramate, lasix, folic acid, oxcarbazepi
Current Illness: CHF, Sarcodosis, Type 2 DM, CKD, Obstructive Sleep Apnea, Hypertension, obesity, asthma
Preexisting Conditions: See above
Allergies: MSG, Coconuts, Latex, Carbamazepine, tape adhesive
Diagnostic Lab Data: See above re: Covid testing. 08/10/2021: Chest X-ray-Consolidation left mid lung likely associated with air bronchograms. Mild patchy interstitial opacities in right lung base. Findings are suspicious for multifocal pneumonia. Consider Covid test correlation. The cardiomediastinal silhouette appers mildly pronounced and there is mild prominence of the bilateral hilum. As the patient has history of mediastinal and bilateral hilar lymphadenopathy, consider constrast-enhanced Chest CT.
CDC Split Type:

Write-up: Pt had first Pfizer Covid vaccine on 01/08/2021 Lot: EL140. Pt reported that symptoms of fever and cough began on 08/07/2021. On 08/09/2021, pt went to ER and tested positive for Covid. Called the office on 08/11/2021 to report Covid symptoms; advised to call hospital and arrange for Monoclonal Antibody Therapy. Also, to return to ER if symptoms worsen. Coroner''s office was called on 08/12/2021 per friend after well check by PD. Explained to clerk at Coroner''s Office what VAERS Reporting entails. Clerk was unsure and asked that clinic submit report. Autopsy Report signed on 11/03/2021 Findings: 1. Complications of Covid-19 infection A. Positive NP swab for covid B. Several day history of fever. 2. Diabetes mellitus and kidney failure


VAERS ID: 1884995 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-09-06
Onset:2021-11-06
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stroke, death


VAERS ID: 1885027 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-20
Onset:2021-05-27
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-06
   Days after onset: 102
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: first shot
Other Medications: yes
Current Illness: arthritis
Preexisting Conditions: osteo arthritis
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1885029 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-11
Onset:2021-11-13
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Adrenal mass, Alveolar lung disease, Arteriosclerosis, Ascites, Atelectasis, Blood culture negative, COVID-19, Central venous catheterisation, Chest X-ray, Colectomy, Colon cancer metastatic, Computerised tomogram abdomen abnormal, Condition aggravated, Death, Deep vein thrombosis, Dyspnoea, Echocardiogram, Echocardiogram normal, Ejection fraction normal, Endotracheal intubation, Explorative laparotomy, Gastrointestinal carcinoma, Hypotension, Inferior vena caval occlusion, Intensive care, Intestinal perforation, Large intestinal obstruction, Lung disorder, Lung opacity, Lymphadenopathy mediastinal, Mechanical ventilation, Metastases to liver, Metastases to lung, Metastases to pelvis, Metastases to peritoneum, Necrotic lymphadenopathy, Oedema, Osteolysis, Pleural effusion, Pneumonia, Pneumoperitoneum, Portal vein occlusion, Renal atrophy, Retroperitoneal neoplasm metastatic, SARS-CoV-2 test positive, Scan with contrast abnormal, Sepsis, Septic shock, Shock, Small intestinal resection, Spinal compression fracture, Splenic infarction, Tenderness, Thrombosis, Vena cava filter insertion
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), 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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal perforation (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   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: baclofen (LIORESAL) 10 MG tablet fentaNYL (DURAGESIC) 25 MCG/HR patch LORazepam (ATIVAN) 0.5 MG tablet mirtazapine (REMERON) 7.5 MG tablet naloxone (NARCAN) 4 mg/0.1 mL LIQD nasal liquid ondansetron (ZOFRAN) 8 MG tablet oxyCODONE 10 M
Current Illness:
Preexisting Conditions: Circulatory Acute deep vein thrombosis (DVT) of femoral vein of both lower extremities Digestive Colon cancer metastasized to multiple sites Therapeutic opioid induced constipation GI bleed Nausea Unspecified severe protein-calorie malnutrition Nervous Cancer related pain Other Encounter for consultation Secondary malignant neoplasm of bone Opioid use agreement exists Advanced care planning/counseling discussion Loss of appetite Shock Multiple comorbid conditions
Allergies: No Known Allergies
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time CV Echo Limited with Contrast Collected: 11/14/21 0808 Order Status: Completed Updated: 11/14/21 0900 Narrative: Heart Center LIMITED ECHOCARDIOGRAPHY REPORT Name: Patient Study Date: 11/14/2021 MRN: Patient Location: DOB: Patient Class: Inpatient Gender: Male Ordering Physician: MD Age: 62 yrs Height: 183 cm Performed By: RDCS Weight: 76 kg Resting HR: 113 BSA: 2.0 m2 Resting BP: 94/58 mmHg Reason For Study: Hypotension/shock, ., shock History/Symptoms: Covid 19, Shock,. Cancer Electronically signed by: MD on 11/14/2021 09:00 AM Interpretation Summary The left ventricular ejection fraction is 60%. The left ventricle is normal in size. No regional wall motion abnormalities noted. Right ventricular function cannot be assessed due to poor image quality. No pericardial effusion. There is no comparison study available. STUDY PERFORMED/QUALITY: A limited two-dimensional transthoracic echocardiogram was performed (2D). The technical quality of the exam was fair. Due to limited acoustic windows, Definity was administered. The study was done portable in the ICU. LEFT VENTRICLE: The left ventricle is normal in size. The left ventricular ejection fraction is 60%. The LV ejection fraction was determined utilizing visual estimation. No regional wall motion abnormalities noted. RIGHT VENTRICLE: Right ventricular function cannot be assessed due to poor image quality. PERICARDIUM/PLEURAL: No pericardial effusion. INFERIOR VENA CAVA: The inferior vena cava is normal in size (less than or equal to 2.1 cm) without assessment for collapse during patient sniff. Tricuspid Valve Great Vessels RAP systole: 3.0 mmHg IVC diam: 1.0 cm ______________________________________________________________________________ Reference Table: Normal Mild ModerateSevere Men LVEF $g 52% 41-51% 30-40% <30% Women LVEF $g 54% 41-53% 30-40% <30% Men LVIDd 4.2-5.8 5.9-6.3 6.4-6.8 $g6.8 Women LVIDd 3.8-5.2 5.3-5.6 5.7-6.1 $g6.1 LA Volume (ml/m^2) < 34 35-41 42-48 $g48 ______________________________________________________________________________ Electronically signed by: MD on 11/14/2021 09:00 AM All sources of data reside in the Cardiology PACS EJECTION FRACTION ECHO Collected: 11/14/21 0808 Order Status: Completed Updated: 11/14/21 0900 EJECTION FRACTION ECHO 60 % DR CHEST SINGLE VIEW Resulted: 11/14/21 0330 Order Status: Completed Updated: 11/14/21 0332 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/14/2021 2:50 AM TECHNIQUE: Portable upright AP INDICATION: Line and Endotracheal tube placement (Left IJ central line) COMPARISON: 11 hours earlier ENCOUNTER: Not applicable _________________________ FINDINGS: Interval intubation with the endotracheal tube tip 6 cm above the carina. New left internal jugular catheter with tip in the mid superior vena cava. Unchanged right-sided infusion port. New enteric tube coursing below the diaphragm and off the inferior aspect of the film with sidehole at the level of the gastroesophageal junction. Improved lung volumes. Normal heart size. Worsening bibasilar alveolar opacification. Persistent and probably unchanged right pleural effusion. No pneumothorax. _________________________ Impression: 1. Endotracheal tube 6 cm above the carina. 2. Enteric tube sidehole at the gastroesophageal junction. Recommend advancing several centimeters. 3. Appropriately positioned left internal jugular catheter. No pneumothorax. 4. Worsening bibasilar atelectasis and pneumonia with unchanged right pleural effusion. CT ABDOMEN AND PELVIS WITH IV CONTRAST Resulted: 11/13/21 1947 Order Status: Completed Updated: 11/13/21 1949 Narrative: EXAMINATION: CT Abdomen and Pelvis with IV Contrast EXAM DATE: 11/13/2021 5:54 PM TECHNIQUE: CT imaging of the abdomen and pelvis was performed with intravenous contrast. Coronal and sagittal images were reconstructed. CONTRAST: The amount and type of contrast are recorded in the medical record. QPP DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: Sepsis, sepsis, abd pain and tenderness COMPARISON: None ENCOUNTER: 10/21/2021 ____________________ FINDINGS: Lung Bases: Patchy airspace disease throughout the visualized lower lungs. Bilateral nodular opacity, may be infectious or neoplastic. Small-moderate bilateral pleural effusions. Partially necrotic mediastinal lymph nodes are partially imaged. Hepatobiliary: Innumerable hepatic metastases are not substantially changed from the recent comparison CT. Chronic occlusion of the left portal vein. The gallbladder is unremarkable. No biliary ductal dilatation. Pancreas: Normal. Spleen: The spleen is not enlarged. Heterogeneous enhancement of the spleen, may be perfusional or represent splenic infarcts. Adrenals: Left adrenal nodules have increased in size. The dominant left adrenal nodule measured 2 cm. The right adrenal gland is normal. Kidneys, Ureters, & Bladder: Small atrophic left kidney. No hydronephrosis. The urinary bladder is unremarkable. Gastrointestinal: Large irregular cecal mass is similar to prior examination. Mild diffuse small bowel distention without discrete transition point, may be on the basis of ileus. Reproductive Organs: Unremarkable. Lymphatic System: Multiple mesenteric, retroperitoneal, and pelvic nodal metastases, significant increased in size from the prior examination. Necrotic lymph node within the mid mesentery measures 3 x 1.7 cm. A right external iliac node measures 2.5 x 2 cm. Vasculature: The abdominal aorta is normal in caliber. Moderate atherosclerotic plaque. Interval placement of an IVC filter. Large thrombus within the IVC extending cephalad to the filter is also new from the comparison study. Stable left portal vein occlusion. Probable right femoral DVT. Peritoneum: Small scattered pneumoperitoneum is new from the prior examination and is likely related to perforation of the colonic mass (5:55). Moderate-large volume ascites, new/increased from prior examination. Several soft tissue tissue peritoneal metastases are again noted. Dominant peritoneal metastasis in the hepatorenal fossa is similar. Abdominal Wall & Musculoskeletal: Diffuse body wall edema. Stable severe T8 compression fracture. Lytic lesions involving the right sacrum and left ilium are similar and suspicious for osseous metastases. ____________________ Impression: 1. New small scattered pneumoperitoneum, likely related to perforation of the large right colonic mass. 2. Moderate-large volume ascites, substantially increased from prior. 3. Interval IVC filter placement. New large IVC thrombus which extends cephalad to the IVC filter. 4. Innumerable hepatic, left adrenal, and nodal metastases as above. Findings of peritoneal carcinomatosis and probable osseous metastases are also noted. 5. Extensive airspace disease in the visualized lower lungs. Bilateral nodular opacities are indeterminate but suspicious for metastatic disease. Mediastinal lymphadenopathy is partially imaged and also suspicious for metastatic disease. 6. New small bilateral pleural effusions. DR CHEST SINGLE VIEW Resulted: 11/13/21 1542 Order Status: Completed Updated: 11/13/21 1544 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/13/2021 2:56 PM TECHNIQUE: Single view chest INDICATION: Shortness of breath. COMPARISON: CT of the chest, abdomen, and pelvis 10/21/2021. ENCOUNTER: Not applicable _________________________ FINDINGS: Right chest port terminating in the lower SVC. The cardiomediastinal silhouette is unremarkable. There is a small right pleural effusion and there are patchy opacities at the lung bases. There is no pneumothorax. _________________________ Impression: Patchy opacities at the lung bases with a small right pleural effusion. Procedure Component Value Ref Range Date/Time Central Line Blood Culture (Normal) Collected: 11/13/21 1330 Order Status: Completed Specimen: Blood, Central Line Updated: 11/18/21 1502 Cult Blood Central Line No bacteria or yeast isolated Peripheral Blood Culture Collected: 11/13/21 1227 Order Status: Completed Specimen: Blood, Venous Updated: 11/18/21 1402 Cult Blood Peripheral No bacteria or yeast isolated COVID-19 PCR (Abnormal) Collected: 11/13/21 1508 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 11/13/21 1658 COVID-19 PCR Detected Abnormal
CDC Split Type:

Write-up: Patient expired 11/15/2021. HOSPITAL COURSE: PRESENTING PROBLEM: Shock [R57.9] Colon cancer metastasized to multiple sites [C18.9] Septic shock [A41.9, R65.21] Small bowel cancer [C17.9] Patient is a 62 y.o. male with history of metastatic stage 4 colon cancer who presented to the emergency department with new bowel perforation of a known right colonic mass. He was hypotensive and unstable at the time of presentation. He was taken for an emergent exploratory laparotomy with a right colectomy and small bowel resection. During the case, he had increasing pressor requirements and worsening hypotension. Decision was made to transfer to the SICU and leave the patient in discontinuity with an abthera for temporary closure. Patient was therefore transferred to the SICU. He was started on multiple pressors including norepinephrine, vasopressin, and epinephrine to maintain his blood pressure. Despite these interventions, he continued to be unstable. Family made the decision to make him DNR/DNI, however with continued aggressive care and interventions on 11/14. He continued to be on the ventilator with progressively increasing pressor requirements. On the morning of 11/15, family made the decision to transition to comfort care measures. Propofol was stopped, and pressors were stopped shortly after. Family desired extubation and patient was extubated at 0625. Time of death was 0647 on 11/15/2021 Preliminary Cause of Death: Colon cancer metastasized to multiple sites


VAERS ID: 1885034 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-26
Onset:2021-11-09
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

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

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

Write-up: DEATH


VAERS ID: 1885098 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-27
Onset:2021-11-19
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated. Hospitalized on 11/03/2021. Expired on 11/19/2021


VAERS ID: 1885160 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-17
Onset:2021-09-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Death, Diabetes mellitus inadequate control, Malaise
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Death
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died 7 days after shot after shot had uncontrolled sugar levels could not get sugar up and felt sick 2 days after and died 7days later


VAERS ID: 1885300 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-11-09
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Non-ST elevation (NSTEMI) myocardial infarction Acute kidney failure, unspecified Thrombocytopenia, unspecified


VAERS ID: 1885309 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-02
Onset:2021-11-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - TIA (transient ischemic attack) - Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC)


VAERS ID: 1885318 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-26
Onset:2021-11-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EFD0809 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Subarachnoid haemorrhage, Subdural haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - Nontraumatic subarachnoid hemorrhage, unspecified - Nontraumatic subdural hemorrhage, unspecified


VAERS ID: 1885324 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-28
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death I63.9 - Cerebral infarction, unspecified J96.01 - Acute respiratory failure with hypoxia J12.82 - Pneumonia due to coronavirus disease 2019 N17.9 - Acute kidney failure, unspecified


VAERS ID: 1885346 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-03
Onset:2021-11-17
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death- Acute kidney failure, unspecified


VAERS ID: 1885359 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-09-21
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Facial paralysis, Mental status changes, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-08
   Days after onset: 48
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death ALTERED MENTAL STATUS FACIAL DROOP G45.9 - Transient cerebral ischemic attack, unspecified


VAERS ID: 1885363 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-19
Onset:2021-10-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Disseminated intravascular coagulation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death- Disseminated intravascular coagulation (defibrination syndrome)


VAERS ID: 1885417 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-22
Onset:2021-04-01
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Blood test, Computerised tomogram, Creutzfeldt-Jakob disease, Death, Irritability, Lumbar puncture, Magnetic resonance imaging, Motor dysfunction
SMQs:, Peripheral neuropathy (broad), Dementia (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 211
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT scan 9/10/2021 MRI 9/24/21 multiple blood tests and Lumbar Puncture late September 2021
CDC Split Type:

Write-up: what began as memory loss and irritability was followed by loss of motor skills, later diagnosed as Cruetzfeldt-Jakobs disease. Death occurred early morning 10/29/2021.


VAERS ID: 1885523 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / UNK LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaemia, Condition aggravated, Diet refusal, Haemoglobin decreased, Unresponsive to stimuli
SMQs:, Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), 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: Clindamycin, allopurinol, Tylenol, oxycodone prn,
Current Illness: anemia with guiac positive stools (suspect lower GI bleed), cellulitis/toe wound
Preexisting Conditions: gout, dementia, peripheral vascular disease
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did not want dinner that evening. Found unresponsive in bed around 7pm. Patient had known severe anemia (HgB6.9) with decision to forgo additional transfusion or GI workup.


VAERS ID: 1885533 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Cerebral arteriosclerosis, Death, Hyperlipidaemia
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Ischaemic central nervous system vascular conditions (narrow), Lipodystrophy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: The patient was prescribed amlodipine (heart medicine) and Lipitor.
Current Illness: 2019-Time of Death: Hypertension, Wernicke?s encephalopathy 2020- Time of Death: Liver cirrhosis, history of TIAs, unspecified chronic kidney disease (stage 3), 2021- Time of Death: Hyperlipidemia
Preexisting Conditions: 2019-Time of Death: Hypertension, Wernicke?s encephalopathy 2020- Time of Death: Liver cirrhosis, history of TIAs, unspecified chronic kidney disease (stage 3), 2021- Time of Death: Hyperlipidemia
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 77 year-old female patient. Patient was a resident of a facility for approximately two years prior to death. Patient received three doses of the Pfizer vaccine. The first was on 1/03/2021, the second was on 1/24/21 and the third was on 9/30/2021, according to immunization records. The patient passed away on 9/30/2021 (the same day the third dose was received) in nursing facility. The death certificate lists ?Cerebral Arteriosclerosis (1 year)? as the immediate cause of death. Prior medical information (obtained from facility) includes: 2019-Time of Death: Hypertension, Wernicke?s encephalopathy 2020- Time of Death: Liver cirrhosis, history of TIAs, unspecified chronic kidney disease (stage 3), 2021- Time of Death: Hyperlipidemia The patient was prescribed amlodipine (heart medicine) and Lipitor.


VAERS ID: 1885536 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-18
Onset:2021-11-01
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

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

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: not listed
Current Illness: not listed
Preexisting Conditions: Squamous cell carcinoma of skin of scalp and neck, Diagnosed 4/26/2021
Allergies: Oxycodone-aspirin
Diagnostic Lab Data: Not listed
CDC Split Type:

Write-up: Nothing listed


VAERS ID: 1885574 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-01
Onset:2021-10-21
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 3 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Breast cancer female, Metastases to bone, Triple positive breast cancer
SMQs:, Breast malignant tumours (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet Take 500 mg by mouth
Current Illness: 9/28/2021 history of an early stage right breast cancer
Preexisting Conditions: Right breast cancer, stage 1 IDC with mucinous component receptor + Her-2 -, lumpectomy/xrt/tamoxifen for 5 years,
Allergies: Alendronate, Povidone, Iodine
Diagnostic Lab Data: Not listed
CDC Split Type:

Write-up: Not listed.


VAERS ID: 1885595 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   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: Had been in hospital to "rule out stroke". It was ruled out.
Preexisting Conditions: CHF, COPD, HTN, Orthostatic Hypotension, A-Fib, DM type II.
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt began complaining of inability to catch his breath. This was 5 and half hours after receiving 1st dose of vaccine. He became unresponsive. CPR was initiated, 911 arrived and took him to ER. He was given numerous doses of epinephrine, and other advanced cardiac life saving meds, as well as intubated, and all life save measures given over the course of an hour. He was pronounced dead at the emergency room by the ER physician.


VAERS ID: 1885720 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-29
Onset:2021-08-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Hypertensive heart disease, Ketoacidosis, Vaccination complication
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan 50mg; Tamsulosin 0.4 mg; docusate sodium 100mg; aspirin 81 mg
Current Illness:
Preexisting Conditions: HTN, Hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found deceased in facility. Medical Examiner cause of death: A. Ketoacidosis B. due to COVID-19 vaccination complicating undiagnosed diabetes mellitus. Contributory: Hypertensive cardiovascular disease.; Autopsy report was signed on 11/4/2021


VAERS ID: 1885770 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-03
Onset:2021-02-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 9265 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Blood test normal, Caffeine consumption, Cardioversion, Death, Resuscitation, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Metformin, Fish oil, Electrolites, Vit C, Vit B-12, CoQ10
Current Illness: Type 2 Diabetes which was under control by Metformin -
Preexisting Conditions: none other
Allergies: none
Diagnostic Lab Data: The autopsy done the very next day showed he did not have a heart attack and he did not have a stroke. The sent his blood off to be analyzed and the only thing found in his blood was caffeine (he drank coffee in the AM). The official death certificate says he died of unknown causes.
CDC Split Type:

Write-up: On February 4th, 2021 patient died suddenly while skiing. About 2 PM, there was no accident, he was found laying down in the snow and the first to find him gave him CPR - ski patrol came quickly and shocked him three times. But none of these brought him back. He was already gone.


VAERS ID: 1885858 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 - / JET

Administered by: Private       Purchased by: ?
Symptoms: Cerebral thrombosis, Cerebrovascular accident, Death, Fall
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), Accidents and injuries (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: namenda nanoxen losartan
Current Illness: none
Preexisting Conditions: atherosclerosis asthma
Allergies: penicillin
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: she woke up normal, she went to her room for her prayers, and that''s when she fell out of her chair with a stroke. she was brought to the hospital immediately and was confirmed to have had blood clot in her brain. She was hospitalized from 11/09/2021 and passed away on11/19/2021.


VAERS ID: 1887636 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-20
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: USJNJFOC20211136879

Write-up: DEATH; This spontaneous report received from a consumer concerned a 60 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, 1 total, start therapy date was not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, "Consumer mentioned he heard of a 60 year old woman dying". The patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0: 20211136879-covid-19 vaccine ad26.cov2.s-Death. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1887894 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-27
Onset:2021-11-12
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

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: Warfarin, potassium, phenazopyridine, iferex, finaseride, tamsulosin, furosemide, pantoprazole, Prednisone, gabenpantin, metropolo, trelegy, diazapame
Current Illness: COPD, congestive heart failure, hypertension
Preexisting Conditions: COPD, congestive heart failure, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rapid declining health and death 14 days after covid booster shot


VAERS ID: 1888822 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-29
Onset:2021-11-20
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-11-21
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: 2021-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired


VAERS ID: 1888979 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-04
Onset:2021-08-25
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-25
   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: Ambien
Current Illness: None
Preexisting Conditions: None known
Allergies: None
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: My brother died from a heart attack just 21 days after receiving his Moderna vaccine.


VAERS ID: 1889080 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-18
Onset:2021-11-20
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 3 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood lactic acid increased, Cardiogenic shock, Computerised tomogram abdomen abnormal, Death, Echocardiogram abnormal, Ejection fraction decreased, Hypotension, Left ventricular dysfunction, Peripheral venous disease, Pulseless electrical activity, Scan with contrast abnormal, Troponin increased
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Complete Heart Block s/p Permanent Pacemaker, atrial fibrillation, diabetes, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was in his usual state of health until 48 hours after receiving his 3rd "booster" Moderna COVID vaccine. He presented in cardiogenic shock as evidenced by hypotension, elevated lactate, CT imaging showing reversal/reflux of contrast in the IVC and hepatic veins, and echo showing severe LV dysfunction (EF 10%) with a prior echo that was EF 50% in 2020. The patient suffered refractory hypotension despite efforts to maintain blood pressures with multiple pressors and eventually developed PEA arrest. Troponin minimally positive on admission and rose to a high level, suggesting a possible etiology of myocardial infarction (likely LAD territory based on echo) versus myocarditis as a result of the vaccine booster. The patient unfortunately was pronounced deceased on 11/21/21 about 8 hours after presentation to the ED.


VAERS ID: 1889084 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-01-11
Onset:2021-01-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Cerebrovascular accident, Computerised tomogram, Magnetic resonance imaging
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   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: B12 SPIRIVA LEVITHYROX METOPROLOL FINESTEROID 1-ZETIA MYRBETREQ TOLTERODINE
Current Illness: HIGH BP BPH HOH SNORING
Preexisting Conditions: AMBULATION DIFFICULTY
Allergies: LYRICA NATUMSTOME ZOCOR
Diagnostic Lab Data: CT MRI Angiograph
CDC Split Type:

Write-up: CVA on 1/14/21


VAERS ID: 1889159 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-01
Onset:2021-11-18
   Days after vaccination:321
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain injury, Cerebrovascular accident, Magnetic resonance imaging abnormal, Mechanical ventilation
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), Acute central respiratory depression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-01
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: N/A
Preexisting Conditions:
Allergies: Cats
Diagnostic Lab Data: MRI
CDC Split Type:

Write-up: Patient found on floor, taken to ER via ambulance, placed on ventilator, MRI determined patient suffered a stroke and had zero brain activity or chance of recovery.


VAERS ID: 1889162 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-04-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Death, Malaise
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-16
   Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Date problems began were right after the shot. Patient died on 7/16/2021.
Preexisting Conditions: Emphysema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had booster. Don''t have her card with me. Very sick, totally weak.


VAERS ID: 1889448 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-18
Onset:2021-11-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   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: Morphine Sulfate Concentrate 20mg/ml, Tylenol 325mg, Med Pass supplement, Diltiazem 60mg,
Current Illness: History of GI bleed, On Hospice at the time of vaccine administration
Preexisting Conditions: History of GI bleeds, Alzeimer''s disease, COPD, CVA, HTN, CHF, Lyme Disease, PVD
Allergies: Propoxyphene, Animal Dander
Diagnostic Lab Data: None due to Hospice level of care.
CDC Split Type:

Write-up: Resident had significant decline in condition on 11/21/2021, Resident passed away the morning of 11/22/2021.


VAERS ID: 1889704 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-11-21
   Days after vaccination:286
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired.


VAERS ID: 1889749 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-11
Onset:2021-11-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired.


VAERS ID: 1889901 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-10-21
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, Fall, Fatigue, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (narrow), 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: 25
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: albuterol (VENTOLIN HFA) 108 (90 BASE) MCG/ACT HFA inhaler aspirin (HALFPRIN) 81 MG tablet dorzolamide (TRUSOPT) 2 % ophthalmic solution ferrous sulfate (FEOSOL, 65 FE,) 325 (65 FE) MG tablet furosemide (LASIX) 40 MG tablet guaiFENesin (ROB
Current Illness: None known
Preexisting Conditions: H/O heart valve replacement with bioprosthetic valve for AS with 21 Magna Valve Hypercholesteremia Chronic fatigue History of permanent cardiac pacemaker placement; Medtronic July 2017 Florid cirrhosis OSA on CPAP Cerebellar infarct Mobitz type 1 second degree AV block Bilateral carotid artery disease; bilat; 50-69% stenosis Vertigo, central Abnormality of gait due to impairment of balance Malignant neoplasm of urinary bladder, unspecified site Blind left eye BPH (benign prostatic hyperplasia) Carotid stenosis GERD (gastroesophageal reflux disease) Glaucoma Essential hypertension Hyperlipidemia Acquired hypothyroidism Actinic keratosis Vitamin D deficiency Acquired urinary meatal stenosis Rheumatoid arthritis involving multiple sites with positive rheumatoid factor Idiopathic chronic gout of multiple sites without tophus Cirrhosis Thrombocytopenia Acute on chronic congestive heart failure, unspecified heart failure type Acute respiratory failure due to COVID-19 Injury due to fall, initial encounter Acute kidney injury
Allergies:
Diagnostic Lab Data: COVID-19 positive on 10/21/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 10/21/2021 following a fall and generalized fatigue. He was found to be COVID-19 positive. His symptoms were relatively mild during admission. He was treated with dexamethasone and albuterol inhaler. He was discharged to home with home health care on 11/2/2021. He was readmitted on 11/4/2021 for increased weakness and rehab placement. He was treated with dexamethasone and supplemental oxygen and discharged on 11/9/2021 to a rehab facility. Patient expired on 11/15/2021.


VAERS ID: 1889986 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-08
Onset:2021-06-01
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Chemotherapy, Death, Dyspnoea, Echocardiogram abnormal, Myocarditis
SMQs:, Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 116
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: Synthroid eliquis lisinopril metoprolol tamsulosin simvastatin
Current Illness: stage 4 sarcoma Heart failure
Preexisting Conditions: diabetes HTN A fib
Allergies: None
Diagnostic Lab Data: Echo on 5/20/21 shows critical result with EF 15% MRI. of heart done 6/1/21. shows myocarditis
CDC Split Type:

Write-up: On 5/18/2021 patient admitted in Hospital with SOB Patient died 9/25/21 in hospice care Also significant- Patient had about 5 days of Votrient (half dose) before this episode. He had just started this chemo agent.


VAERS ID: 1890018 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-17
Onset:2021-11-20
   Days after vaccination:276
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: NO LOT NUMBER PROVIDED. BOTH DOSES OF VACCINE ENTERED INTO THE STATE SYSTEM AS "HISTORICAL DOSES" BY MEDICAL GROUP. BREAKTHROUGH CASE; COVID RELATED DEATH


VAERS ID: 1890024 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-12
Onset:2021-11-20
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Public       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: 2021-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Metastatic melanoma, CAD, afib, hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Pfizer given 2/19/2021 lot # EN6203 Patient had a cardiac arrest at home and died in the emergency room.


VAERS ID: 1890159 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-10-10
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood culture positive, Blood gases abnormal, Bronchoscopy abnormal, COVID-19, Chest X-ray abnormal, Computerised tomogram abdomen normal, Computerised tomogram head normal, Computerised tomogram thorax normal, Death, Endotracheal intubation, Fraction of inspired oxygen, Hypercapnia, Intensive care, Klebsiella infection, Lung disorder, Malaise, Mechanical ventilation, Prone position, Pyrexia, Respiratory acidosis, SARS-CoV-2 test positive, Sputum culture positive, Staphylococcal infection, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Lactic acidosis (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), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-04
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See prior VAERS submission from initial hospitalization: 685006 (patient now deceased)
Current Illness: See prior VAERS submission from initial hospitalization: 685006 (patient now deceased)
Preexisting Conditions: See prior VAERS submission from initial hospitalization: 685006 (patient now deceased)
Allergies: See prior VAERS submission from initial hospitalization: 685006 (patient now deceased)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is now deceased. Date of Death: 11/4/21 Time of Death: 2:37 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19 See prior VAERS submission from initial hospitalization: 685006 (patient now deceased) HOSPITAL COURSE: Patient is a 69 y.o. male PMHx notable for history of cardiac sarcoidosis, persistent atrial fibrillation and PVCs (hx of watchman not on AC), CKD, COPD, insulin dependent type 2 diabetes. He was admitted on 10/12 for acute hypoxic respiratory failure secondary to COIVD-19. Symptom onset was 10/8, positive test on 10/10 and intubated and transferred to the ICU on 10/16. S/p 5 day course of ceftriaxone and azithromycin (10/12-10/16). Proning (10/17-10/19). No remdesivir given due to CKD. Patient received 10 day course of decadron for covid-19 infection. Was continued on steroids afterwards, tapering down to daily dose of 10mg. Was placed on endotool for insulin-dependent type 2 diabetes worsened by steroids. Sputum culture on 10/24 grew klebsiella and he was subsequently started on Zosyn and vancomycin. De-escalated to rocephin following susceptibilities for 7 day course. Throughout admission in ICU patient was on volume control, and we attempted to wean FIO2 as tolerated. He was being considered for tracheostomy as he had been intubated for 2 weeks, however this was limited by inability to tolerate lower vent settings. He continued to spike fevers in the days before his death. Chest x-rays demonstrated diffuse airspace disease bilaterally, stable in right lung with progression in left lung. A CT thorax/abdomen/pelvis and CT sinus were ordered to try to locate any foci of infections however were negative. WCC were not elevated, cultures from bronchoscopy grew klebsiella. One peripheral blood culture grew staph haemolyticus, subsequent cultures negative. He was started on vancomycin and zosyn on 11/2. The 72 hours before his death he began experiencing worsening hypoxemia, requiring increased FiO2. He was on lung protective setting and permissive hypercapnia. On the day of his death his respiratory failure worsened further, and he required escalating pressors to maintain MAPs $g65. He was on 100% FiO2 and asynchronous. Sedation was increased and paralytic started. Despite adjusting vent settings multiple times his SpO2 remained in the 70s. ABG also demonstrated worsening respiratory acidosis. Goals of care discussion was held with patients wife, two daughters and son. The decision was made to transition to comfort care. He was taken off the paralytic, with goal to make the patient comfortable. He passed peacefully at 14:37 surrounded by family.


VAERS ID: 1890192 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-09-27
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated with Pfizer vaccine. Last dose on 2/26/2021. Tested positive for COVID 19 on 9/27/2021. Admitted to Medical Center on 11/13/2021 related to COVID and expired on 11/13/2021 while still hospitalized.


VAERS ID: 1890222 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-06
Onset:2021-11-19
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 3 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   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:
Current Illness: Cardiac cachexia
Preexisting Conditions: Cardiac cachexia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1890266 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-02-01
Onset:2021-02-28
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Heart meds
Current Illness:
Preexisting Conditions: COPD Pace maker Heart complications
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clot


VAERS ID: 1890301 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-29
Onset:2021-10-24
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, Echocardiogram abnormal, Ejection fraction normal, Embolism venous, Fibrin D dimer increased, Imaging procedure abnormal, Lung disorder, Pulmonary embolism, Pulmonary hypertension, Respiratory disorder, Right atrial dilatation, Ultrasound Doppler normal, Ventilation/perfusion scan abnormal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, amLODIPine, atorvastatin, azelastine, BASAGLAR KWIK; carvediloL, doxazosin, fluticasone propionate, hydrALAZINE, ipratropium, nitroglycerin, omeprazole, tamsulosin, torsemide, TRULICITY
Current Illness:
Preexisting Conditions:
Allergies: Janumet [Sitagliptin-metformin]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 63 y.o. male admitted on 10/19/21 with Covid-19 (symptom onset around 10/15) and admitted on 10/24 for worsening symptoms. He was treated with decadron and tocilizumab. Remdesivir was contraindicated due to CKD IV. Due to worsening respiratory status and elevated d-dimer he had V/Q scan on 11/1 which was low probability for a PE. He has been transferred out of the Covid unit as he is off precautions. Initially he was being weaned from oxygen, awaiting a level low enough for discharge. He had increased oxygen requirements on 11/14. Pulmonary Medicine was consulted. It was opted to started empiric lovenox for VTE. Patient did not want to have CT for PE done, due to concern for contrast injury. needing dialysis. LE venous US was negative for DVT. V/Q scan was done on 11/16 with high probability for PE. TTE with evidence of severe pulmonary HTN, dilated RA but no evidence of RV Strain and normal LVEF. clinically worsening. Discussed imaging findings which suggest signficant lung damage likely still related to his COVID infection and PE


VAERS ID: 1890336 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-20
Onset:2021-11-06
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Atrial fibrillation, COVID-19, Cerebral haemorrhage, Cerebral infarction, Chronic kidney disease, Deafness neurosensory, Death, Glomerular filtration rate, Hemiparesis, Hemiplegia, Hypertension, Immunodeficiency, Renal transplant
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (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 (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was previously submitted to VAERS on 11/9/2021, VAERS E report # 706662 Updating with pt death 11/21/2021 Principal Problem: Cerebral Hemorrhage Active Problems: Debility Atrial Fibrillation Paroxysmal Transplant Renal Loss Hearing Sensorineural Medication Therapy Long Term Not Anticoagulant Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29 Immunodeficiency Due To Drugs Hypertension And Chronic Kidney Disease Stage 3 Hemiplegia And Hemiparesis Following Cerebral Infarction Affecting Left Nondominant Side COVID-19 Infection Acute Respiratory Failure With Hypoxia


VAERS ID: 1890705 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-18
Onset:2021-11-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood gases abnormal, Blood pH decreased, Carbon dioxide increased, Death, Intensive care, Pulse absent, Respiratory arrest, Resuscitation
SMQs:, Anaphylactic reaction (broad), Lactic acidosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   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: albuterol nebs, baclofen, vitamin D, flonase, glycopyrrolate, levetiracetam, nystatin topical, phenobarbital, Miralax, azithromycin, PRN tylenol and ibuprofen
Current Illness: Recent admission for rhino/enterovirus, mycoplasma pneumoniae ab+ for acute respiratory failure.
Preexisting Conditions: PMH of twin to twin transfusion born at erm, neuroimaging showed significant loss of gray-white matter, hydrocephalus s/p VP shunt, spastic CP, seizure disorder. Use CPAP at home at night.
Allergies: none known
Diagnostic Lab Data: Blood gas was done indicating pH<6, high CO2.
CDC Split Type:

Write-up: Due to patient''s complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine. Patient was moved from PICU to general peds floor due to improvement in condition on Thursday. Vaccine was administered that evening. Patient did well. Remained on room air. Was discharged home on Saturday. On Monday morning, father checked on patient and she was found pulseless and not breathing. It is unclear whether or not patient was placed on home CPAP during the night. EMS called. Patient arrived to ED as a CPR in progress. Patient presented with a pH of <6. Last known well 9pm the evening prior. Patient expired at 11/22/21 at 11:05 CST.


VAERS ID: 1890720 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-11-10
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Blood lactic acid, COVID-19, COVID-19 pneumonia, Cardiac arrest, Cardiac telemetry abnormal, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Death, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, General physical health deterioration, Heart rate increased, Hypertension, Hypotension, Hypothermia, Hypoxia, Laboratory test, Lung opacity, Nausea, Pleural effusion, SARS-CoV-2 test positive, Sepsis, Urinary tract infection, Urine analysis abnormal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), 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), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet artificial tears (PURALUBE/TEARS NATURALE) OINT ophthalmic ointment beclomethasone Diprop HFA (QVAR REDIHALER) 80 MCG/ACT inhaler benzonatate (TESSALON) 200 MG capsule bisacodyl (BISAC-EVAC) 10 MG suppo
Current Illness:
Preexisting Conditions: Asthma in adult, mild intermittent, uncomplicated HTN (hypertension) A-fib CHF (congestive heart failure) Nonischemic cardiomyopathy LVH (left ventricular hypertrophy) Mitral regurgitation Pulmonary HTN GERD (gastroesophageal reflux disease) Constipation Vitamin D deficiency Skin tag of anus Anemia, unspecified Ear drainage right Urinary incontinence CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Hypothyroidism Spinal stenosis, lumbar region, without neurogenic claudication OA (osteoarthritis) Basal cell carcinoma Rosacea Anxiety with depression Personal history of fall Mild cognitive impairment Trigger middle finger of right hand Medication management Daytime sleepiness Requires assistance with activities of daily living (ADL) Skin tear of left lower leg without complication Pressure injury of skin of left ankle, unspecified injury stage
Allergies: Desmopressin Ciprofloxacin Hair Booster Talwin Vibramycin Gabapentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased 11/12/2021; Hospitalized 11/11/2021; COVID-19 positive 11/10/2021; fully vaccinated BRIEF OVERVIEW: Discharge Provider: DO Primary Care Physician at Discharge: MD Admission Date: 11/11/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute UTI Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present COVID-19 HOSPITAL COURSE: Patient is a 88 y.o. female, with a PMH of atrial fibrillation, CHF, CKD stage 3, hypertension, asthma, depression, anxiety, chronic pain, hypothyroidism, mild cognitive impairment, who presented to the emergency department with ongoing nausea/vomiting and diarrhea. In the ED the patient was noted to be hypertensive with an elevated heart rate. EKG confirmed AFib with RVR. She was noted to be hypoxic and placed on 3 L. Laboratory evaluation revealed an elevated white blood cell count and a lactate of 5.6 which trended down to 5.1 following 1 L of normal saline. Chest x-ray showed extensive multifocal pulmonary opacities. CT of the abdomen and pelvis showed evidence of COVID-19 pneumonia with small to moderate pleural effusions and marked cardiomegaly. She did test positive for COVID-19. Urinalysis was suspicious for urinary tract infection. Patient was given a total of 2 L of normal saline, Decadron Rocephin. She was admitted to the hospitalist service for further care. She has an out of hospital DNR on file. Overnight her work of breathing increased as well as oxygen demand. She also became hyopthermic and hypotensive. Due to decline overnight and wishes to be DNR patient''s family was contacted and planned to be at bedside by morning however a RAP was called at 715am for hypotension. On evaluation the patient had no chest rise and was not breathing. Tele showed asystole. Pronunciation of death was completed at 0720 and family was informed (daughter and son-2 children. Her other son was not able to be reached) along with patients PCP. Death certification to be completed by admitting physician.


VAERS ID: 1892677 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Cerebral haemorrhage, Cerebral venous sinus thrombosis, Death, Imaging procedure, Nausea, Platelet count, Portal vein thrombosis, Thrombosis with thrombocytopenia syndrome, Visceral venous thrombosis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Platelet count; Result Unstructured Data: ranging from 10000 to 127000; Test Name: Imaging procedure; Result Unstructured Data: Cerebral Venous Sinus Thrombosis
CDC Split Type: USJNJFOC20211138044

Write-up: THROMBOTIC THROMBOCYTOPENIA; CEREBRAL VENOUS SINUS THROMBOSIS; SPLANCHNIC VEIN THROMBOSIS; PORTAL VEIN THROMBOSIS; INTRAPARENCHYMAL BRAIN HAEMORRHAGE; ABDOMINAL PAIN; BACK PAIN; NAUSEA; VOMITING; DEATH; This spontaneous report received from a consumer concerned multiple patients (6) of unspecified age and sex. The patients'' height, and weight were not reported. No past medical histories or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose, start therapy date were not reported for prophylactic vaccination. The batch numbers were not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, five patients presented with initial symptoms of headache and back pain in the sixth patient who subsequently developed headache (subsumed under CVST). It was reported that one patient also had abdominal pain, nausea, and vomiting. The four patients developed focal neurological symptoms focal weakness, aphasia, visual disturbance (subsumed under CVST) prompting presentation for emergency care. The median days from vaccination to hospital admission was 15 days (range 10 to 17 days). All were eventually diagnosed with cerebral venous sinus thrombosis (CVST) by intracranial imaging. The two patients were also diagnosed with splanchnic and portal vein thrombosis. It was unusual for patients presenting with thrombotic events, all six patients showed evidence of thrombocytopenia (less than 150,000 platelets per microliter of blood), consistent with a condition known as thrombotic thrombocytopenia, with platelet nadir counts ranging from 10,000 to 127,000 during their hospitalizations. It was reported that four patients developed intraparenchymal brain hemorrhage and one subsequently died. Laboratory data (dates unspecified) included: Imaging procedure (NR: not provided) Cerebral Venous Sinus Thrombosis, and Platelet count (NR: not provided) ranging from 10000 to 127000. On an unspecified date, one patient died from unknown cause of death. It was unspecified if an autopsy was performed. The outcomes for the multiple patients with cerebral venous sinus thrombosis, thrombotic thrombocytopenia, back pain, abdominal pain, nausea, vomiting, splanchnic vein thrombosis, portal vein thrombosis and intraparenchymal brain haemorrhage was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged). This case, from the same reporter is linked to 20210340967.; Sender''s Comments: V0: 20211138044- covid-19 vaccine ad26.cov2.s-thrombotic thrombocytopenia, Cerebral venous sinus thrombosis, splanchnic vein thrombosis, portal vein thrombosis. This event(s) is labeled per RSI and is therefore considered potentially related. 20211138044- covid-19 vaccine ad26.cov2.s-Death, intraparenchymal brain haemorrhage. 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: 1892683 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211140935

Write-up: RARE BLOOD CLOTS; This spontaneous report received from a consumer via a company representative concerned an adult female (older than 50 years) of unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown expiry: unknown) dose, therapy start date 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. On an unspecified date, the patient had rare blood clots (Clot blood) and died. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of rare blood clots was reported as fatal. This report was serious (Death). This case, from the same reporter is linked to 20210654540, 20211010045, 20210446964 and 20211023372.; Sender''s Comments: V0:20211140935- covid-19 vaccine ad26.cov2.s -rare blood clots. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: RARE BLOOD CLOTS


VAERS ID: 1892686 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient was healthy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211141837

Write-up: DEATH; This spontaneous report received from a consumer via social media (Twitter) via company representative concerned a patient of unspecified age and sex of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. Patient was healthy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number and expiry: Unknown) 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. Reporter stated that, on an unspecified date the patient who was perfectly healthy, died. Reportedly, reporter had guaranteed that patient would not had died from the treatment. The cause of death was unknown. It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was fatal. This report was serious (Death). This case, from the same reporter is linked to 20211141893.; Sender''s Comments: V0: 20211141837-COVID-19 VACCINE AD26.COV2.S-Death. This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1892837 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-01
Onset:2021-11-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: insulin
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath, followed by syncope and collapse and subsequently death


VAERS ID: 1892989 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pericardial effusion, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Boody pink fluid built up in his lungs; Bloody pink fluid built up around his heart; This spontaneous case was reported by a consumer and describes the occurrence of PULMONARY OEDEMA (Boody pink fluid built up in his lungs) and PERICARDIAL EFFUSION (Bloody pink fluid built up around his heart) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) 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. On an unknown date, the patient experienced PULMONARY OEDEMA (Boody pink fluid built up in his lungs) (seriousness criteria death and medically significant) and PERICARDIAL EFFUSION (Bloody pink fluid built up around his heart) (seriousness criteria death and medically significant). The reported cause of death was boody pink fluid built up in his lungs and bloody pink fluid built up around his heart. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment information was not provided. Patient was died 15 weeks after taking the vaccine. Company Comment: This case concerns a male patient (age not provided) with no relevant medical history, who experienced the unexpected events of Pulmonary Edema and Pericardial Effusion. The events occurred at unspecified interval after a dose of mRNA-1273 (Moderna covid-19 vaccine) and had a fatal outcome, with death occurring approximately 15 weeks after the dose. It''s unclear if it was the first or second dose. The rechallenge was not applicable, as the event happened after a dose and resulted in death. The benefit-risk relationship of mRNA-1273 (Moderna covid-19 vaccine) is not affected by this report.; Sender''s Comments: This case concerns a male patient (age not provided) with no relevant medical history, who experienced the unexpected events of Pulmonary Edema and Pericardial Effusion. The events occurred at unspecified interval after a dose of mRNA-1273 (Moderna covid-19 vaccine) and had a fatal outcome, with death occurring approximately 15 weeks after the dose. It''s unclear if it was the first or second dose. The rechallenge was not applicable, as the event happened after a dose and resulted in death. The benefit-risk relationship of mRNA-1273 (Moderna covid-19 vaccine) is not affected by this report.; Reported Cause(s) of Death: Boody pink fluid built up in his lungs; Bloody pink fluid built up around his heart


VAERS ID: 1893019 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Congestive heart failure; Lung disease; Type 2 diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: PCR test for SARS-CoV-2; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Breakthrough COVID-19 infection; This literature-study case was reported in a literature article and describes the occurrence of COVID-19 (Breakthrough COVID-19 infection) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Congestive heart failure, Lung disease and Type 2 diabetes mellitus. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced COVID-19 (Breakthrough COVID-19 infection) (seriousness criteria death and hospitalization). The reported cause of death was breakthrough covid-19 infection. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) Positive. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered COVID-19 (Breakthrough COVID-19 infection) to be possibly related. Patient was in Intensive care unit (ICU) and critical in covid-19 severity provided with Non-invasive positive pressure ventilation support. Patient was treated with immunosuppressive agent. Company Comment: This literature-study case concerns a 65-year-old female patient with relevant medical history of congestive heart failure, lung disease and type 2 diabetes and concurrent use of immunosuppressive agents, who experienced serious unexpected event of special interest (RA) COVID-19. The event occurred after the second dose of the Moderna COVID-19 Vaccine (mRNA-1273) however, the exact time to onset was not provided. The patient was admitted to the ICU due to critical COVID-19 with non-invasive positive pressure ventilation support. The patient passed away due to the event. Rechallenge was not applicable since the event occurred after the second dose so, no rechallenge was done and recurrence was not applicable. The benefit-risk relationship of drug is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 16-Nov-2021: Follow up received by safety on 16-Nov-2021 included an Email with RA received from RA team and does not contain any new information; Sender''s Comments: This literature-study case concerns a 65-year-old female patient with relevant medical history of congestive heart failure, lung disease and type 2 diabetes and concurrent use of immunosuppressive agents, who experienced serious unexpected event of special interest (RA) COVID-19. The event occurred after the second dose of the Moderna COVID-19 Vaccine (mRNA-1273) however, the exact time to onset was not provided. The patient was admitted to the ICU due to critical COVID-19 with non-invasive positive pressure ventilation support. The patient passed away due to the event. Rechallenge was not applicable since the event occurred after the second dose so, no rechallenge was done and recurrence was not applicable. The benefit-risk relationship of drug is not affected by this report.; Reported Cause(s) of Death: Breakthrough COVID-19 infection


VAERS ID: 1893302 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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 INC202101587440

Write-up: Passed away after taking the 2 first vaccines covid vaccines; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose 1, single, and via an unspecified route of administration on an unspecified date as dose 2, single for COVID-19 immunization. Medical history and concomitant medications were not reported. It was reported that the patient passed away after taking the 2 first vaccines COVID vaccines on an unspecified date. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible. Information about batch/lot number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Passed away after taking the 2 first vaccines covid vaccines


VAERS ID: 1893312 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-23
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 INC202101597828

Write-up: I now know 11 people who are dead due to these unnecessary evil non vaccines; This is a spontaneous report from a contactable consumer. This consumer reported for eleven patients. This case is part of a batch of eleven cases reporting dead for BNT162B2. This is the second of eleven people. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: Not reported, Expiration date: Unknown), via an unspecified route of administration on an unspecified date as dose number unknown, single for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. Reporter stated that now he knew eleven people who were dead due to these unnecessary evil non-vaccines. The patient died due to unknown cause of death on an unspecified date. It was not reported if an autopsy was performed. The lot number for the vaccine [BNT162B2] was not provided and will be requested during follow up.; Reported Cause(s) of Death: I now know 11 people who are dead due to these unnecessary evil non vaccines


VAERS ID: 1893326 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-22
Onset:2021-10-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Arrhythmia, Cardiac failure congestive, Immunisation, Myocardial infarction
SMQs:, Cardiac failure (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-30
   Days after onset: 4
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: Medical History/Concurrent Conditions: COVID-19 (If covid prior vaccination: Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101618999

Write-up: Booster; Congestive Heart Failure; Arrhythmia; Heart Attack; This is a spontaneous report from a contactable consumer. An elderly female patient received bnt162b2 (BNT162B2), dose 3 via an unspecified route of administration on 22Oct2021 (Batch/Lot number was not reported) as DOSE 3 (BOOSTER), SINGLE for covid-19 immunisation. Medical history included covid-19. Historical vaccine inlcuded bnt162b2 dose 1 on 06Jan2021 and dose 2 on 26Jan2021 both for COVID-19 Immunization.The patient''s concomitant medications were not reported. The patient experienced congestive heart failure (death, hospitalization, life threatening) on 26Oct2021, arrhythmia (death, hospitalization, life threatening) on 26Oct2021, heart attack (death, hospitalization, life threatening) on 26Oct2021. Therapeutic measures were taken Lavix, Nitro paste (nitroglycerin); Transferred back to Long-Term Care Facility. The patient died on 30Oct2021. Autopsy was not performed. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Reported Cause(s) of Death: Heart Attack; Arrhythmia; Congestive Heart Failure


VAERS ID: 1893708 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-10-21
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Swelling after pfizer vaccine
Other Medications: allopurinol (ZYLOPRIM) 100 MG tablet apixaban (ELIQUIS) 5 MG tablet atorvastatin (LIPITOR) 40 MG tablet (Expired) Blood Glucose Monitoring Suppl (ACCU-CHEK GUIDE ME) w/Device KIT calcium carbonate (TUMS) 500 MG chewable tablet Continuo
Current Illness:
Preexisting Conditions: Cardiovascular and Mediastinum Atrial fibrillation with RVR Atrial fibrillation, permanent Exhausted vascular access Respiratory Pneumonia Digestive GERD (gastroesophageal reflux disease) Chronic diarrhea Gastric outlet obstruction GI bleed Endocrine Proteinuria due to type 2 diabetes mellitus Type 2 diabetes mellitus with hemoglobin A1c goal of less than 7.5% Type 2 diabetes mellitus with diabetic neuropathy, with long-term current use of insulin Moderate nonproliferative diabetic retinopathy of both eyes without macular edema associated with type 2 diabetes mellitus Diabetic ketoacidosis without coma associated with type 2 diabetes mellitus Musculoskeletal and Integument DDD (degenerative disc disease), cervical Onychomycosis Genitourinary Acute kidney injury superimposed on CKD CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Pyelonephritis Other Gout, unspecified Low magnesium levels Monitoring for long-term anticoagulant use Leukocytosis Mixed hyperlipidemia Severe sepsis Chronic anticoagulation Bacteremia due to Klebsiella pneumoniae
Allergies: MetforminDiarrhea Sulfa AntibioticsDiarrhea Covid-19 Mrna Vaccine (Pfizer) [Covid-19 Mrna Vacc (Moderna)]Swelling Ace Inhibitors Aricept [Donepezil]Diarrhea
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt deceased. Unsure of reason for death


VAERS ID: 1893761 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-01
Onset:2021-03-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Arterial occlusive disease, Blood pressure abnormal, Cholecystectomy, Cholelithiasis, Death, Dysphagia, Haematemesis, Intensive care, Mechanical ventilation, Pancreatitis, Pyrexia, Sepsis, Surgery, Tachycardia, Tracheostomy, Vomiting
SMQs:, Acute pancreatitis (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 90 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Blood pressure
Current Illness: None
Preexisting Conditions: Copd, gout
Allergies: Heparin
Diagnostic Lab Data: hospital has all records
CDC Split Type:

Write-up: Received 1st injection in March. Had 2nd dose set up in 20 days but after 11 days was sent to hospital for throwing up and abdominal pain. Was diagnosed with full stones and pancreatitis. Had surgery to remove gull bladder. Sent home after a week but returned to hospital after 4 days with sepsis and put in icu. Had fever and tachycardia. Spent 45 days in hospital. Sent home with a thickened diet because had swallowing issues. After 4 days went back to hospital after throwing up blood and bile. Spent 2 months back in hospital with tachycardia and blood pressure issues. Had developed narcotic pancreatitis and had 2 more surgeries to fix a block in arteries. Put on vent twice and couldn?t get o2 levels regulated. Ended up with a Trach before going home with hospice and passing away 9 days later.


VAERS ID: 1893815 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-11-03
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Aortic aneurysm rupture, Back pain, Death, Resuscitation
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: resuscitated 3 times in ambulance, at hospital. Ultimately he did not survive!
CDC Split Type:

Write-up: Pain in back and high stomach area for 2 weeks. Ultimately resulted in aorta pulling away from stomach and causing repaired aneurysm to rupture.


VAERS ID: 1893818 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066F212 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   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: Rosuvastatin Calicum 20mg 1 daily Carvedilol 12.5mg 2 daily Tamsulosin HCL
Current Illness: none
Preexisting Conditions: Diabetes, high blood pressure, kidney failure, asthma, high cholesterol, obesity
Allergies: strawberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the Booster shot 12pm on 11/5/2021, had chest pain at 9pm 11/5/2021. Was hospitalized at 10pm on 11/5/2021. Heart stopped on 11/10/2021 was revived and placed on a ventilator. Heart stopped again on 11/11/2021 at around 7pm was again revived. Died on 11/13/2021


VAERS ID: 1893929 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-11-13
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Blood culture, Blood lactic acid normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Death, Hypotension, Lung opacity, Mental status changes, Pneumonia, Renal impairment, SARS-CoV-2 test positive, Sedation, Skin ulcer, Ulcer haemorrhage, Varicose vein, Venous ulcer pain, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (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: 2021-11-19
   Days after onset: 6
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) 650 MG suppository bisacodyl (DULCOLAX) 10 MG suppository fentaNYL 250 MCG/5ML SOLN in sodium chloride 0.9 % SOLN haloperidol (HALDOL) 2 MG/ML solution hyoscyamine (LEVSIN) 0.125 MG/ML solution LORazepam (LORAZEPAM I
Current Illness:
Preexisting Conditions: CAD (coronary artery disease) Hypertension Cardiac pacemaker in situ Pulmonary emboli PAF (paroxysmal atrial fibrillation) Venous stasis ulcer of other part of right lower leg with fat layer exposed with varicose veins Venous stasis ulcer of other part of left lower leg with fat layer exposed with varicose veins Chronic deep vein thrombosis (DVT) of femoral vein of right lower extremity PAD (peripheral artery disease) GERD (gastroesophageal reflux disease) Cellulitis of left foot Acute gout due to renal impairment involving left knee Protein C deficiency Protein S deficiency Sciatica Left hip pain Dyslipidemia Edema History of pulmonary embolism Lymphedema Insomnia Closed compression fracture of L4 lumbar vertebra with delayed healing, subsequent encounter AMS (altered mental status)
Allergies: Keflex Cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased 11/19/2021; Hospitalized 11/11/2021; COVID-19 positive 11/13/2021; fully vaccinated BRIEF OVERVIEW: Admission Date: 11/11/2021 Discharge Date: Nov 19, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Generalized weakness AKI (acute kidney injury) Altered mental status, unspecified altered mental status type Venous stasis ulcer of other part of left lower leg with fat layer exposed with varicose veins Venous stasis ulcer of other part of right lower leg with fat layer exposed with varicose veins Pneumonia due to COVID-19 virus COVID-19 AMS (altered mental status) HOSPITAL COURSE: 90 y.o. male who presents today from assisted living with one week of progressive generalized weakness and AMS. PMHx of venous stasis ulcers on legs chronic, unhealable, CAD, HTN, pacemaker, PAF, CKD3, h/o PE and DVT on Eliquis. Patient was actually enrolled in hospice recently to try to achieve better pain control for leg ulcers, despite life expectancy being $g6 months. He had been started on neurontin and hydromorphine, then the narcotic was changed to moprhine. Patient has CKD. In the ED he was noted to be COVID+ but on RA. He was admitted for further care. Neurontin and narcotics were held and patient''s mental status improved. Palliative care was consulted and began oxycodone for pain control. This was titrated up. Initially patient remained on RA and was symptoms free with the covid19 infection. Repeat CXR was consistent with multifocal PNA and PCR confirmed covid +. Was offered monoclonal AB treatment but declined. On 11/14 patient began declining again with AKI and hypotension and worsening AMS. Lactic acid was normal, WBC 11. CXR 11/14 showed new medial rt lung base opacities concerning for aspiration/PNA. Unchanged lt opacities. Blood cultures sent and zosyn given while ruling out superimposed bacterial infection. Given worsening renal function, despite patient not having had received narcotics in the past 12 hours, narcan was given with good response. Narcotics held. Patient was placed on IVFs and bolused. Starting on 11/14 patient began to have an O2 requirement and was started on Decadron. After initial narcan patient then had recurrent hypotension and sedation. 2nd narcan given with some response. At this point discussion was had with daughter regarding goals of care. As patient was at the beginning of his covid course, which was likely to continue to worsen, having AKI, AMS, and then bleeding and severe pain from his chronic LE venous ulcers, We made the decision to pursue comfort care. All aggressive interventions were discontinued and patient was started on comfort medications. Hospice were consulted. The patient was discharged home with hospice on 11/19/21.


VAERS ID: 1893982 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-11-10
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chest X-ray abnormal, Condition aggravated, Cough, Death, Diarrhoea, Dyspnoea, Endotracheal intubation, Hypervolaemia, Intensive care, Oedema, Oxygen saturation decreased, Paralysis, Polyuria, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (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: 2021-11-17
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization ALBUTEROL 108 (90 Base) MCG/ACT inhaler aspirin 81 MG EC tablet atorvastatin (LIPITOR) 20 MG tablet busPIRone (BUSPAR) 15 MG tablet Calcium Carbona
Current Illness:
Preexisting Conditions: Obstructive sleep apnea Chronic respiratory failure with hypoxia Chronic obstructive pulmonary disease, unspecified COPD type Acute respiratory failure Hypertension Acute on chronic diastolic heart failure Neuropathy Diabetic neuropathic arthropathy Acute hip pain, left Type 2 diabetes mellitus with diabetic nephropathy History of smoking 30 or more pack years Anasarca Decubitus ulcer of left buttock, stage 3 Decubitus ulcer of right buttock, stage 3 Venous stasis ulcer of other part of right lower leg limited to breakdown of skin without varicose veins Pelvic ring fracture with routine healing
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased 11/17/2021; Hospitalized 11/10/2021; COVID-19 positive 11/10/2021; fully vaccinated BRIEF OVERVIEW: Admission Date: 11/10/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure [J96.00] COVID [U07.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 57 y.o. female who initially presented on 11/10 for 3-4 days of worsening shortness of breath, diarrhea, and nonproductive cough. She had pitting edema and signs of fluid overload on CXR and was diagnosed with COVID on arrival. She is on 5 L oxygen at baseline and was started on high-flow nasal cannula and initially admitted to hospitalist service. She was diuresed aggressively. She was started on steroids; did not qualify for Remdesivir due to kidney function.Her oxygen requirements continued to increase and she was transitioned to 100% high-flow nasal cannula with non-rebreather mask. Overnight on 11/11, she desated into low 80s and was placed on BIPAP and transferred to ICU service due to concern for impending intubation. Her respiratory status declined and was intubated on 11/13. We had multiple conversations about her likely poor prognosis considering her baseline respiratory status, and patient elected to proceed with intubation at that time. She was sedated and paralyzed, and she subsequent required initiation of norepinephrine. Her respiratory status continued to worsen and we began proning on 11/14. She responded to proning and was continued on a 20:4 proning schedule. Palliative care was consulted on 11/15 after family expressed concern about patient''s grim prognosis and likelihood of tracheostomy and long-term care even if she survived this illness. On 11/16, palliative spoke with all first-degree relatives, and they decided to transition to DNR and comfort care. Paralytics turned off and patient pronounced dead on 11/17/21 at 12:45AM. Family at bedside, condolences offered.


VAERS ID: 1894184 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CONGESTIVE HEAR / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood potassium increased, Chronic kidney disease, Condition aggravated, Cough, Death, Gait inability, Hypervolaemia, Hypophagia, Hypotension, Oliguria, Pyrexia, Swelling, Urinary tract infection, Urine analysis abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-19
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tylenol#3, alprazolam, aspirin, calcitriol, Citrical + D, carvedilol, ferous sulfate, furosemide, lipitor, losartan, omeprazole, potassium, sertraline, tramadol
Current Illness: Congestive Heart Failure, Chronic Kidney Disease, Hypertension
Preexisting Conditions: Congestive Heart Failure, Chronic Kidney Disease, Hypertension, anemia of chronic disease, Type 2 diabetes, Arthritis, edema
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within a few days (at least by 9/6/2021) patient began to have fever and a cough. Patient began to progressively decline. Started with inability to ambulate. At baseline patient could ambulate independently in her assisted living room. Within days, she was no longer able to do so, her swelling worsened, and her oral intake declined. This time period was complicated by an elevated potassium that improved with oral hydration and it was rechecked and improved, but her decline continued. She was treated for a UTI from a gathered urine sample starting 9/7/21, but there is uncertainty to the extent it was either responsible or contributing to her declining status. Patient was carried to the office on 9/16/21. She was found to have an oxygen saturation of 79-81% on room air, she was too weak to hold her head up, and her swelling had increased. EMS was recommended for transport to the hospital and with some convincing with her son''s assistance, she finally agreed. Patient was transferred from the rural hospital to a tertiary center in city. She became severely oliguric. She was given IV furosemide that was not very effective. Patient was not only volume overloaded but also hypotensive requiring ionotropic treatment. Renal failure worsened and nephrology opinioned that she was a poor candidate for dialysis given her poor clinical condition and recommended hospice care. Patient died three days after admission on 9/19/21. Inpatient team determined that urinary tract infection did not appear to be septic in nature.


VAERS ID: 1894208 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-17
Onset:2021-11-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood lactic acid, Chest X-ray, Computerised tomogram head, Death, Dizziness, Fatigue, Full blood count, Generalised tonic-clonic seizure, Haemoptysis, Metabolic function test, Pain, Pyrexia, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-23
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Liver Cancer
Preexisting Conditions: Alzheimer''s and Liver cancer
Allergies: NKDA
Diagnostic Lab Data: Chest X-Ray, CT of head, Venous Lactic acid, CBC, COMP, and UA.
CDC Split Type:

Write-up: Pt stated the morning after getting his booster shot he had severe body aches, joint pain, severe fatigue and light headedness. On 11/20/2021 he reported he started coughing up blood. On 11/22/2021 he stated he had a fever and ended up having a Grand Mal Seizure. All symptoms lasted until he was pronounced dead on 11/23/2021.


VAERS ID: 1894216 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-11
Onset:2021-11-11
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M208 / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, 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: 2021-11-20
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pos on admission 11.11.21
CDC Split Type:

Write-up: SOB resp failure


VAERS ID: 1894478 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-11
Onset:2021-11-18
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiogenic shock, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: pos 11.18.21
CDC Split Type:

Write-up: cardiogenic shock


VAERS ID: 1894487 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-05
Onset:2021-11-17
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Apnoea, Breath sounds abnormal, COVID-19, Cardiac arrest, Cardiogenic shock, Death, End-tidal CO2 decreased, Endotracheal intubation, Hypoxia, Pulse absent, Resuscitation, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (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: 2021-11-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was an 88 y.o. female with complex past medical history coronary artery disease, congestive heart failure, CKD, COPD narcolepsy, recent diagnosis of COVID19 on 11/06, who presented to the emergency department in cardiac arrest. Pt arrived in cardiac arrest. Unresponsive with GCS of 3 and different exam as detailed in D/C . She was given another dose of epinephrine at time of arrival and given her shockable rhythm of Vfib pre-hospital, Doctor administered lidocaine. ACLS was continued with continuous chest compressions. Her first initial end-tidal that was obtained in the ED with 9. She was hypoxic at presentation to the 60s with symmetric coarse breath sounds bilaterally. Given the low end-trial and persistent hypoxia she was intubated. Tolerated well with no acute change. Following intubation, her oxygen saturations did temporally improved to the 90s and end-trial did temporally improve to 30; however, she remained pulseless, apneic, unresponsive and asystolic. Sodium bicarbonate was given as she was recently diagnosed with COVID-19 and concern for possible acidosis. ACLS was continued with continuous chest compression and pt. remained asystolic throughout her resuscitation in the ED. Family was available and was able to be with patient and was understandable and agreeable with termination of CPR given no ROSC after 60 minutes of resuscitation efforts. Time of Death was 12.53pm. on 11/17/20


VAERS ID: 1894527 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-16
Onset:2021-07-25
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0198/WALG 10 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Meds for diabetis n highblood pressure
Current Illness: None
Preexisting Conditions: Diabetis and highblook pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Could not breath, was admitted to Hosp on Aug 2, 2021 around 11a and passed away Aug 16, 2021


VAERS ID: 1894536 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-12
Onset:2021-11-19
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Ejection fraction decreased, Endotracheal intubation, Life support, Pulse absent, Resuscitation, Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: # Sudden Cardiac Death - The afternoon/evening of 11/20. patient was found to be without a pulse - ACLS performed with intubation, did obtain ROSC - While prepping to transfer to ICU, patient had recurrent loss pulse and ACLS resume - Event felt likely related to an arrhythmia due to her severely low ejection fraction - Family was contacted, requested that CPR be discontinued Time of Death: 1904


VAERS ID: 1894687 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 3 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Disease progression
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient expired (likely as a natural consequence of disease progression) on Hospice about 2 weeks after a C19 vaccine dose on 09/30/2021. Expired on 10/13/2021


VAERS ID: 1894700 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-17
Onset:2021-09-23
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-28
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Myeloma, Dialysis
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: The client was diagnosed with COVID-19 and was full-vaccinated. He was hospitalized from what appears to be September 24-25, 2021. He had co-morbid conditions (Myeloma, Kidney Failure, Diabetes, Dialysis) and passed away on September 28, 2021.


VAERS ID: 1894771 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-16
Onset:2021-10-06
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-16
   Days after onset: 41
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Diabetes
Preexisting Conditions: Diabetes
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death related to COVID illness


VAERS ID: 1894933 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-09-05
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248*SFSU / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264*SFSU / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-09
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. died in the hospital of complications of SARS CoV2 pneumonia. Underlying h/o chronic end-stage renal disease requiring hemodialysis preceding her acute illness.


VAERS ID: 1895092 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-27
Onset:2021-09-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: the vaccine recepient died 9/9/2021, 2 weeks after receiving the J&J covid vaccine


VAERS ID: 1895355 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-23
Onset:2021-10-26
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-02
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin Carbadopa levadopa Isosorbide Hydrchlorthiazide Amlodypine Atorvastatin Clapedigral Cisostizol Metoporol Rasagaline
Current Illness: Diabetic Parkinsons Coronary Artery Disease
Preexisting Conditions: See above
Allergies: None
Diagnostic Lab Data: CPR
CDC Split Type:

Write-up: Extreme fatigue stared several days after his covid booster. Then 8 days later he had a sudden cardiac arrest that resulted in death.


VAERS ID: 1896397 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Alanine aminotransferase, Aspartate aminotransferase, Autopsy, Blood alkaline phosphatase, Blood bilirubin, Blood creatinine, Blood culture, Blood fibrinogen, Blood pressure measurement, Body temperature, C-reactive protein, Chest X-ray, Computerised tomogram head, Cytomegalovirus test, Echocardiogram, Ehrlichia test, Ejection fraction, Fatigue, Fibrin D dimer, Gram stain, HIV antigen, Haematocrit, Haemoglobin, Heart rate, Histology, Influenza virus test, International normalised ratio, Lymphocyte count, Malaise, Microscopy, Monocyte count, Mononucleosis heterophile test, Multisystem inflammatory syndrome in adults, Neutrophil count, Pathology test, Physical examination, Platelet count, Polymerase chain reaction, Procalcitonin, Prothrombin time, Red blood cell sedimentation rate, SARS-CoV-2 antibody test, SARS-CoV-2 test, Serum ferritin, Streptococcus test, Troponin I, White blood cell count
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Fatigue; Loss of smell; Loss of taste
Allergies:
Diagnostic Lab Data: Test Name: D-Dimer; Result Unstructured Data: Test Result:5.2; Comments: microgFEU/mL; Test Name: D-Dimer; Result Unstructured Data: Test Result:4.3; Comments: microgFEU/mL; Test Name: D-Dimer; Result Unstructured Data: Test Result:12.2; Comments: microgFEU/mL; Test Name: Gram stain; Result Unstructured Data: Test Result:results were negative on lung and heart tissue; Test Name: Hematocrit; Test Result: 39.6 %; Test Name: Hematocrit; Test Result: 33.8 %; Test Name: Hematocrit; Test Result: 34.3 %; Test Name: Hematocrit; Test Result: 27.7 %; Test Name: Hemoglobin; Result Unstructured Data: Test Result:13.7 g/dl; Test Name: Hemoglobin; Result Unstructured Data: Test Result:11.7 g/dl; Test Name: Hemoglobin; Result Unstructured Data: Test Result:10.8 g/dl; Test Name: Hemoglobin; Result Unstructured Data: Test Result:9.5 g/dl; Test Name: heart rate; Result Unstructured Data: Test Result:113; Comments: beats/min; Test Name: heart rate; Result Unstructured Data: Test Result:90-135; Comments: beats/min; Test Name: Histopathologic findings; Result Unstructured Data: Test Result:Lung tissue shows capillaritis characterized by ne; Comments: Lung tissue shows capillaritis characterized by neutrophilic inflammation and necrosis within interalveolar septa (arrowhead). Fibrin and organizing intraluminal microthrombi in small arteries are also seen (arrows). Original magnification 20x. B) Higher magnification of fibrin microthrombus within a lung vessel (arrow). Original magnification 63x. C) Heart tissue shows myocarditis with myocyte necrosis and mixed inflammatory infiltrate. Original magnification 20x. D) Higher magnification cardiac vessel showing microthrombus and perivascular mononuclear inflammatory infiltrate (arrow). Original magnification 40x. E) Stomach tissue shows submucosal microthrombi with perivascular lymphocytic infiltrate. Original magnification 63x. F) Kidney tissue shows multiple fibrin thrombi in glomerular (arrow) and interstitial capillaries (arrow). Original magnification 40x.; Test Name: HIV-1 p24 Ag; Result Unstructured Data: Test Result:Nonreactive; Test Name: rapid infl uenza antigen; Test Result: Negative ; Test Name: INR; Result Unstructured Data: Test Result:1.1; Test Name: INR; Result Unstructured Data: Test Result:4.2; Test Name: INR; Result Unstructured Data: Test Result:3.6; Test Name: Absolute lymphocytes; Result Unstructured Data: Test Result:0.4 x10 3/mm3; Test Name: Absolute lymphocytes; Result Unstructured Data: Test Result:0.4 x10 3/mm3; Test Name: Absolute lymphocytes; Result Unstructured Data: Test Result:5.0 x10 3/mm3; Test Name: Lymphocytes; Test Result: 3.8 %; Test Name: Lymphocytes; Test Result: 2.8 %; Test Name: Lymphocytes; Test Result: 15.9 %; Test Name: Microscopic examination of stomach, kidneys, and liver; Result Unstructured Data: Test Result:disseminated microvascular thrombosis; Test Name: Microscopic examination of the lungs; Result Unstructured Data: Test Result:showed diffuse congestion, increased intra-alveola; Comments: showed diffuse congestion, increased intra-alveolar macrophages, multifocal hemorrhage, capillaritis, and microthrombi throughout We observed no viral inclusions or diffuse alveolar damage. Trachea and bronchi showed mild tracheobronchitis; Test Name: Sections of the heart; Result Unstructured Data: Test Result:showed multifocal myocarditis with mixed inflammat; Comments: showed multifocal myocarditis with mixed inflammatory infiltrate, myocyte necrosis, and numerous microthrombi. We also identified disseminated microvascular thrombosis in the heart; Test Name: Monocytes; Test Result: 1.9 %; Test Name: Monocytes; Test Result: 0.9 %; Test Name: Monocytes; Test Result: 0.9 %; Test Name: Mononucleosis screen; Test Result: Negative ; Test Name: Absolute neutrophils; Result Unstructured Data: Test Result:10.5 x10 3/mm3; Test Name: Absolute neutrophils; Result Unstructured Data: Test Result:13.7 x10 3/mm3; Test Name: Absolute neutrophils; Result Unstructured Data: Test Result:23.9 x10 3/mm3; Test Name: Segmented neutrophil; Test Result: 95.3 %; Test Name: Segmented neutrophil; Test Result: 95.3 %; Test Name: Segmented neutrophil; Test Result: 76.6 %; Test Name: Segmented neutrophil; Test Result: 93.5 %; Test Name: Histopathologic findings; Result Unstructured Data: Test Result:Lung tissue shows capillaritis characterized by ne; Comments: Lung tissue shows capillaritis characterized by neutrophilic inflammation and necrosis within interalveolar septa (arrowhead). Fibrin and organizing intraluminal microthrombi in small arteries are also seen (arrows). Original magnification 20x. B) Higher magnification of fibrin microthrombus within a lung vessel (arrow). Original magnification 63x. C) Heart tissue shows myocarditis with myocyte necrosis and mixed inflammatory infiltrate. Original magnification 20x. D) Higher magnification cardiac vessel showing microthrombus and perivascular mononuclear inflammatory infiltrate (arrow). Original magnification 40x. E) Stomach tissue shows submucosal microthrombi with perivascular lymphocytic infiltrate. Original magnification 63x. F) Kidney tissue shows multiple fibrin thrombi in glomerular (arrow) and interstitial capillaries (arrow). Original magnification 40x.; Test Name: Physical examination; Result Unstructured Data: Test Result:right-sided cervical lymphadenopathy; Comments: right-sided cervical lymphadenopathy marked bilateral con junctival erythema and a faint papular rash on the pelvis and left fl ank.; Test Name: platelet count; Result Unstructured Data: Test Result:110,000 /mm3; Comments: Thrombocytopenia; Test Name: Platelets; Result Unstructured Data: Test Result:110.0 x10 3/mm3; Test Name: Platelets; Result Unstructured Data: Test Result:86.0 x10 3/mm3; Test Name: Platelets; Result Unstructured Data: Test Result:45.0 x10 3/mm3; Test Name: Platelets; Result Unstructured Data: Test Result:17.0 x10 3/mm3; Test Name: Adenovirus DNA PCR; Result Unstructured Data: Test Result:Not detected; Test Name: Procalcitonin level; Result Unstructured Data: Test Result:4.9 ng/ml; Test Name: PT; Test Result: 13.9 s; Test Name: PT; Test Result: 39.6 s; Test Name: aPTT; Test Result: 29.3 s; Test Name: aPTT; Test Result: 54.2 s; Test Name: aPTT; Test Result: 80.9 s; Test Name: ALT; Result Unstructured Data: Test Result:61.0 IU/l; Comments: U/L; Test Name: ALT; Result Unstructured Data: Test Result:3,386.0 IU/l; Comments: U/L; Test Name: ALT; Result Unstructured Data: Test Result:3,421.0 IU/l; Comments: U/L; Test Name: AST; Result Unstructured Data: Test Result:78.0 IU/l; Comments: U/L; Test Name: AST; Result Unstructured Data: Test Result:5,938.0 IU/l; Comments: U/L; Test Name: AST; Result Unstructured Data: Test Result:8,861.0 IU/l; Comments: U/L; Test Name: autopsy; Result Unstructured Data: Test Result:a 525-mL pericardial effusion and cardiac enlargem; Comments: a 525-mL pericardial effusion and cardiac enlargement, as well as a 5-L hemoperitoneum and a 20-cm diameter perisplenic hematoma; Test Name: Alkaline phosphatase; Result Unstructured Data: Test Result:76.0 IU/l; Test Name: Alkaline phosphatase; Result Unstructured Data: Test Result:74.0 IU/l; Test Name: Alkaline phosphatase; Result Unstructured Data: Test Result:295.0 IU/l; Test Name: Alkaline phosphatase; Result Unstructured Data: Test Result:202.0 IU/l; Test Name: Total bilirubin; Test Result: 1.9 mg/dl; Test Name: Total bilirubin; Test Result: 1.4 mg/dl; Test Name: Total bilirubin; Test Result: 1.6 mg/dl; Test Name: Creatinine; Test Result: 1.2 mg/dl; Test Name: Creatinine; Test Result: 1.3 mg/dl; Test Name: Creatinine; Test Result: 3.4 mg/dl; Test Name: Creatinine; Test Result: 1.9 mg/dl; Test Name: Peripheral blood culture; Result Unstructured Data: Test Result:No growth; Test Name: Peripheral blood culture; Result Unstructured Data: Test Result:No growth; Test Name: Peripheral blood culture; Result Unstructured Data: Test Result:No growth; Test Name: Peripheral blood culture; Result Unstructured Data: Test Result:No growth; Test Name: Fibrinogen; Test Result: 642.0 mg/dl; Test Name: Fibrinogen; Test Result: 750.0 mg/dl; Test Name: blood pressure; Result Unstructured Data: Test Result:117/66 mmHg; Comments: mmHg; Test Name: blood pressure; Result Unstructured Data: Test Result:92/56 mmHg; Comments: mmHg; Test Name: temperature; Result Unstructured Data: Test Result:37.2 Centigrade; Test Name: chest radiograph; Result Unstructured Data: Test Result:showed an enlarged cardiac silhouette; Test Name: Portable chest radiograph; Result Unstructured Data: Test Result:results were without notable fi ndings; Comments: results were without notable fi ndings; Test Name: computed tomography scan of the head; Result Unstructured Data: Test Result:was negative for cerebrovascular accident and show; Comments: was negative for cerebrovascular accident and showed normal brain parenchyma and no evidence of acute infarction, mass, or hemorrhage; Test Name: C-reactive protein; Result Unstructured Data: Test Result:284.0 mg/l; Test Name: C-reactive protein; Result Unstructured Data: Test Result:174.0 mg/l; Test Name: CMV PCR; Result Unstructured Data: Test Result:Negative; Comments: quantitative; Test Name: CMV PCR, quantitative; Test Result: Negative ; Test Name: echocardiogram; Result Unstructured Data: Test Result:showed severe biventricular dysfunction, severe gl; Comments: showed severe biventricular dysfunction, severe global hypokinesis of the left ventricle, and left ventricular ejection fraction of 20%; Test Name: Ehrlichia chaffeensis DNA PCR; Result Unstructured Data: Test Result:Not detected; Test Name: left ventricular ejection fraction; Test Result: 20 %; Test Name: ESR; Result Unstructured Data: Test Result:40.0; Comments: mm/h; Test Name: SARS-CoV-2 IgG antibody; Result Unstructured Data: Test Result:4.96; Comments: index value; Test Name: COVID-19 test by reverse transcription PCR (RT-PCR); Test Result: Negative ; Test Name: SARS-CoV-2 RT-PCR; Test Result: Negative ; Comments: index value; Test Name: SARS-CoV-2 RT-PCR; Result Unstructured Data: Test Result:was negative on lungs, trachea, bronchi, and heart; Comments: was negative on lungs, trachea, bronchi, and heart; Test Name: Ferritin; Test Result: 1434.9 mg/dl; Test Name: Ferritin; Result Unstructured Data: Test Result:greater than 40,000.0 mg/dl; Test Name: rapid antigen detection for group A Streptococcus; Test Result: Negative ; Test Name: Troponin-I; Result Unstructured Data: Test Result:18.0 ng/ml; Test Name: Troponin-I; Result Unstructured Data: Test Result:15.5 ng/ml; Test Name: Peripheral leukocyte count; Result Unstructured Data: Test Result:11.0 x10 3/mm3; Test Name: Peripheral leukocyte count; Result Unstructured Data: Test Result:14.4 x10 3/mm3; Test Name: Peripheral leukocyte count; Result Unstructured Data: Test Result:28.1 x10 3/mm3; Test Name: Peripheral leukocyte count; Result Unstructured Data: Test Result:8.8 x10 3/mm3; Test Name: peripheral-blood leukocyte count; Result Unstructured Data: Test Result:11,000 cells/uL
CDC Split Type: USPFIZER INC202101557161

Write-up: Fatal Multisystem Infl ammatory Syndrome in Adult after SARS-CoV-2 Natural Infection and COVID-19 Vaccination; After the second dose, he reported fatigue and malaise which resolved within 2 days.; After the second dose, he reported fatigue and malaise which resolved within 2 days.; This is a literature report. Amultisystem infl ammatory syndrome in children (MIS-C) and adults (MIS-A) occurring after coronavirus disease (COVID-19) has been identifi ed; onset is 4-6 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A case defi nition for MIS-A has been developed by the Centers for Disease Control and Prevention (CDC); MIS-A after vaccination is rare and remains of great clinical and public health interest. We report a case study and histopathologic fi ndings from a fatal MIS-A case after SARS-CoV-2 infection and subsequent complete COVID-19 vaccination. The patient was a healthcare worker in his 30s with no notable medical history. In December 2020, he experienced mild COVID-19-like illness symptoms, including fatigue and loss of taste and smell. He did not undergo testing for SARS-CoV-2 at that time and was unaware of the need for isolation. Six days after onset of COVID-19-like symptoms, and when fully recovered, the patient received the first dose of Pfizer/BioNTech (https://www.pfi zer.com) mRNA COVID-19 vaccine. He received the second dose 20 days later. After the second dose, he reported fatigue and malaise, which resolved within 2 days. Twenty-two days after receiving the second dose of the COVID-19 vaccine, he had onset of new fever, malaise, headache, and odynophagia. He was examined by an outpatient medical provider. Diagnostic testing was notable for a negative COVID-19 test by reverse transcription PCR (RT-PCR), negative rapid influenza antigen, and negative rapid antigen detection for group A Streptococcus. Four days later, the patient visited an emergency department because of worsening symptoms. Assessment of vital signs revealed a temperature of 37.2C, heart rate 113 beats/min, and blood pressure of 117/66 mmHg. Physical examination identifi ed right-sided cervical lymphadenopathy, marked bilateral conjunctival erythema, and a faint papular rash on the pelvis and left flank. Laboratory testing revealed a peripheral-blood leukocyte count of 11,000 cells/ microL, 93.5% segmented neutrophils, and thrombocytopenia with a platelet count of 110,000/microL (Table). Portable chest radiograph results were without notable findings. On hospital day 2, the patient remained febrile and tachycardic (heart rate 90-135 beats/min) and had a blood pressure of 92/56 mmHg. Diagnostic evaluation revealed a negative SARS-CoV-2 RT-PCR test but a positive serologic test for SARS-CoV-2 nucleocapsid IgG. Additional diagnostic tests were conducted (Table). Inflammatory markers showed elevated C-reactive protein at 284.0 mg/L, serum ferritin at 1434.9 ng/mL, and troponin-I at 18.0 ng/mL. On the evening of hospital day 2, the patient received 75 g of intravenous immune globulin (IVIG). Early morning on hospital day 3, the patient had an acute change in mental status, including confusion and global aphasia. An emergent computed tomography scan of the head was negative for cerebrovascular accident and showed normal brain parenchyma and no evidence of acute infarction, mass, or hemorrhage. On completion of the scan, the patient was found nonresponsive and without a pulse. He underwent multiple rounds of advanced cardiac life support, resulting in return of spontaneous circulation. A chest radiograph showed an enlarged cardiac silhouette, and an echocardiogram showed severe biventricular dysfunction, severe global hypokinesis of the left ventricle, and left ventricular ejection fraction of 20%. The patient received a second dose of IVIg and intravenous steroids and extracorporeal membrane oxygenation support was initiated. On hospital day 4, severe multisystem organ failure continued to progress. The patient died on hospital day 4. We reviewed the patients medical history and clinical chart. We assessed serum samples collected during the hospital course before and after IVIg, and we determined endpoint titers to SARS-CoV-2 nucleocapsid (IgM and IgG) and spike receptor binding domain with neutralization functions against spike protein. The endpoint titer was a modified protocol. We completed an autopsy and sent formalin-fixed, paraffin-embedded tissues to CDC. Microscopic examination of lung, airways, pulmonary lymph node, liver, heart, spleen, kidneys and stomach tis sue samples was performed; LT-Gram stain was performed on lungs and heart. An RT-PCR assay for SARS-CoV-2 was performed on RNA extracted from formalin-fixed, paraffin-embedded tissues from lungs, airways, and heart by methods previously published. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy. Serum antibody results drawn before IVIg infusion were negative for SARS-CoV-2 IgM but positive for IgG. Serum results had a high titer of anti-spike receptor binding domain antibody both before and after IVIg (1:75,000) compared with a naturally infected SARS-CoV-2-positive control (1:4,000). In addition, the pre-IVIG sample serum results demonstrated neutralizing function. Notable findings on gross internal autopsy examination included a 525-mL pericardial effusion and cardiac enlargement, as well as a 5-L hemoperitoneum and a 20-cm diameter perisplenic hematoma. Microscopic examination of the lungs showed diffuse congestion, increased intra-alveolar macrophages, multifocal hemorrhage, capillaritis, and microthrombi throughout. We observed no viral inclusions or diffuse alveolar damage. Trachea and bronchi showed mild tracheobronchitis. Sections of the heart showed multifocal myocarditis with mixed inflammatory infiltrate, myocyte necrosis, and numerous microthrombi. We also identified disseminated microvascular thrombosis in the heart, stomach, kidneys, and liver. Gram stain results were negative on lung and heart tissue. SARS-CoV-2 RT-PCR was negative on lungs, trachea, bronchi, and heart. Conclusions This fatal case of MIS-A occurred after full COVID-19 vaccination in a patient with prior natural SARSCoV-2 infection suspected 6 weeks before MIS-A symptom onset. Serum antibody results before IVIg infusion indicated the patient was previously infected with SARS-CoV-2 and was vaccinated with a COVID-19 vaccine. Antibodies to the nucleocapsid protein are the most sensitive target for serologic diagnosis for natural infection, and these antibodies are not present following COVID-19 vaccination alone. In addition, clinical history was compatible with natural infection beginning 6 days before the first mRNA vaccine dose and consistent with negative SARS-CoV-2 nucleocapsid IgM on testing during hospitalization. The patient demonstrated similar clinical findings to previously reported MIS-A cases, including fever for 3 consecutive days, laboratory evidence of inflammation, neurologic and mucocutaneous clinical findings, and severe cardiac illness that included systemic hypotension progressing to cardiogenic shock. These criteria meet the CDC case definition for MIS-A, as well as a definitive case at level 1 of diagnostic certainty by the Brighton collaboration case definition for MIS-A and MIS-C. In addition, the histopathologic findings of capillaritis and multiorgan microvascular thrombosis in association with clinical symptoms and laboratory findings are compatible with MIS-A. Substantial blood loss on gross examination may represent a diffuse intravascular coagulation-type picture in which diffuse microthrombosis depleted platelets and clotting factors. The etiology for clinical deterioration was likely multifactorial, although considerabl cardiac compromise in the setting of high fluid volumes and intraperitoneal hemorrhage may have contributed to multiorgan failure Whether mRNA COVID-19 vaccination contributed to MIS-A onset in this case is unclear, and future epidemiologic studies are needed to understand whether an association exists. The immunopathology leading to hyperinflammation causing MISA after SARS-CoV-2 infection remains unknown, although postinfection immune dysregulation is consistent among reported cases. Notably, MIS-A has not been reported among adult participants of COVID-19 vaccine trials, and no direct evidence exists to support vaccine alone as the primary etiology in this case. This article further emphasizes the importance of COVID-19 prevention, for which infection prevention strategies and vaccination remain our greatest defense. Table. Results of pertinent laboratory testing completed during the 4-day hospitalization of a patient with fatal multisystem inflammatory syndrome in adult, 2021. Histopathologic findings in a fatal case of multisystem inflammatory syndrome in adult after natural severe acute respiratory syndrome coronavirus 2 infection and coronavirus disease vaccination, 2021. A) Lung tissue shows capillaritis characterized by neutrophilic inflammation and necrosis within interalveolar septa (arrowhead). Fibrin and organizing intraluminal microthrombi in small arteries are also seen (arrows). Original magnification 20. B) Higher magnification of fibrin microthrombus within a lung vessel (arrow). Original magnification 63. C) Heart tissue shows myocarditis with myocyte necrosis and mixed inflammatory infiltrate. Original magnification 20. D) Higher magnification cardiac vessel showing microthrombus and perivascular mononuclear inflammatory infiltrate (arrow). Original magnification 40. E) Stomach tissue shows submucosal microthrombi with perivascular lymphocytic infiltrate. Original magnification 63. F) Kidney tissue shows multiple fibrin thrombi in glomerular (arrow) and interstitial capillaries (arrow). Original magnification 40.; Sender''s Comments: Considering the plausible drug-event temporal association, a contributory role of the suspect product BNT162B2 to the reported Fatal Multisystem Inflammatory Syndrome in Adult cannot be completely excluded. It was noted that "Whether mRNA COVID-19 vaccination contributed to multisystem inflammatory syndrome in adults (MIS-A) onset in this case is unclear, and future epidemiologic studies are needed to understand whether an association exists. It was also noted that Notably, MIS-A has not been reported among adult participants of COVID-19 vaccine trials, and no direct evidence exists to support vaccine alone as the primary etiology in this case." SARS-CoV-2 natural infection is assessed as a contributing factor. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Multisystem inflammatory syndrome in adults; Autopsy-determined Cause(s) of Death: a 525-mL pericardial effusion and cardiac enlargement, as well as a 5-L hemoperitoneum and a 20-cm diameter perisplenic hematoma; a 525-mL pericardial effusion and cardiac enlargement, as well as a 5-L hemoperitoneum and a 20-cm diameter perisplenic


VAERS ID: 1896468 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211142701

Write-up: DIED; This spontaneous report received from a patient via a social media via a company representative concerned multiple patients of unknown race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown, expiry: unknown) dose, 1 total administered, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On17-NOV-2021, it was reported on that 3 patients died after being fully vaccinated. Reporter stated that "I know three who died. All fully vaxd". The cause of death was unknown. It was unknown if 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: 20211142701-Covid-19 vaccine ad26.cov2.s-Died. 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: 1896992 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-02-20
Onset:2021-11-09
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-12
   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: Home Medications Medication Confirmed Date Route Dose Frequency SPIRONOLACTONE 50 MG TABLET Oral 1 tablet Daily AMLODIPINE 10 MG TABLET 11/9/2021 9:34:29 PM Oral 1 tablet In the Morning GABAPENTIN ORAL 11/9/2021 9:35:52 PM Oral 1 BID
Current Illness:
Preexisting Conditions: Past medical history: Asthma with history of multiple intubations, A. fib, GERD, hypertension, obstructive sleep apnea, anxiety, chronic anemia, lymphedema
Allergies: Macrobid,Bactrim,diclofenac,adhesive bandage,ceclor,soma,ciprofloxacin,niacin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid Vaccination Monitoring Documentation: PT admitted 11/9/21 ? 11/12/21. POC SARS COV2 ANTIGEN resulted 11/11/21. Patient had Pfizer covid vaccine 1/30/21 Lot: EL9265, Pfizer covid vaccine 2/20/21 Lot# EL9266. Patient expired 11/12/21. Documented cause of death: Acute respiratory failure 2/2 covid 19, sepsis, tracheobronchomalacia.


VAERS ID: 1897085 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-26
Onset:2021-10-16
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, SARS-CoV-2 RNA
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 2019 Novel Coronavirus RNA specimen collection 10/7/2021
CDC Split Type:

Write-up: Deceased 10/16/2021


VAERS ID: 1897094 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-25
Onset:2021-10-23
   Days after vaccination:271
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, SARS-CoV-2 RNA
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 2019 Novel Coronavirus RNA specimen collection 10/8/21
CDC Split Type:

Write-up: Deceased 10/23/2021


VAERS ID: 1897102 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-29
Onset:2021-10-26
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Dementia
Allergies:
Diagnostic Lab Data: SARS-CoV-2 Antigen specimen collection 10/18/21
CDC Split Type:

Write-up: Deceased 10/26/2021


VAERS ID: 1897224 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-30
Onset:2021-04-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Cardiomegaly, Condition aggravated, Death, Depression, Toxicologic test
SMQs:, Cardiac failure (broad), Retroperitoneal fibrosis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: back pain from previous back injury
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coroners report and toxicology report. (I still do not have the coroners report and have been asking for it for over 6 months). His cause of death is listed as "being investigated".
CDC Split Type:

Write-up: My brother died 1-2 weeks after receiving his second Moderna vaccine. Outcome was death. The coroner marked an enlarged heart as a significant contribution to his cause of death along with a combination of prescription drugs for back pain and depression. There was no previous awareness of an enlarged heart in his life.


VAERS ID: 1897280 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-11-05
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, Intensive care, 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: 2021-11-13
   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: bumetanide (BUMEX) 2 MG tablet calcitRIOL (ROCALTROL) 0.5 MCG capsule calcium carbonate (TUMS) 500 MG chew tablet cinacalcet (SENSIPAR) 30 MG tablet heparin 1000 unit/mL injection insulin detemir (LEVEMIR) 100 UNIT/ML VIAL injection i
Current Illness: none known
Preexisting Conditions: Obesity Neuropathy in diabetes LBP (low back pain) HTN (hypertension) Insulin dependent diabetes mellitus Dependent edema Uncontrolled type 2 diabetes mellitus with stage 3 chronic kidney disease, with long-term current use of insulin Hyperlipidemia, unspecified hyperlipidemia type Elevated troponin Lymphadenitis CKD stage 5 due to type 1 diabetes mellitus Class 3 obesity with alveolar hypoventilation and body mass index (BMI) of 40.0 to 44.9 in adult ESR raised Hyperphosphatemia Pre-op evaluation Heart murmur on physical examination Left carotid bruit Acute renal failure (ARF) CHF (congestive heart failure), NYHA class I, unspecified failure chronicity, combined COVID-19 Acute renal failure, unspecified acute renal failure type
Allergies: no known allergies
Diagnostic Lab Data: tested at covenant healthcare - covid-19 test positive on 11/5/21
CDC Split Type:

Write-up: patient presented to emergency department on 11/5/21 with shortness of breath, cough and fever. covid-19 specimen taken and came back positive patient was admitted for further management of covid-19 patient did require treatment for symptoms associated with covid-19 infection. treatment with dexamethasone patient was intubated on 11/9/21 and extubated on 11/13/21 patient''s condition worsened requiring transfer to the intensive care unit on 11/7/21 patient expired on 11/13/21


VAERS ID: 1897283 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-24
Onset:2021-10-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: patient passed away and was found dead over a day after receiving the vaccine; expiration date of vaccine 11/25/21; patient received this as a booster dose he had first and second dose in the Spring


VAERS ID: 1897295 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-14
Onset:2021-02-02
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood sodium abnormal, Death
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetamin, Ativan, Senexon-S Lexapro, Zesteril
Current Illness: Health Decline: 1/11/2021 difficulty eating 1/12/2021 lethargic 1/13/2021 difficulty drinking 1/27/2021 critical sodium level -re-admitted to hospice 1/28/2021
Preexisting Conditions: Dementia, CKD2, DM11, ASCVD, Vit D def, Cerebral artherosclerosis, Hyperlipidemia
Allergies: Ampicillin, Penicillin, Pravachol, Lipitor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away 2/2/2021


VAERS ID: 1897319 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-17
Onset:2021-11-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient passed away on 11/22/21. There is no clinical evidence to support that the death was caused by the vaccine, but since it meets the definition of reportable we are doing so as required.


VAERS ID: 1897353 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-03
Onset:2021-11-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030E21A / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT2317NA / 1 LA / IM

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

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: Aspirin EC Tablet Delayed Release 81 MG (Aspirin) Give 1 tablet by mouth one time a day Citalopram Hydrobromide Tablet 20 MG Give 1 tablet by mouth one time a day Digoxin Tablet 125 MCG Give 1 tablet by mouth one time a day Furosemide Table
Current Illness: UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION MILD COGNITIVE IMPAIRMENT, SO STATED UNSPECIFIED FALL, INITIAL ENCOUNTER NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED ALTERED MENTAL STATUS, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATIONS ANOREXIA UNSPECIFIED OPEN WOUND OF LEFT FOREARM, INITIAL ENCOUNTER HYPOKALEMIA UNSPECIFIED OPEN WOUND, RIGHT FOOT, INITIAL ENCOUNTER CANDIDIASIS, UNSPECIFIED ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED OTHER SYMBOLIC DYSFUNCTIONS DYSPHAGIA, OROPHARYNGEAL PHASE CONSTIPATION, UNSPECIFIED CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH (ACUTE) EXACERBATION PAROXYSMAL ATRIAL FIBRILLATION OLD MYOCARDIAL INFARCTION PRESENCE OF CARDIAC PACEMAKER PERSONAL HISTORY OF OTHER DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS PERSONAL HISTORY OF TRAUMATIC BRAIN INJURY PRESENCE OF AUTOMATIC (IMPLANTABLE) CARDIAC DEFIBRILLATOR SHORTNESS OF BREATH ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS CARDIOMYOPATHIES TOBACCO USE MUSCLE WEAKNESS (GENERALIZED) UNSTEADINESS ON FEET LIMITATION OF ACTIVITIES DUE TO DISABILITY FOLATE DEFICIENCY ANEMIA, UNSPECIFIED ACUTE ON CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE
Preexisting Conditions: UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION MILD COGNITIVE IMPAIRMENT, SO STATED UNSPECIFIED FALL, INITIAL ENCOUNTER NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED ALTERED MENTAL STATUS, UNSPECIFIED TYPE 2 DIABETES MELLITUS WITH UNSPECIFIED COMPLICATIONS ANOREXIA UNSPECIFIED OPEN WOUND OF LEFT FOREARM, INITIAL ENCOUNTER HYPOKALEMIA UNSPECIFIED OPEN WOUND, RIGHT FOOT, INITIAL ENCOUNTER CANDIDIASIS, UNSPECIFIED ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED OTHER SYMBOLIC DYSFUNCTIONS DYSPHAGIA, OROPHARYNGEAL PHASE CONSTIPATION, UNSPECIFIED CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH (ACUTE) EXACERBATION PAROXYSMAL ATRIAL FIBRILLATION OLD MYOCARDIAL INFARCTION PRESENCE OF CARDIAC PACEMAKER PERSONAL HISTORY OF OTHER DISEASES OF THE NERVOUS SYSTEM AND SENSE ORGANS PERSONAL HISTORY OF TRAUMATIC BRAIN INJURY PRESENCE OF AUTOMATIC (IMPLANTABLE) CARDIAC DEFIBRILLATOR SHORTNESS OF BREATH ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS CARDIOMYOPATHIES TOBACCO USE MUSCLE WEAKNESS (GENERALIZED) UNSTEADINESS ON FEET LIMITATION OF ACTIVITIES DUE TO DISABILITY FOLATE DEFICIENCY ANEMIA, UNSPECIFIED ACUTE ON CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE
Allergies: Diltiazem
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Death; was hospice and was declining prior to vaccination


VAERS ID: 1897657 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-02
Onset:2021-11-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal X-ray, Blood chloride increased, Blood glucose normal, Blood sodium increased, Blood urea increased, Diarrhoea, Glomerular filtration rate, Hypophagia, Mean cell haemoglobin concentration decreased, Metabolic function test abnormal, Nephrolithiasis, Red cell distribution width increased, Vomiting
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro Tablet 5 MG, Polyethylene Glycol 3350 Powder, Senna-Plus Tablet 8.6-50 MG, Vitamin D3 Capsule 50000 UNIT, I-Vite Tablet, Tylenol Tablet 325 MG, Mylanta Suspension 200-200-20 MG/5ML
Current Illness: The patient had resided in a long term care nursing facility since December, 2014. Family reports agent orange disease and colon cancer. The patient had a pressure injury to left heel develop on 10/26/21. On 11/3/21 the patient had emesis, followed by 2 loose bowel movements. Patient was started on Miralax. The patient had decrease food and fluid intake. Was given 2 L of IV fluids on 11/16/21. Due to abnormal lab results the patient was transferred to the hospital on 11/18/21. The patient was transferred back from hospital with orders for hospice.
Preexisting Conditions: Dementia with behavioral disturbance, depression, anxiety, PTSD, Type 2 DM, COPD, Schizoaffective disorder, hypertension, GERD. The patient had resided in a long term care nursing facility since December, 2014. Family reports agent orange disease and colon cancer.
Allergies: Aspirin, Potassium Iodide, Pen-Vee-K, latex, Natural rubber
Diagnostic Lab Data: 11/17/2021- BMP with the following abnormal results: Sodium - 166.0, Chloride- 135, Glucose- 121, BUN- 70, GFR- 57.72. 11/17/2021- CMP with the following abnormal results: MCHC- 31.2, RDW- 15.8. 11/12/2021- X-Ray Abdomen- FINDINGS: The bowel gas pattern is unremarkable without large or small bowel dilatation or obstruction. There is no soft tissue mass or pathologic air There is no hernia or free air. There is slight amount of rectal stool present. CONCLUSION: Normal abdominal study. There is slight amount of rectal stool present. 1 cm right pelvic calcification
CDC Split Type:

Write-up: On 11/3/21 the patient had emesis, followed by 2 loose bowel movements. Patient was started on Miralax. The patient had decrease food and fluid intake. Was given 2 L of IV fluids on 11/16/21. Due to abnormal lab results the patient was transferred to the hospital on 11/18/21. The patient was transferred back from hospital with orders for hospice.


VAERS ID: 1897665 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-11-17
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALBUTEROL, APIXABAN, AUGMENTIN, AZITHROMYCIN, DOCUSATE SODIUM, DRONABINOL, LASIX, METOPROLOL, MIRTAZAPINE, PREDNISONE, PROTONIX, SERTRALINE, SIMVASTATIN
Current Illness:
Preexisting Conditions: HYPERTENSION, KIDNEY STONES, PNEUMONIA, PULMONARY EMBOLISM
Allergies: ASA
Diagnostic Lab Data: COVID POSITIVE TEST
CDC Split Type:

Write-up: HOSPITAL VISIT, CARDIAC ARREST


VAERS ID: 1897686 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-12
Onset:2021-11-22
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Hypoxia, Intensive care, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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: 2021-11-22
   Days after onset: 0
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: acetaminophen 325 mg oral tablet, 650 mg= 2 TAB, PO, Q4H (Every 4 hours), PRN acetaminophen 325 mg oral tablet, 650 mg= 2 TAB, PO, Q4H (Every 4 hours), PRN aspirin 81 mg oral delayed release tablet, 81 mg= 1 TAB, PO, Daily atorvastatin 4
Current Illness:
Preexisting Conditions: Atrial fibrillation CABG - Coronary artery bypass graft CAD - Coronary artery disease COPD Cardiomyopathy Coronary artery disease Dementia.... Depression Diabetes mellitus Dysphagia GERD - Gastro-esophageal reflux disease Hemiparesis (weakness on one side) Hemiplegia Hypercholesterolemia Hypertension Incontinence Insomnia Pacemaker catheter, device Stroke Urinary tract infection
Allergies: Ace inhibitors, codeine, lisinopril
Diagnostic Lab Data: COVID19 test not performed at hospital, done outside. Positive PCR on 11/8/2021 11/17/2021 CXR done due to worsening hypoxia. Impression: slightly increasing, suspicious for pneumonia in this COVID19 positive patient.
CDC Split Type:

Write-up: Patient tested positive for COVID on 11/8/2021 Developed severe respiratory syndrome 2ndary to COVID pneumonia required up to 50L heated high flow oxygen due to respiratory failure Received remdesivir, dexamethasone Was in the ICU. Patient''s wishes were to be DNR. Patient placed on comfort care and subsequently died on 11/22/2021


VAERS ID: 1897811 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-10
Onset:2021-03-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Biopsy, Nausea, Oesophageal adenocarcinoma, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 256
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Metoprolol, Rosuvastatin, Jardiance, Zinc, Vitamin D, ASA
Current Illness: None
Preexisting Conditions: Hyperlipid, HTN, DM, Obesity
Allergies:
Diagnostic Lab Data: endoscopic biopsy with findings of adenocarcinoma
CDC Split Type:

Write-up: Nausea and vomitting began after second dose. Patient also started a new medication, Rebylsus, the same time he recieved the injections. Nausea and vomitting progressed despite discontinuing the medication. Eventually diagnosed with esophageal adenocarcinoma


VAERS ID: 1897823 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-03
Onset:2021-11-05
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   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: Albuterol MDI PRN, Amlodipine 5 mg QD, Aspirin 81 mg QD, Atorvastatin 10 mg QD, Fluticasone 44 mcg BID, Hydroxyzine 25 mg QD, Methocarbamol 500 mg QID PRN, MS Contin 45 mg Q12H, MSIR 15 mg Q4H PRN, Miralax 17 grams BID, Rivaroxaban 20 mg Q
Current Illness:
Preexisting Conditions: Invasive adenocarcinoma of lung, Atrial FIbrillation, NHL in remission, Hypertension, Hyperlipidemia, HFrEF
Allergies: Penicillin
Diagnostic Lab Data: COVID-19 Positive on 11/5/2021 using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/13/2021 and 4/3/2021. Patient presented to ED on 11/5/2021 with 1 day worsening of shortness of breath and labored breathing. Patient increased home 0xygen from 2L to 5L, with pulse ox readings in the 60s while on the 5L. Oxygen requirements escalated over following days. Patient''s COVID treated with dexamethasone, remdesivir and antibiotics. Intubated on day 9 of admission. Resuscitation efforts limited to intubation only per patient request. Expired on 11/18/2021.


VAERS ID: 1897825 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-11-16
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Chest tube insertion, Death, Dyspnoea, Endotracheal intubation, Pneumothorax, Pulmonary air leakage, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 10 mg QD, Atorvastatin 10 mg QD, Carvedilol 3.125 mg BID, DIazepam 5 mg PRN, Adviar Diskus 100/50 BID, Gabapentin 200 mg TID, Hydrochlorothiazide 25 mg QD, Hydroxyzine 25 mg QHS PRN, Lisinopril 10 mg QD, Pantoprazole 40 mg BID, S
Current Illness:
Preexisting Conditions: CAD, CHF, COPD, HTN, Bullous emphysema, H/O melanoma, CKD, H/O Stroke,
Allergies: NKDA
Diagnostic Lab Data: COVID-19 positive on 11/16/2021 via PCR.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/11/2021 and 4/01/2021. PMHx significant for COPD heart failure and CKD3. Presented to ED on 11/16/2021 with shortness of breath for several days, noted to have severe respiratory distress with oxygen saturation in 50''s requiring intubation in ED. CXR in ED confirmed pneumothorax requiring chest tube. Due to chronic lung disease and Covid-19 infx lung status remained poor with persistent air leak. Family decided to withdraw life support on 11/19/2021.


VAERS ID: 1897826 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-30
Onset:2021-11-12
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chills, Death, Dyspnoea, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   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: Ascorbic Acid 500 mg TID, Alendronate 70 mg Weekly, Ergocalciferol 1250 mcg Q2Weeks, Levetiracetam 1000 mg BID.
Current Illness:
Preexisting Conditions: ENlarged prostate, H/O Seizure, H/O Stroke, TBI secondary to MVA, Neurogenic bladder, Iron deficiency anemia
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 3/9/2021 and 3/30/2021. Presented to ED on 11/12/2021 with complaints of difficulty breathing, fever, and chills. Reported previous tx''d at home with decron 6mg POD x7 days, tessalon and azithromycin without relief. Admitted 11/12/2021 for acute respiratory failure with hypoxia, Covid-19 pneumonia and sepsis of undetermined organism. Reports testing positive for COVID on 11/5/2021. Inpatient treated with remdesivir, dexamethasone, and antibiotics. On 11/15/2021 patient''s Airvo demand rapidly worsened to 93 FIO2/60L with sats of 92%. Transitioned to comfort care and expired on 11/20/2021.


VAERS ID: 1897832 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-04
Onset:2021-10-16
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Immunodeficiency, Nucleic acid test, Pulmonary embolism, Respiratory failure, Respiratory symptom, 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), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (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: 2021-11-07
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Coronary atherosclerosis of unspecified type of vessel, native or graft 3 stents ? GERD (gastroesophageal reflux disease) ? Hyperlipaemia ? Myositis immunocompromised patient on combination prednisone and CellCept for treatment of polymyositis ? Pneumonia 12/2020 ? Renal disorder ? Syncope, neurocardiogenic ? Type II or unspecified type diabetes mellitus without mention of complication, not stated as uncontrolled ? Unspecified essential hypertension right lower lobe adenocarcinoma of the lung felt to be metastatic probably GI in origin post right lower lobectomy in 2018 with subsequent adjuvant chemotherapy with admission August 2021 with community-acquired pneumonia
Allergies: unknown
Diagnostic Lab Data: 10/17/2021 Covid-19 positive per NAAT
CDC Split Type:

Write-up: Admitted to the hospital on 10/16/2021 with respiratory symptoms. Passed away 11/7/2021. Cause: RESPIRATORY FAILURE COVID-19 PNEUMONIA PULMONARY EMBOLISM Contributing: IMMUNOCOMP BY PAST LUNG CANCER Submitter does not have access to full medical record. For further details, please contact the admitting hospital


VAERS ID: 1897869 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-18
Onset:2021-11-21
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Breath sounds absent, Cardiac arrest, Cardioversion, Dyspnoea, Pulse absent, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), 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 (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   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: Duloxetine, Novolog, Cysteamine, semaglutide, cyclobenzaprine, codeine-guiafenesin, dulera, ropinirole, ozempic, fenofibradte, humulin, multivitamin, omeprazole, januvia, ezetimibe, lisinopril,
Current Illness: In ER on 11/13 for Nausea and vomiting since the 9th
Preexisting Conditions: Chronic back pain, chronic neck pain, diabetes, dyslipidemia, elevated liver enzymes, chronic GERD, osteoarthritis, hypertension, lumbar spondylosis, obesity,
Allergies: Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Difficulty breathing starting at approximately 1254, upon EMS arrival she was unresponsive, absent pulse and absent breath sounds. Blood glucose 390. CPR initiated. initially in asystole then 1 episode of a shockable rhythm and was defibrillated at 150 joules, but then returned to asystole. Transferred to hospital. During transport received 5 rounds of epinephrine and supraglottic airway in place with ETCO2 at 25 and chest compression administered via LUCAS device. 1L of NS given during transport and sodium bicarb. Arrived at hospital unresponsive time 45-50 minutes.


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