National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

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 91 out of 227

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190   next


VAERS ID: 1897872 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-03
Onset:2021-11-19
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   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: Venous thromboembolic disease, Hyperlipidemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-complications of covid-19 death


VAERS ID: 1897886 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-13
Onset:2021-10-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A UNKNOWN / 3 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Chest X-ray abnormal, Cough, Death, Dyspnoea, Hypoxia, Lung infiltration, Nucleic acid test, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   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: unknown
Current Illness: unknown
Preexisting Conditions: arthritis, prediabetes, DVT and recurrent PE, HLD, HTN, and PAF (on Eliquis)
Allergies: unknown
Diagnostic Lab Data: 10/28/2021 CXR - pneumonia infiltrates 10/26/2021 SARS CoV2 Detected per NAA
CDC Split Type:

Write-up: Presented to ED on 10/28/2021 with hypoxia, SOB, fever, cough, congestion. Entered Hospice on 11/3/2021 with terminal diagnosis of Covid-19 pneumonia, and passed away 11/5/2021 Previously fully vaccinated: Pfizer 1/28/2021 and 2/18/2021 Submitter does not have access to full medial record. If further information is needed, please contact the admitting hospital.


VAERS ID: 1897897 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-11-11
Onset:2021-11-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   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: COPD, DM2, HTN, History of ischemic stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cause of death-complications of covid 19. fully vaccinated


VAERS ID: 1897981 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-26
Onset:2021-03-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2316 / 1 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   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: IC Metformin HCL 500 MG (one a day) Armour Thyroid 120 MG (30 mg tablet a day) IC Enalapril Maleate 5 MG (one a day) He also was a type one diabetic and would inject insulin into himself four times a day.
Current Illness: No illness.
Preexisting Conditions: He was a type one diabetic.
Allergies: No allergies.
Diagnostic Lab Data: The patient died of a heart attack on March 28, 2021
CDC Split Type:

Write-up: The patient had a heart attack and died two days after his second COVID-19 vaccine. He was taken to the hospital. Their phone number is (Privacy).


VAERS ID: 1898001 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-06
Onset:2021-08-02
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   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: carbidopa-levodopa (SINEMET) 25-100 mg per tablet carbidopa-levodopa (SINEMET) 25-100 mg per tablet Dosage: Please take 2 tablets in the morning, 1.5 at noon, 2 in the evening and 1.5 at bedtime for one week then increase to 2 tablets 4 t
Current Illness: Parkinson''s Dementia due to Parkinson''s Benign Hypertension
Preexisting Conditions: Parkinson''s Dementia due to Parkinson''s Benign Hypertension
Allergies: No known allergies
Diagnostic Lab Data: dered Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen by Lab with probe detection (SARS Coronavirus 2) Ordered Test Codes: (LN LOINC)/2019nCoV (L LOCAL) Status: Final Accession Number: Specimen Source: Other Specimen Site: Specimen Collection Date/Time: 2021-07-27 00:00:00.0 Results: * Resulted Test: SARS-CoV-2 (COVID-19) RNA [Presence] in Specimen by NAA with probe detection (SARS Coronavirus 2 RNA) Coded Result: Detected Numeric Result: Units: Text Result: Reference Range From: NOT Detected Reference Range To: Performing Facility Details: Date/Time: 2021-07-28 14:40:34.0 Performing Facility:PUBLIC HEALTH LABORATORY Facility ID:MT PHL (FI) Interpretation: Abnormal Result Method: Status: Final Test Code: (LN LOINC)/2019nCoV (L LOCAL) Result Code: (SCT/
CDC Split Type:

Write-up: Case died of Covid 6 months after being vaccinated for it.


VAERS ID: 1898008 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-11-13
Onset:2021-11-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head normal, Computerised tomogram thorax normal, Culture negative, Death, Depressed level of consciousness, Inflammation, Injection site pain, White blood cell count increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   Days after onset: 3
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: He was hospitalized due to exacerbation of CHF 3 days after his second Covid (Moderna) vaccine. He was hospitalized for 7 days a
Other Medications: Sotolol, hydralazine, gabapentin, bumex, spironolactone, metolazone, atorvastatin, warfarin, allopurinol, aspirin, flomax
Current Illness: no specific acute illnesses
Preexisting Conditions: CHF, COPD, chronic renal insufficency, history of mitral valve replacement, gout
Allergies: iodine
Diagnostic Lab Data: CT of head and chest were negative. WBC was elevated by pan cultures were negative. I was told by the attending physician that labs indicated a "massive inflammatory response of unknown etiology."
CDC Split Type:

Write-up: The patient was feeling relatively normal after vaccine, reporting minimal pain at injection site and no fever at 1900 on 11/14. On 11/16 he was found obtunded on the floor at his home and was transported via ambulance to Medical Center, where he died on 11/18 at 3:20 a.m.


VAERS ID: 1898729 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-22
Onset:2021-11-17
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood culture positive, COVID-19, Chest X-ray normal, Computerised tomogram abdomen abnormal, Computerised tomogram head, Computerised tomogram spine, Computerised tomogram thorax abnormal, Death, Encephalopathy, Endotracheal intubation, Intensive care, Lactic acidosis, Lumbar puncture abnormal, Mechanical ventilation, Mental status changes, Oxygen saturation decreased, Pneumatosis intestinalis, Respiration abnormal, Rhabdomyolysis, SARS-CoV-2 test positive, Staphylococcal infection, Unresponsive to stimuli, Xanthochromia
SMQs:, Rhabdomyolysis/myopathy (narrow), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-23
   Days after onset: 6
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: acetaZOLAMIDE (DIAMOX) 250 MG tablet aspirin 81 MG tablet buPROPion (WELLBUTRIN SR) 150 MG 12 hr tablet escitalopram (LEXAPRO) 10 MG tablet gabapentin (Neurontin) 600 MG tablet lisinopril (PRINIVIL,ZESTRIL) 20 MG tablet Magnesium 400 MG CAP
Current Illness: NA
Preexisting Conditions: Hepatitis C AMS (altered mental status) COVID-19 HTN (hypertension), benign Type 2 diabetes mellitus, without long-term current use of insulin Cirrhosis of liver without ascites Portal hypertension Depression MSSA bacteremia Pneumonia due to COVID-19 virus Acute encephalopathy Acute respiratory failure with hypoxia Traumatic rhabdomyolysis Alcoholism Unspecified severe protein-calorie malnutrition Acute deep vein thrombosis (DVT) of tibial vein Septic shock Refeeding syndrome Bacteremia due to Klebsiella pneumoniae Multiple comorbid conditions ACP (advance care planning)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is deceased. Hospitalized (11.17.21); COVID-19 positive (11.17.21); Fully vaccinated PLUS booster. Admission Date: 11/17/2021 Date of Death: 11/23/21 Time of Death: 2:13 AM Preliminary Cause of Death: COVID-19 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Lactic acidosis Encephalopathy acute Non-traumatic rhabdomyolysis AMS (altered mental status) COVID-19 HOSPITAL COURSE: Patient is a 64 year old male with past medical history significant for alcohol abuse, cirrhosis, prior hepatitis C infection, diabetes, left BKA. He presented to the ER 11/17 after being found unresponsive at home (reportedly found by program after several uncollected meals left on doorstep). CT head with possible subdural hygroma. CT spine without acute abnormality. CT t/a/p with possible contusion to left upper arm and left anterior chest wall, liver cirrhosis with portal hypertension. He was incidentally found to be COVID positive but was admitted on room air. Patient was orientated x0 but was protecting airway and was admitted to hospitalist service. Overnight, patient became more obtunded and was transferred to ICU 11/18am and emergently intubated. Blood cultures from admission 2:2 positive for staph aureus. Neurology and infectious disease consulted. CT thoracic and lumbar imaging without evidence of abscess (currently unable to obtain MRI due to inability to complete questionnaire). Pt was breath stacking, therefore changed into PSV mode. During turns, pt suddenly desatted requiring full vent support and 100% FIO2. Stat CXR was done and NEG for pneumothorax. CTA chest was ordered and demonstrated pneumotosis of colon, portal venous system and gastric. LP + for Xanthochromia. Family was updated and decided not to pursue ongoing aggressive care. He was pronounced at 02:13 on 11/23/2021. Brother was called and updated.


VAERS ID: 1899499 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-20
Onset:2021-11-20
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, Cardiomyopathy, Computerised tomogram thorax abnormal, Condition aggravated, Death, End stage renal disease, Hypotension, Pleural effusion, Pneumonia bacterial, SARS-CoV-2 test positive, Septic shock, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), 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: 2021-11-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet atorvastatin (LIPITOR) 10 MG tablet B Complex-C-Folic Acid (RENA-VITE) TABS bisacodyl (DULCOLAX) 10 MG suppository citalopram (CELEXA) 20 MG tablet cyanocobalamin (B-12) 1000 MCG/ML injection diclofenac
Current Illness: ED 11.20.21 - CC: low blood pressure -- $g hypotension, septic shock, COVID-19
Preexisting Conditions: Chronic systolic congestive heart failure Urolithiasis - hx of uric acid stones Pulmonary hypertension Morbid obesity Osteoarthritis Gout Obstructive sleep apnea syndrome CPAP/BiPAP dependent Type 2 diabetes mellitus with diabetic polyneuropathy, with long-term current use of insulin Restless legs syndrome (RLS) Hemochromatosis Depression Permanent atrial fibrillation Cardiomyopathy, ischemic ESRD (end stage renal disease) Dyslipidemia ICD (implantable cardioverter-defibrillator), biventricular, in situ Calcium deficiency disease Secondary hyperparathyroidism Advanced care planning/counseling discussion Renal mass, right Cervical radiculopathy Mixed restrictive and obstructive lung disease Hoarseness of voice Frequent falls Polycystic kidney disease Diabetic retinopathy associated with type 2 diabetes mellitus Anemia in chronic kidney disease Coronary artery disease LAD Cypher stent 2006 Hypertension LBBB Other chronic sinusitis Bilateral pleural effusion OSA treated with BiPAP Idiopathic hypotension Diabetic polyneuropathy Hyperlipidemia Iron deficiency anemia, unspecified Hypotension Cardiomyopathy
Allergies: Iron SucroseGI Upset Acetaminophen-codeineDizziness AtenololOther CodeineDizziness
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is now deceased. ED 11.20.21; hospitalized 11.21.21; COVID-19 positive (11.20.21); fully vaccinated Admitted for hypotension, septic shock, COVID-19 (with ESRD, cardiomyopathy, bilateral PE) Admission Date: 11/21/2021 Date of Death: 11/23/21 Time of Death: 12:59 PM Preliminary Cause of Death: Hypotension DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Shock (HCC) [R57.9] Hypotension [I95.9] HOSPITAL COURSE: This is a 77 year old male with a PMH significant for HTN, HLD, ESRD on HD, T2DM with retinopathy & neuropathy, gout, hemochromatosis, hyperparathyroidism, cardiomyopathy, OSA on BiPAP, CAD and obesity who was brought to the emergency department on 11/20 by EMS from his care facility with concerns of hypotension. The patient was noted to be hypotensive on initial evaluation and was given Levophed, also found to be positive for COVID-19 and noted to have CT thorax findings of large right effusion unchanged from prior imaging, increasing moderate left effusion, as well as patchy airspace disease in the right upper lobe and right middle lob suggestive of pneumonia representative of changes secondary to COVID-19 with inflammatory changes and early bacterial pneumonia. There was also question about the possibility of a PE on the CT thorax, however it was deemed unlikely as the patient had been anticoagulated with Warfarin for Atrial Fibrillation with therapeutic INR. The patient was started on broad spectrum antibiotics for bacterial pneumonia and was started on Remdesivir and Decadron for treatment of COVID-19 with admission for further evaluation and management. On the first full day after his ER visit that led to admission, the patient had elected not to pursue treatments any further. Hospice was consulted and patient/patient''s family ultimately elected for inpatient hospice. Nephrology had been consulted for assistance with the patient''s dialysis, although they ultimately signed off the patient''s care due to patient choosing not to pursue further treatment and deciding to pursue inpatient hospice care. During the patient''s hospitalization, his ICD was turned off given the patient''s decision for hospice care. The patient was kept comfortable with the help of hospice during the remainder of his hospitalization and he expired comfortably on 11/23/21 with his wife and son at bedside. The patient was pronounced expired at 12:59PM on 11/23/21.


VAERS ID: 1899232 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-08-01
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, Dependence on respirator, Ill-defined disorder, SARS-CoV-2 test
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 31
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: Comments: The patient was super healthy before.
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211143152

Write-up: DEATH; PATIENT PLACED ON VENTILATOR; COVID-19 INFECTION; ILLNESS; This spontaneous report received from a consumer concerned a 61 year old male male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient was super healthy before. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry: unknown) dose was not reported, 1 total administered on 12-AUG-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date in AUG-2021, few days after receiving vaccine, the patient started getting sick. On 12-Aug-2021, as soon as received vaccine patient got deathly ill. On an unspecified date, patient tested positive for covid -19. It was reported that the patient was anti vaxer. On an unspecified date, the patient was hospitalized for unspecified number of days and on ventilator at time in hospital. The reporter thought that getting the vaccine and having Covid complicated patient illness. On 01-SEP-2021, 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. The patient died of death on 01-SEP-2021, and the outcome of covid-19 infection, patient placed on ventilator and illness was not reported. This report was serious (Death, and Hospitalization Caused / Prolonged and Life Threatening).; Sender''s Comments: V0: 20211143152-covid-19 vaccine ad26.cov2.s-Death, Patient placed on ventilator, covid-19 infection, Illness. 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: 1899233 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211143972

Write-up: RARE BLOOD CLOTS; This spontaneous report received from a consumer via a news article concerned two female patients of age over 50 years. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, 1 total was 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 patients experienced rare blood clots and died. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20211023372, 20211010045 and 20211140935.; Sender''s Comments: V0: 20211143972-COVID-19 VACCINE AD26.COV2.S- Rare blood clots. 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: RARE BLOOD CLOTS


VAERS ID: 1899620 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Passed away) in a 56-year-old patient of an unknown gender 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. Death occurred on 01-Nov-2021 The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Patient passed away on 01-NOV-2021 at the age of 56. Concomitant medication of the patient was not reported. No treatment information was provided by the reporter. Company Comment : This spontaneous case concerns a 56-year-old patient, of unknown gender, with no medical history reported, who experienced the unexpected, serious event of death. The patient passed away on 01Nov2021 after administration of an unspecified dose of the Moderna mRNA-1273. The cause of death was not reported. Very limited information has been provided via social media. The benefit-risk relationship of the Moderna mRNA-1273 is not affected by this report.; Sender''s Comments: This spontaneous case concerns a 56-year-old patient, of unknown gender, with no medical history reported, who experienced the unexpected, serious event of death. The patient passed away on 01Nov2021 after administration of an unspecified dose of the Moderna mRNA-1273. The cause of death was not reported. Very limited information has been provided via social media. The benefit-risk relationship of the Moderna mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1899642 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-11
Onset:2021-10-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematoma, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-30
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: High blood pressure Cholesterol lowering A fib medication
Current Illness: None
Preexisting Conditions: A fib High cholesterol
Allergies: None
Diagnostic Lab Data: Dr visit
CDC Split Type:

Write-up: Patient had hematoma form on arm then 3 days later died suddenly


VAERS ID: 1899968 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-18
Onset:2021-11-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012H21B / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Bladder catheterisation, Confusional state, Death, Neurogenic bladder, Unresponsive to stimuli, Urine analysis normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: 2021-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen Tablet 325 MG Give 2 tablet bymouth every 4 hours as needed for pain amLODIPine Besylate Tablet 2.5 MG Give 1 tablet bymouth one time a day for HTN Atorvastatin Calcium Tablet 10 MG Give 1 tablet bymouth at bedtime for Hyperli
Current Illness: Suprapubic catheter secondary to neurogenic bladder with leaking confusion noted on 11/22/21 with dipstick completed that was negative
Preexisting Conditions: GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS(K21.9), HYPERLIPIDEMIA, UNSPECIFIED(E78.5), ESSENTIAL (PRIMARY)HYPERTENSION(I10), OTHER SPECIFIED DISORDERS OF NOSE AND NASAL SINUSES(J34.89), ALLERGIC RHINITIS, UNSPECIFIED(J30.9),PRESENCE OF UROGENITAL IMPLANTS(Z96.0), OVERACTIVE BLADDER(N32.81), MUSCLE WEAKNESS (GENERALIZED)(M62.81), DIFFICULTY INWALKING, NOT ELSEWHERE CLASSIFIED(R26.2), UNSTEADINESS ON FEET(R26.81), GENERALIZED ANXIETY DISORDER(F41.1), UNSPECIFIEDDEMENTIA WITHOUT BEHAVIORAL DISTURBANCE(F03.90), PERSONAL HISTORY OF COVID-19(Z86.16), ANXIETY DISORDER, UNSPECIFIED(F41.9),MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED(F32.9), VITAMIN D DEFICIENCY, UNSPECIFIED(E55.9
Allergies: Allopurinol, Chlorpromazine, Fluconazole, Meperidine, Metronidazole, Trazodone, Cipro, Macrobid, Monistat, Angiotensin Receptor Blockers
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident noted to be unresponsive and passed away


VAERS ID: 1901073 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-03
   Days after onset: 33
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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Negative; Test Date: 202110; Test Name: SARS-CoV-2 rapid diagnostic test; Result Unstructured Data: Negative; Comments: Two days later patient went to the ENT with worsening symptoms, and another rapid test was performed (still negative).; Test Date: 20211015; Test Name: COVID-19 PCR test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20211151782

Write-up: CONFIRMED COVID19 INFECTION; DEATH; CONFIRMED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer concerned a 76 year old male. The patient''s weight, height, and medical history were not reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: unknown) dose was not reported, 1 total was administered to right arm on 09-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. About the first week of OCT-2021, the patient felt ill and went to an urgent care, performed rapid test result came negative, two days later he went to the ears, nose, throat (ENT) with worsening symptoms, and had another rapid test still negative. On 15-OCT-2021, the patient went to the hospital and was feeling severely ill, he was critical in the hospital and did polymerase chain reaction (PCR) test and tested positive (confirmed clinical vaccination failure, confirmed covid19 infection (acute hypoxia)), by then he was advanced and had significant lung damage. The number of hospitalized day was unspecified. On 03-NOV-2021, the patient died from unknown cause of death. An autopsy was not performed. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event death was fatal and outcome of confirmed clinical vaccination failure and confirmed covid19 infection was not reported. This report was serious (Death, Hospitalization Caused / Prolonged, and Other Medically Important Condition). This case, from the same reporter is linked to 20211152663. This report was associated with product quality complaint.; Sender''s Comments: V0: 20211151782-Covid-19 vaccine ad26.cov2.s-Confirmed clinical vaccination failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS 20211151782-Covid-19 vaccine ad26.cov2.s-Death, Confirmed covid19 infection . This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1901084 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-26
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 had no known prior issues.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211154559

Write-up: DEATH; This spontaneous report received from a consumer via a company representative via social media concerned a 28 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no known prior issues. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown and expiry: Unknown) dose, start therapy date were not reported, 1 total, administered for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient died after vaccination from unknown cause of death. It was unspecified if an autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20211154617.; Sender''s Comments: V0: 20211154559-Covid-19 vaccine ad26.cov2.s- Death. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1901193 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-17
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: USPFIZER INC202101626192

Write-up: Died shortly after receiving second dose and contracting covid; Died shortly after receiving second dose and contracting covid; This is a spontaneous report from a non-contactable consumer. An adult male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2 via an unspecified route of administration on an unspecified date in 2021, dose 1 via an unspecified route of administration on an unspecified date, both single for COVID-19 immunisation. The patient''s medical history was not reported. It was unknown whether the patient received any other vaccines within 4 weeks prior to the COVID vaccine. It was unknown whether there was list of any other medications the patient received within 2 weeks of vaccination. Prior to vaccination, the patient was not diagnosed as COVID-19. On 17Nov2021, the patient died shortly after receiving second dose and contracting COVID on 17Nov2021. The outcome of event was fatal. It was unknown if the patient received treatment. Since the vaccination, it was unknown of the patient had been tested for COVID-19. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Died shortly after receiving second dose and contracting covid


VAERS ID: 1901194 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       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: USPFIZER INC202101630011

Write-up: Died of blood clots after being vaccinated; This is a spontaneous report from a non-contactable consumer. A 36-year-old male patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Batch/Lot number was not reported) on an unspecified date for covid-19 immunization. The patient died of blood clots after being vaccinated on an unspecified date, reported as Serious with serious criteria death, medically significant. The patient died on an unspecified date. It was not reported if an autopsy was performed. The outcome of the event Clot blood was fatal. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Died of blood clots after being vaccinated


VAERS ID: 1901261 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Illness
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: USJNJFOC20211143279

Write-up: DEATHLY ILL; This spontaneous report received from a consumer via a company representative concerned multiple patients of unknown race and ethnicity. The patients height and weight were not reported. No past medical history or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown, expiry : Unknown) dose, frequency 1 total, start therapy date were not reported for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, family members and friends had died from the virus, they had became deathly ill within days and months after the vaccine. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event deathly ill was fatal. This report was serious (Death).; Sender''s Comments: V0: 20211143279-COVID-19 VACCINE AD26.COV2.S-Deathly ill. 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: DEATHLY ILL


VAERS ID: 1901356 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-08-01
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: COVID; Diagnosed with COVID but no symptoms; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (COVID) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In August 2021, the patient experienced ASYMPTOMATIC COVID-19 (Diagnosed with COVID but no symptoms). In September 2021, the patient experienced COVID-19 (COVID) (seriousness criterion death). The patient died on an unknown date. The reported cause of death was covid. It is unknown if an autopsy was performed. At the time of death, ASYMPTOMATIC COVID-19 (Diagnosed with COVID but no symptoms) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment medications were reported. This case concerns a male patient of an unknown age with no relevant medical history, who experienced the unexpected adverse events of special interest of Asymptomatic COVID-19 and COVID-19. The event occurred on an unknown number of days after receiving an undisclosed dose number of mRNA-1273 Vaccine and had a fatal outcome, with death occurring on an unknown date. The reported cause of death was COVID. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 18-Nov-2021: follow up received has no new information; Sender''s Comments: This case concerns a male patient of an unknown age with no relevant medical history, who experienced the unexpected adverse events of special interest of Asymptomatic COVID-19 and COVID-19. The event occurred on an unknown number of days after receiving an undisclosed dose number of mRNA-1273 Vaccine and had a fatal outcome, with death occurring on an unknown date. The reported cause of death was COVID. 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: COVID


VAERS ID: 1901540 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-10-09
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain lower, Angiogram, Asthma, Atrial fibrillation, COVID-19, Death, Deep vein thrombosis, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Hypoxia, Pleural effusion, Pulmonary embolism, SARS-CoV-2 test, Thrombocytopenia, Ultrasound scan, Ultrasound scan abnormal, Vaccination failure, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haematopoietic thrombocytopenia (narrow), Lack of efficacy/effect (narrow), Systemic lupus erythematosus (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20211009; Test Name: COVID-19 virus test; Result Unstructured Data: Positive; Test Date: 20211021; Test Name: Diagnostic ultrasound; Result Unstructured Data: Deep Vein Thrombosis; Test Date: 20211021; Test Name: Echocardiogram; Result Unstructured Data: LVEF 20-25%; Test Date: 20211024; Test Name: CT angiography; Result Unstructured Data: pulmonary emboli; Test Date: 20211025; Test Name: Echocardiogram; Result Unstructured Data: LVEF 25%
CDC Split Type: USJNJFOC20211130291

Write-up: DEATH; HYPOXIA; PULMONARY EMBOLISM; PLEURAL EFFUSION; ANGIOGRAM; ATRIAL FIBRILLATION; ULTRASOUND SCAN ABNORMAL; DEEP VEIN THROMBOSIS; ECHOCARDIOGRAM ABNORMAL; ASTHMA; THROMBOCYTOPENIA; CONFIRMED CLINICAL VACCINATION FAILURE; COVID-19; VACCINE BREAKTHROUGH INFECTION; ABDOMINAL PAIN LOWER; DYSPNOEA; This spontaneous report received from a health care professional via a Regulatory Authority Vaccine Adverse Event Reporting System (VAERS) concerned a 65 year old male of unspecified race and ethnic origin. Initial information was processed along with the additional information received on 19-Nov-2021 and from Central Complaint Vigilance department on 23-Nov-2021. The patient''s height and weight were not reported. The patient concurrent conditions include hypertension and type 2 diabetes. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1805031 expiry: UNKNOWN) dose was not reported, 1 total administered on 01-APR-2021 to left arm for an unspecified indication. No concomitant medications were reported. On 09-OCT-2021, the patient tested positive for Covid-19 (confirmed clinical vaccination failure). On 20-OCT-2021, the patient was admitted to hospital with worsening shortness of breath and asthma. In emergency room patient presented with ST elevation DKA (diabetic ketoacidosis). Insulin drip protocol was started and patient was taken to lab where 100% LAD (left anterior descending) occlusion was observed and received DES (drug-eluting stent). Later admitted to intensive care unit (ICU) started on remdesivir, Decadron, insulin drip. Continued thrombocytopenia was noted consistent with DIC (disseminated intravascular coagulation) and no "TOCI" given requiring high flow oxygen, transferred out of ICU. On 21-OCT-2021 echocardiogram showed left ventricular ejection fraction (LVEF) 20-25%, DVT (Deep vein thrombosis) ultrasound showed right distal femoral to entire popliteal DVT. The patient was started on enoxaparin. On 23-OCT-2021, the patient developed atrial fibrillation with rapid ventricular response (A fib RVR) and was initially treated with digoxin and then with amiodarone drip, patient developed more shortness of breath and was then transferred to ICU, downgraded to med telemetry on 24-OCT-2021 in early morning. On 24-OCT-2021, chest computed tomography angiogram showed bilateral lower lobe pulmonary emboli consolidations and bilaterally bilateral pleural effusions and was started on Eliquis. The patient required ongoing high flow oxygen need. On 25-OCT-2021 repeat echocardiogram was done with similar results of LVEF of 25%. On 26-OCT-2021 the patient was started on empiric treatment of ceftriaxone and doxycycline. On 28-OCT-2021, patient was transferred to ICU for work of breathing hypoxia intolerant of BiPAP (bilevel positive airway pressure) and was able to come off Bipap in the evening to high flow oxygen, able to take in some through oral. During the course of the night on the same day the patient experienced desaturations despite Bipap. The patient was intubated. Unfortunately, patient expired, PEA (Pulseless electrical activity) arrest later in the morning on 29-OCT-2021. Despite several rounds of cardiopulmonary resuscitation, patient expired at 3:05 am on 29-OCT-2021 from an unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of from an unknown cause of death on 29-OCT-2021, and the outcome of abdominal pain lower, angiogram, asthma, atrial fibrillation, covid-19, deep vein thrombosis, dyspnoea, echocardiogram abnormal, hypoxia, pleural effusion, pulmonary embolism, thrombocytopenia, ultrasound scan abnormal, vaccine breakthrough infection was fatal and the outcome of confirmed clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition). This report was associated with a product quality complaint: 90000203205. The suspected product quality complaint has been confirmed to be the reported allegation could not be confirmed. A manufacturing related root cause could not be identified based on the PQC evaluation/investigation performed. Additional information received from Central Complaint Vigilance department on 24-NOV-2021. The following information was updated and incorporated into the case narrative: PQMS number and Product quality complaint investigation result added.; Sender''s Comments: V1:Additional information received updates: PQMS number and Product Quality complaint investigation result. This updated information does not alter prior causality assessment of reported events. 20211130291-COVID-19 VACCINE AD26.COV2.S - deep venous thrombosis, thrombocytopenia, pulmonary embolism, ultrasound scan abnormal . This event(s) is labeled per RSI and is therefore considered potentially related. 20211130291-COVID-19 VACCINE AD26.COV2.S -asthma, atrial fibrillation, echocardiogram abnormal, covid-19, vaccine breakthrough infection, death, dyspnoea, hypoxia, pleural effusion, abdominal pain lower, angiogram. 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). 20211130291-COVID-19 VACCINE AD26.COV2.S -confirmed clinical vaccine failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1901641 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-25
Onset:2021-10-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822B11 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Anal incontinence, Deafness unilateral, Headache, Mobility decreased, Swelling, Urinary incontinence, Visual field defect
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Noninfectious diarrhoea (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-21
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, Insulin, Atorvastatin, Seraquel, Lasix, Zoloft
Current Illness: Type 2 diabetes and renal failure
Preexisting Conditions: Diabetes Kidney Failure
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Stabbing" headaches, progressive memory loss, unexplained uncontrollable swelling below the waist, loss of bowel & bladder control, deaf in right ear, blind spot in left eye, could no longer perform basic movements independently.


VAERS ID: 1901707 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-01
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: The patient passed away; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (The patient passed away) in a 56-year-old patient of an unknown gender 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. Death occurred on 01-Nov-2021 The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medication reported. No Treatment Medication reported. Company comment This is a spontaneous case concerning a 56-year-old male patient with no relevant medical history reported, who experienced serious, unexpected event of death. The event occurred on an unknown date after receiving a dose of mRNA-1273 vaccine. The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This is a spontaneous case concerning a 56-year-old male patient with no relevant medical history reported, who experienced serious, unexpected event of death. The event occurred on an unknown date after receiving a dose of mRNA-1273 vaccine. The patient died on 01-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1902018 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-11-22
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose decreased, COVID-19, Confusional state, Death, Exposure to SARS-CoV-2, Hypoxia, Intensive care, Mental status changes, Pyrexia, SARS-CoV-2 test positive, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (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? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, 650 mg= 2 TAB, PO, Q4H (Every 4 hours), PRN amLODIPine, 2.5 mg= 1 TAB, PO, Daily aspirin, 81 mg= 1 TAB, PO, Daily atorvastatin, 80 mg= 2 TAB, PO, QHS (At bedtime) cholecalciferol, 1000 Inter_Units= 1 TAB, PO, Daily clopi
Current Illness:
Preexisting Conditions: Acute on chronic renal insufficiency DM type 2 (diabetes mellitus, type 2) Essential hypertension Pacemaker PAF (paroxysmal atrial fibrillation) SSS (sick sinus syndrome)
Allergies: fleet phospho soda
Diagnostic Lab Data: 11/12/21 Sars COV2 RAPID positive
CDC Split Type:

Write-up: [ 89-year-old with past history coronary disease congestive heart failure diabetes pacemaker presents to for altered mental status. Patient was be confused this morning at his nursing blood glucose was checked was 50 so was given dextrose. Also noted be hypoxic. Apparently patient did have a COVID exposure recently had a fever yesterday however is COVID test was pending. At time of evaluation patient is now alert still little confused is A&O x2. No chest pain, abdominal pain vomiting or diarrhea. Of no, EMS found him to be in V-tach at 1 point during transport. This seems to have converted spontaneously.] Patient hospitalized in ICU from 11/12/21 through 11/22/2021 Patient expired on 11/22/2021


VAERS ID: 1902165 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Unknown  
Location: Wisconsin  
Vaccinated:2021-10-28
Onset:2021-11-20
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Condition aggravated, 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: 2021-11-20
   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: Prior strokes Diabetes Hyperlipidemia HTN GERD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient admitted for stroke 10/20-11/2/2021. received Pfizer vaccine 10/28/2021. discharged to SAR 11/2/2021. date of death = 11/20/2021.


VAERS ID: 1903479 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-21
Onset:2021-05-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Muscle spasms, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 176
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: morphine, Percocett,
Current Illness: COPD
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: red swollen arm with fever to it for 3/4 days after it cleared up leg cramps occured frequently.


VAERS ID: 1903577 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-05
Onset:2021-11-15
   Days after vaccination:314
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039*K20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Eye disorder, Hyperhidrosis, Limb discomfort, Loss of consciousness, Skin discolouration
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high (had high blood pressure (but under control).); Diabetes (had diabetes (but under control).); Overweight
Preexisting Conditions: Medical History/Concurrent Conditions: Heart disease, unspecified; Heart valve replacement (three years ago he had a heart valve replacement surgery, but he had been fine since.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Passed away/ Doctors couldn''t revive him; passed out; gasping for air/couldn''t breathe/tried to breathe for him and do CPR, but it wasn''t working; He was sweating/chest was wet; looked a little ashy; his legs went limb and relaxed; "His eyes were, like, not right"; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Passed away/ Doctors couldn''t revive him), LOSS OF CONSCIOUSNESS (passed out), DYSPNOEA (gasping for air/couldn''t breathe/tried to breathe for him and do CPR, but it wasn''t working), HYPERHIDROSIS (He was sweating/chest was wet), SKIN DISCOLOURATION (looked a little ashy), LIMB DISCOMFORT (his legs went limb and relaxed) and EYE DISORDER ("His eyes were, like, not right") in a 71-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 076C21A, 039*K20A and 038K20A) for COVID-19 vaccination. The patient''s past medical history included Heart disease, unspecified and Heart valve replacement (three years ago he had a heart valve replacement surgery, but he had been fine since.) in 2018. Concurrent medical conditions included Diabetes (had diabetes (but under control).), Blood pressure high (had high blood pressure (but under control).) and Overweight. On 05-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 14-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 15-Nov-2021, the patient experienced LOSS OF CONSCIOUSNESS (passed out) (seriousness criteria death and medically significant), DYSPNOEA (gasping for air/couldn''t breathe/tried to breathe for him and do CPR, but it wasn''t working) (seriousness criterion death), HYPERHIDROSIS (He was sweating/chest was wet) (seriousness criterion death), SKIN DISCOLOURATION (looked a little ashy) (seriousness criterion death), LIMB DISCOMFORT (his legs went limb and relaxed) (seriousness criterion death) and EYE DISORDER ("His eyes were, like, not right") (seriousness criterion death). The patient died on 15-Nov-2021. The cause of death was not reported. An autopsy was performed, but no results were provided. Patient was sitting on the couch, gasping for air, and told reporter to hurry and call 911 since he couldn''t breathe.The ambulance people tried to revive him, they put him on the floor, and they took his pulse. They asked for his medications and took him into the ambulance. When they arrived at the hospital, it took a while for any doctor to come and talk to her, so she thought they could revive him and was expecting some damage, like slow speech or paralysis. But when the doctor came in, he told her that they couldn''t revive him, and he had passed. When she got in to see him, he had a tube on his mouth and his body temperature was fine, but he wasn''t there anymore. No concomitant medication information were given. No treatment information were given. Company comment: This case concerns a 71-year-old, male patient, with medical history of diabetes, heart disease, and heart valve replacement surgery, who experienced the serious, unexpected events of death, loss of consciousness, dyspnea, hyperhidrosis, skin discoloration, limb discomfort and eye disorder. One day after receiving the booster dose of mRNA 1273 vaccine, patient called out for his wife as he was gasping for air and couldn''t breathe, he was sweating and looked a little ashy. Patient passed out before ambulance arrived, CPR was done but patient was not revived. Wife requested for an autopsy by private individual, result not yet provided. The patient''s co-morbidities of diabetes, heart disease, and heart valve replacement remains as a confounder to the events. The benefit risk relationship of vaccine is not affected by this report.; Sender''s Comments: This case concerns a 71-year-old, male patient, with medical history of diabetes, heart disease, and heart valve replacement surgery, who experienced the serious, unexpected events of death, loss of consciousness, dyspnea, hyperhidrosis, skin discoloration, limb discomfort and eye disorder. One day after receiving the booster dose of mRNA 1273 vaccine, patient called out for his wife as he was gasping for air and couldn''t breathe, he was sweating and looked a little ashy. Patient passed out before ambulance arrived, CPR was done but patient was not revived. Wife requested for an autopsy by private individual, result not yet provided. The patient''s co-morbidities of diabetes, heart disease, and heart valve replacement remains as a confounder to the events. The benefit risk relationship of vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1904084 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-03-01
Onset:2021-11-04
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Brain death, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Laboratory test abnormal, Thrombectomy
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: 2021-11-06
   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: Warfarin, Metformin, Allopurinol, Dilitiazem, Furosemide
Current Illness: none
Preexisting Conditions: A-fib, pacemaker (all controlled with medications)
Allergies: No known allergies
Diagnostic Lab Data: CTscans, surgery to remove clots, brain death response tests...
CDC Split Type:

Write-up: On November 4th, 2021 he had a catastrophic stroke due to blood clots in his brain. He was declared brain dead on November 6th, 2021 at 12:00 pm. We believe these clots were caused by the covid 19 vaccination. He also had a flu shot in addition weeks prior, which he was advised to get by medical professionals.


VAERS ID: 1904384 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-21
Onset:2021-04-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Cystic fibrosis, Death
SMQs:, Congenital, familial and genetic disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid, first dose 3/2/21 Moderna, 012A21A CVS5027 - cold-like symptoms developed into CF leading to pneumonia
Other Medications: Metformin, novolog, trulicity, furosemide, lopressor, magnesium oxide, eliquis, Claritin, multivitamin, calcium
Current Illness: Congestive heart failure, pneumonia after first vaccine dose
Preexisting Conditions: Diabetes insipidus, Diabetes melitus, A-fib, HBP
Allergies: Unk
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Death - the patient was hospitalized after receiving the 1st dose, with CF and other issues, upon entry to RRLC she was in recovery - vitals were good. Her health was improving. Three days after the second dose in the morning while the aide waited outside, she died on the toilet - shocking all staff at the facility and the family.


VAERS ID: 1904387 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-11-19
Onset:2021-11-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Back pain, Blood pressure increased, Chest X-ray, Gastrointestinal wall thickening, Scan abdomen abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Angrelide, eliquis, Tylenol, blood pressure med. I can''t remember the exact one. Multivitamin plus K2, Areds (eye vitamin), B12, D3 CoQ10.
Current Illness: He received a bag of blood a week before his vaccine . This was for his platelet issue.
Preexisting Conditions: MDS, also stroke 2 years ago.
Allergies: ue.that I know of.
Diagnostic Lab Data: 11/21/21 had abdominal scan and chest xray. Thickening of small intestine and possible pneumonia. Pain was now in back and stomach.
CDC Split Type:

Write-up: Dad was fine until 7:30 11/20/21. Called me to say he had terrible stomach pain, blood pressure through the roof. He vomited 2x. Neighbor had him call for an ambulance and rushed to emergency. when I arrived his BP was still very high and his pain was still bad. He remained in emergency until Sunday when a bed became available.


VAERS ID: 1904459 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-24
Onset:2021-11-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-28
   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: tylenol cyanocobalamin lasix lupron potassium procrit folic acid retacrit benadryl betadine
Current Illness: dysphagia vitamin b diff edema malignant neoplasm of prostate hypokalemia anemia pain kidney failure severe protein cal malnutrition malignant neoplasm of colon secondary malignant neoplasm of liver and intrahepatic bile duct
Preexisting Conditions: cancer
Allergies: aspirin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: death on 11/28/2021


VAERS ID: 1905343 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-18
Onset:2021-11-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Discomfort, Full blood count, Metabolic function test, Moaning, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   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: Lipitor, Zyrtec, Calcium, Keppra, Synthroid, Lisinopril,
Current Illness: neoplasm of colon (status post right colectomy on 11/15/21)
Preexisting Conditions: epilepsy, benign neoplasm of left breast,hypothyroidism, glaucoma, agranulocytosis (drug induced)
Allergies: NKA
Diagnostic Lab Data: CBC, Chem7
CDC Split Type:

Write-up: Lap Right Colectomy on 11/15/21 11/18/21:10:28 received Covid 19 booster 11/18/21: 8 pm, moaning and discomfort-given tylenol and ultram at 9:45 pm 11/19/21: 2 am, tossing and turning 11/19/21: 7 am, vomited, doctor contacted for ondansetron 11/19/21:7:15 am, patient expired


VAERS ID: 1905368 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-11-25
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated, COVID breakthrough, inpatient hospital stay


VAERS ID: 1905379 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-11-01
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Death, Dyspnoea, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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: 2021-11-15
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG tablet aspirin (HALFPRIN) 81 MG tablet ergocalciferol D-2 (DRISDOL) 50000 UNIT capsule furosemide (LASIX) 40 MG tablet isosorbide mononitrate (IMDUR) 30 MG SR tablets meclizine (ANTIVERT) 25 MG tablet metoprolol t
Current Illness: None known
Preexisting Conditions: AAA (abdominal aortic aneurysm, ruptured) (HCC) Hypertrophic scar Aortic aneurysm (HCC) Arthritis Atrial fibrillation (HCC) High cholesterol Peripheral vascular disease (HCC) Renal insufficiency Keloid scar of skin Chronic respiratory failure with hypoxia (HCC) Abdominal pain Osteoarthrosis, unspecified whether generalized or localized, unspecified site Essential hypertension Post-menopausal SOB (shortness of breath) on exertion Ruptured thoracic aortic aneurysm (HCC) Nonrheumatic aortic valve insufficiency Non-rheumatic mitral regurgitation Cardiac murmur Palpitations Varicose veins of both lower extremities with pain Unsteady gait Primary osteoarthritis involving multiple joints Chest discomfort Oxygen dependent Vitamin D deficiency Fluid overload Acute respiratory failure with hypoxia (HCC) CHF (congestive heart failure), NYHA class II, acute, systolic (HCC) Hypervolemia, unspecified hypervolemia type Acute on chronic systolic congestive heart failure (HCC)
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 11/15/2021.
CDC Split Type:

Write-up: Patient presented to emergency room on 11/2/2021 after testing positive for COVID-19 infection on 11/1/2021. She was experiencing shortness of breath, weakness, and cough. Patient was admitted for further management. Patient''s respiratory status continued to decline despite steroids and oxygen supplementation. Patient expired on 11/15/2021.


VAERS ID: 1905402 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-11
Onset:2021-11-28
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL9266 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Cardiac failure, Death, Respiratory failure, SARS-CoV-2 test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 24 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, CAD, GI bleeds, CKD, anemia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed away 11/28/2021, heart failure, anemia and respiratory failure. Patient was negative for Covid 19. Dose 1 given 1/18/2021, Moderna, Lot # n/a


VAERS ID: 1905409 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-11-25
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
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:
Current Illness:
Preexisting Conditions: diabetes, COPD, asthma, lung disease, hypertension, CAD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given 2/5/2021 Moderna lot # 016M20A Patient died of Covid 19 pneumonia, respiratory failure


VAERS ID: 1905445 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-11-27
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Private       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: 2021-11-27
   Days after onset: 0
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: COPD, CKD, dementia, CAD, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given 2/25/2021 Pfizer Lot # EN6198 Patient died from Covid 19


VAERS ID: 1905460 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-11-25
   Days after vaccination:253
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac failure, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease, hypertension, CKD, diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Moderna 2/17/2021 Lot # N/A Patient died at a local hospital 11/25/2021 from heart failure, pallitive care initiated. Not a Covid 19 death


VAERS ID: 1905479 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-09-18
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, COVID-19, Death, Diabetic ketoacidosis, Dyspnoea, Endotracheal intubation, Hypotension, Intensive care, Mental status changes, Positive airway pressure therapy, Prone position, SARS-CoV-2 test positive, Septic shock
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: diagnosed positive for COVID on 9/18/21; EMS brought pt to ED with altered mental state, increased SOB and hypotension; 70% O2 saturation on RA, glucose greater than 600; PMH: DM, chronic kidney disease; treated with DKA protocol, dexamethasone, remdesivir, Olumiant, Budesonide; to ICU; BiPAP ; intubated on 10/3/21 requiring FiO2 of 100% and proned; septic shock; DNR; transitioned by family to comfort care with worsening condition of pt; pt died in the hosp


VAERS ID: 1905482 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-11-24
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure, Death, Multiple organ dysfunction syndrome
SMQs:, Cardiac 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), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiac disease, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 Pfizer given 4/1/2021 Lot # ER8737 Patient died of heart failure, multiorgan failure at hospital on 11/24/2021, this is not a covid 19 death.


VAERS ID: 1905628 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-18
Onset:2021-11-23
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 RA / SC

Administered by: Private       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: 2021-11-23
   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: Atorvastatin; citalopram; Colace; coreg; ergocalciferol; gabapentin; galantamine; glipizide; HCTZ; Imdur; Norco; Losartan; Nitrostat; Norvasc; Ondansetron; Pantoprazole; Travoprost 0.004%; trazodone; warfarin
Current Illness:
Preexisting Conditions: Afib; CABG; CAD; Cardiomyopathy; dementia; chronic pain; depression; HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID infection in vaccinated patient. Pt expired on 11/23/21


VAERS ID: 1905662 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-04
Onset:2021-11-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cerebrovascular accident, Chest X-ray abnormal
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (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), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-17
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol succinate, ASA, Protonix, ferrous gluconate, potassium chloride, iCaps AREDS, multivitamin, vitamin B12, vitamin D3, furosemide, SSD cream, magnesium oxide, allopurinol, pravastatin, levothyroxine, ezetimbe, omeprazole
Current Illness: Lung Cancer
Preexisting Conditions: CHF, CAD, Cardiomyopathy
Allergies: tramadol, Valium, methocarbamol
Diagnostic Lab Data: CXR etc. 11/8/2021 through 11/17/2021
CDC Split Type:

Write-up: Acute Respiratory Failure, Acute CVA, COVID-19 pneumonia


VAERS ID: 1905714 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-09
Onset:2021-11-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood culture negative, Culture urine negative, Death, Erythema, Full blood count normal, Hypophagia, Lethargy, Metabolic function test normal, Pain in extremity, Peripheral swelling, Pyrexia, Skin warm, Tachycardia, Urine analysis normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 10 mg tablet, Humalog Insulin, Mirtazapine 7.5 mg tablet, Voltaren Gel 1% topical
Current Illness: No acute illness at time of vaccination or one month prior
Preexisting Conditions: History of pulmonary embolism, vascular dementia, adjustment disorder with depressed mood, history of TIA and CI, Type II DM, muscle weakness, history of encephalopathy
Allergies: Allergic to cayenne pepper
Diagnostic Lab Data: Patient received COVID booster shot on 11/9/2021. Within 24 hours patient''s left arm became erythematous, warm, swollen, painful. Attending M.D. was notified and ordered course of doxycycline. No other reaction noted until the week beginning on 11/15/2021 the patient began having low grade fevers and was more subdued, quieter. The patient became more lethargic by 11/17/2021 and PO intake declined as a result. Attending M.D. ordered CBC, CMP, blood cultures and urine analysis with C+S on 11/17/21. Labs did not have significant findings. The patient continued to be extremely lethargic, very minimal PO intake, having fevers, tachycardia. Patient deceased on 11/20/2021.
CDC Split Type:

Write-up: Patient received COVID booster shot on 11/9/2021. Within 24 hours patient''s left arm became erythematous, warm, swollen, painful. Attending M.D. was notified and ordered course of doxycycline. No other reaction noted until the week beginning on 11/15/2021 the patient began having low grade fevers and was more subdued, quieter. The patient became more lethargic by 11/17/2021 and PO intake declined as a result. Attending M.D. ordered CBC, CMP, blood cultures and urine analysis with C+S on 11/17/21. Labs did not have significant findings. The patient continued to be extremely lethargic, very minimal PO intake, having fevers, tachycardia. Patient deceased on 11/20/2021.


VAERS ID: 1905782 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-26
Onset:2021-11-24
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Coronary Artery Disease, Diabetes, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is now deceased, very likely from Covid-19, based on the positive test of her spouse, and very similar symptoms


VAERS ID: 1905809 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-08
Onset:2021-11-10
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, Intensive care, Malaise, Mechanical ventilation, Paralysis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-28
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: papillary thyroid carcinoma s/p thyroidectomy, now in acquired hypothyroidism, HTN, gout, and anxiety
Allergies:
Diagnostic Lab Data: COVID PCR+11/10/21
CDC Split Type:

Write-up: Onset of COVID symptoms 11/8, tested positive for COVID 11/10/21. admitted from the floor earlier today for acute hypoxic respiratory failure secondary to Covid PNA. Patient was initially a transfer from a hospital on 11/13. Admitted after he needed NIPPV. Intubated 11/17 and paralyzed and proned 11/17. Deceased 11/28/21.


VAERS ID: 1905891 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-18
Onset:2021-08-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SD8448 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Chest discomfort, Cough, Death, Dyspnoea, Fatigue, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-08
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Congestive Heart Failure
Allergies: N/A
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Pt.''s states that after receiving the 1st dose of Phizer 08/18/2021, started experiencing symptoms 08/25/2021 of shortness of breath, fatigue, dry cough, difficulty breathing while sleeping, and heaviness in the chest. 09/02/2021 Primary visit, Prescribed Inhalers for Follow-Up. Emergency Room transported (passed out), Pt. passed 09/08/2021. Cause of Death : Acute Hypoxia Respiratory Failure and Covid Pneumonia.


VAERS ID: 1905897 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-21
Onset:2021-11-11
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Anticoagulant therapy, Asthenia, Atelectasis, Blood potassium decreased, Blood pressure increased, Brain natriuretic peptide increased, Breath sounds absent, COVID-19, Cardiac telemetry, Chest X-ray abnormal, Chest pain, Chills, Choking, Condition aggravated, Cough, Death, Diabetes mellitus, Diarrhoea, Dyspnoea, Echocardiogram, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram abnormal, Electrolyte imbalance, Essential hypertension, Hyperlipidaemia, Hypertension, Hypervolaemia, Hypocalcaemia, Hypokalaemia, Hypomagnesaemia, Hyponatraemia, Hypophagia, Hypopnoea, Hypoxia, Intensive care, Left atrial dilatation, Left ventricular end-diastolic pressure, Lung disorder, Mitral valve calcification, Mitral valve incompetence, Nausea, Oesophageal stenosis, Pain, Pleural effusion, Polyuria, Pulmonary valve incompetence, Pulse absent, Pupil fixed, Pyrexia, Restlessness, Right ventricular systolic pressure, SARS-CoV-2 test positive, Sinus tachycardia, Sleep apnoea syndrome, Stress cardiomyopathy, Stroke volume, Total lung capacity decreased, Tricuspid valve incompetence, Troponin increased, Ultrasound Doppler abnormal, Unresponsive to stimuli, Ventricular extrasystoles, Ventricular hypokinesia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ascorbic Acid (VITAMIN C) 500 MG tablet, take 500 mg by mouth Daily. ? aspirin 81 MG tablet, take 81 mg by mouth Daily. ? cholecalciferol (VITAMIN D3) 25 MCG (1000 UT) capsule, Take 25 mcg by mouth daily. ? hydroCHLOROthiazide (HYDRODIUR
Current Illness: diarrhea beginning 11/3/21 - 3-4 episodes/day - pt taking immodium & drinking pedialyte for 4 days
Preexisting Conditions: Hypocalcemia 11/11/2021 ? Osteoarthritis of both knees, unspecified osteoarthritis type 10/31/2020 ? UTI (urinary tract infection) 11/13/2018 ? Post herpetic neuralgia 03/28/2018 ? Postmenopausal bleeding 02/05/2018 ? ETD (Eustachian tube dysfunction), left 04/07/2017 ? Lesion of parotid gland 07/19/2016 ? Bicuspid aortic valve 01/19/2016 ? Status post aortic valve replacement 01/19/2016 ? Eczematoid otitis externa of left ear 10/05/2015 ? Glaucoma 05/13/2014 ? Hyperlipidemia 10/25/2011
Allergies: NKA
Diagnostic Lab Data: DR CHEST SINGLE VIEW Resulted: 11/18/21 1140 Order Status: Completed Updated: 11/18/21 1142 Narrative: EXAMINATION: Single View Chest EXAM DATE: 11/18/2021 11:02 AM TECHNIQUE: Single view chest INDICATION: hypoxia COMPARISON: 11/13/2021 and earlier exams. ENCOUNTER: Not applicable _________________________ FINDINGS: There are surgical changes from prior median sternotomy. The lung volumes are low. Grossly stable cardiac silhouette. Blunting of the costophrenic angles, probably due to small pleural effusions. Increasing patchy consolidation in the mid to lower left and right lung zones No pneumothorax is identified. _________________________ Impression: Bilateral airspace disease, significantly increased compared with 11/13/2021. CV Echo Complete Collected: 11/15/21 1043 Order Status: Completed Updated: 11/15/21 1312 Narrative: ECHOCARDIOGRAPHY REPORT Study Date: 11/15/2021 Patient Class: Inpatient Gender: Female Ordering Physician: Age: 83 yrs Height: 158 cm Performed By: RDCS, RVT Weight: 66 kg Resting HR: 97 Resting BP: 130/83 mmHg BSA: 1.7 m2 Reason For Study: Abnormal cardiac biomarkers History/Symptoms: Aortic Valve Replacment 2003, Hypertension, Hyperlipidemia, Diabetes, Obstructive Sleep Apnea, NSTEMI, Recent COVID Electronically signed by: MD on 11/15/2021 01:11 PM Interpretation Summary The left ventricle is normal in size. Distal 2/3 of LV akinetic. Basal segments moderately hypokinetic. The left ventricular ejection fraction is 21%. The left atrium is severely dilated. The estimated right ventricular systolic pressure is 40 mmHg. There is a bioprosthetic aortic valve. There is mild mitral regurgitation. There is mild to moderate tricuspid regurgitation. Today''s study was compared to one performed on 7/26/2021. The LVEF was 63% on the prior study. STUDY PERFORMED/QUALITY: AORTIC VALVE: A complete two-dimensional There is no aortic valve stenosis. No transthoracic echocardiogram was aortic regurgitation is present. There performed (2D, M-mode, spectral flow is a bioprosthetic aortic valve. The Doppler and color flow doppler). The prosthetic aortic valve is well- technical quality of the exam was seated. fair. Location: Department. Definity was not given because patient refused. MITRAL VALVE: Normal anterior leaflet. There is LEFT VENTRICLE: moderate mitral annular calcification. The left ventricle is normal in size. There is no mitral valve stenosis. There is normal left ventricular wall There is mild mitral regurgitation. thickness. Distal 2/3 of LV akinetic. Basal segments moderately hypokinetic. TRICUSPID VALVE: The left ventricular ejection fraction Structurally normal tricuspid valve. is 21%. The LV ejection fraction was There is mild to moderate tricuspid determined utilizing Simpson''s Biplane regurgitation. The estimated right method. ventricular systolic pressure is 40 mmHg. LEFT ATRIUM/ATRIAL SEPTUM: The left atrium is severely dilated. PULMONIC VALVE: Structurally normal pulmonic valve. RIGHT ATRIUM: Mild pulmonic valvular regurgitation. Right atrial size is normal. RIGHT VENTRICLE: The right ventricle is not well visualized. PERICARDIUM/PLEURAL: No pericardial effusion. AORTA/PULMONARY ARTERY: The Sinus of Valsalva is measured at 2.6cm. INFERIOR VENA CAVA: The inferior vena cava was not visualized during the exam. Left Ventricle Left Atrium EF(MOD-Avg): 21 % LA vol index: 66.8 ml/m2 EDV(MOD-sp4): 86.9 ml LA vol: 111.7 ml ESV(MOD-sp4): 61.2 ml SV(MOD-Avg): 20.5 ml IVSd: 0.85 cm LVPWd: 0.61 cm LVIDd: 5.0 cm LVIDs: 4.1 cm EDV(MOD-sp2): 117.3 ml ESV(MOD-sp2): 102.0 ml ______________________________________________________________________________
CDC Split Type:

Write-up: Deceased (11.21.21); Hospitalized (11.11.21); COVID-19 positive (11.11.21); Fully vaccinated ASSESSMENT / PLAN: * Hypokalemia severe Assessment & Plan Severe hypokalemia Orally and IV potassium replacement Suspect a combination of diarrhea as well as hydrochlorothiazide Hold hydrochlorothiazide consider starting a set discharge instead of hydrochlorothiazide Hypomagnesemia likely contributed as well Intensive care unit on telemetry monitoring until potassium has significantly improved Hypocalcemia Assessment & Plan Suspect related to poor oral intake as well as severe hypomagnesemia IV replacement Replace magnesium Suspect will improve calcium level with magnesium replacement Hypomagnesemia Assessment & Plan Suspect due to hydrochlorothiazide and or diarrhea IV replaced COVID-19 Assessment & Plan Patient vaccinated likely explaining why her oxygenation is so good. No indication for dexamethasone or remdesivir Main symptom is diarrhea Continue respiratory isolation Generalized weakness Assessment & Plan Suspect multiple factors including all of her electrolyte abnormalities on baseline weakness PT OT Essential hypertension with goal blood pressure less than 140/90 Assessment & Plan Blood pressure elevated in the ER will follow. Holding hydrochlorothiazide Consider changing to lisinopril at discharge. Or during hospitalization if antihypertensive needed. Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypocalcemia [E83.51] Hypokalemia [E87.6] Hypomagnesemia [E83.42] Diarrhea, unspecified type [R19.7] COVID-19 [U07.1] HOSPITAL COURSE: Patient was admitted 11/11/21 with main complaint of weakness, as well as diarrhea, fever, chills, and cough. In the ER she was found to be COVID positive and hypokalemic with a potassium of 2.0. She had been vaccinated for COVID and was not hypoxic at time of admission. She was initially placed in the ICU while potassium was replaced. She was eventually started on IVF for hyponatremia. On 11/13, the patient had a choking episode while taking pills, which resulted in hypoxia and shortness of breath. She had a history of "tight esophagus" but did not want to have repeat dilation per daughter. That evening the patient complained of chest pain and nausea. EKG revealed sinus tachycardia with occasional PVCs. BNP was markedly elevated at 32,400 and troponin was 206. CXR showed atelectasis. IVF were discontinued and she was given IV lasix for suspected fluid overload. Heparin drip was started for suspected NSTEMI and nitro paste was placed. She received ASA, statin, and beta blocker. She was started empirically on antibiotics to cover for potential aspiration pneumonia. The patient did not desire cardiac intervention. SLP evaluated the patient and suggested thin liquids with medications crushed in puree or liquidized. Echocardiogram was obtained and notable for diffuse apical akinesis and an EF of 21%. This was discussed with cardiology and felt to likely be takotsubo cardiomyopathy. Her weakness and hypoxia continued to worsen. She continued to be diuresed. The evening of 11/17 the patient expressed thoughts of transitioning to comfort care. 11/18 she stated that she did not want to continue aggressive medical therapies. Family was in support of this decision and Hospice was consulted. The plan was that she would transition to hospice care at discharge. She was given medications as needed for restlessness and pain. The early morning of 11/21, Patient had very shallow respirations. She was pronounced dead at 3:26 on 11/21/21. On exam she was unresponsive, pupils fixed and dilated, no pulse, no breath sounds, and no heart tones. Daughter was notified. Funeral home arrangements pending.


VAERS ID: 1905900 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-14
Onset:2021-11-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Hypotension, Hypoxia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had severe hypoxia and hypotension, arrived to the hospital on 11/25/21, was intubated, and died 8hrs later.


VAERS ID: 1905948 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-27
Onset:2021-11-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Condition aggravated, Death, Dyspnoea, Fall, Hip fracture, Hip surgery, Pancreatitis, Unresponsive to stimuli, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Osteoporosis/osteopenia (broad), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-28
   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: many prescription
Current Illness: pancreatitis, hip fracture repair, dementia
Preexisting Conditions: atrial fibrillation
Allergies: None
Diagnostic Lab Data: elevated WBC 4 hours after vaccine to 28,000
CDC Split Type:

Write-up: Patient received 1st vaccine in series at 11:45 am 11/27/21 during hospitalization. She had been in hospital for 10 days after pancreatitis, fall with hip fracture and fixation of hip fractures. At 11:45pm she was noted to be short of breath. at 6:15 pm on 11/28/21 she was found unresponsive, coded and expired.


VAERS ID: 1905991 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-29
Onset:2021-11-08
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-27
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metolazone, Norco, Torsemide, Stiolto, docusate senna, DuoNeb, allopurinol , gabapentin, Levoxyl, Trazodone, Cholecalciferol, nortriptyline, Benefiber, albuterol MDI, Zarelto, Flonase
Current Illness: CHF, A-fib, Chronic kidney disease, chronic hypoxic respiratory failure, Corpulmonale, HTN, GI reflux, hypothyroidism, Depression, Osteoarthritis, hyper parathyroidism, spinal stenosis, pulmonary nodules.
Preexisting Conditions: CHF, A-fib, Chronic kidney disease, chronic hypoxic respiratory failure, Corpulmonale, HTN, GI reflux, hypothyroidism, Depression, Osteoarthritis, hyper parathyroidism, spinal stenosis, pulmonary nodules.
Allergies: Cefuroxime, fluoxetine, EES, Doxycycline, metoprolol, Moxifloxacin, PCN, Pregabalin, Sulfa, Iodine contrast
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (In House)) Ordered Test Codes: 94500-6 7459134031 Status: Final Accession Number: 2021312003766001 Specimen Source: Nasopharynx Specimen Collection Date/Time: 2021-11-08 13:10:00.0 Results: * Resulted Test: SARS-CoV-2 RNA Resp Ql NAA+probe (SARS CoV-2 PCR (COVID-19)) Coded Result: Positive Reference Range From: Negative Facility ID:27D0666145 (FI) Interpretation: Abnormal Result Method: (Xpert Xpress SARS-Co) Status: Final Test Code: 94500-6 Result Code: 10828004 (SCT/Positive} Result Comments: Positive results are indicative of active infection with SARS-CoV-2. Positive results do not rule out bacterial infection or co-infection with other viruses.
CDC Split Type: 1055381

Write-up: Case was hospitalized then died of Covid 8 months after being fully vaccinated for Covid. Admitted 11/8/21 for Covid pneumonia, Dexamethasone/remdesivir course completed. Transitioned to Comfort care 11/23/21, died 11/27/21


VAERS ID: 1906086 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-09-30
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood lactic acid, Brain natriuretic peptide, C-reactive protein, COVID-19, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram thorax, Depressed level of consciousness, Differential white blood cell count, Electrocardiogram, Feeling abnormal, Fibrin D dimer, Full blood count, Haematuria, Hypoacusis, Hypokalaemia, Hypoxia, Inflammation, Influenza A virus test, Influenza B virus test, Lipase, Metabolic function test, Nervous system disorder, Pleural effusion, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin I, Urinary tract infection, Urine analysis
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab Tests Completed BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL D-DIMER QUANTITATIVE LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID LIPASE SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Imaging Tests CT CHEST ABDOMEN PELVIS WITHOUT CONTRAST CT HEAD WITHOUT CONTRAST EKG
CDC Split Type:

Write-up: 96yr old female presents via ambulance for complaints of neurological changes. Patient lives with so., Son reports patient has had "decrease alertness last couple of hours and" not feeling good for couple of days" Patient heard of hearing, does not answer nurses questions, opens eyes to sternum rub. Urinary tract infection with hematuria, site unspecified cefdinir (OMNICEF) 300 mg capsule cefdinir (OMNICEF) 300 mg capsule 2. COVID-19 virus infection 3. Pleural effusion on right 4. Weakness 5. Hypoxemia 6. Hypokalemia Neurological Changes


VAERS ID: 1906128 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-11-18
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient fully vaccinated for Covid-19 and deceased.


VAERS ID: 1906144 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Bradycardia, Death, Pyrexia, Respiratory distress, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 0
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: Pepcid,
Current Illness: PNA treated within the last 30 days
Preexisting Conditions: Seizure Disorder, COPD, CVA, Hypertension, GERD, Dementia, HLD, Aphasia, Anxiety, Depression,
Allergies: none
Diagnostic Lab Data: Sent to the hospital for Eval and Treat - Hospital called facility with notification of death of Patient
CDC Split Type:

Write-up: Respiratory distress - Tachycardia, with periods of bradycardia, fever observed at approx 3:09 pm - call to MD who gave order to send to ER for Eval and Treat


VAERS ID: 1906148 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-11-21
   Days after vaccination:230
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anion gap normal, Anticoagulant therapy, Arthralgia, Asthenia, Blood bicarbonate decreased, Blood chloride normal, Blood creatinine increased, Blood culture, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood urea increased, Brain natriuretic peptide increased, C-reactive protein, COVID-19, COVID-19 pneumonia, Cardiac telemetry, Chest X-ray abnormal, Chills, Cough, Crepitations, Culture urine, Death, Deep vein thrombosis, Dehydration, Diarrhoea, Differential white blood cell count, Dry skin, Dyspnoea, Dyspnoea at rest, Fatigue, Fibrin D dimer increased, Fluid intake reduced, Full blood count normal, Glomerular filtration rate decreased, Glycosylated haemoglobin increased, Haematocrit decreased, Haemoglobin decreased, Inguinal hernia, Lung opacity, Malaise, Mean cell volume normal, Metabolic function test, Neutrophil count normal, Otitis media acute, Oxygen saturation decreased, Platelet count normal, Pneumonia, Positive airway pressure therapy, Procalcitonin increased, Productive cough, Pulse absent, Pupil fixed, Pyrexia, Red blood cell count decreased, Respiration abnormal, Respiratory distress, Respiratory failure, SARS-CoV-2 test positive, Sepsis, Sinusitis, Skin warm, Tachyarrhythmia, Tachypnoea, Tremor, Unresponsive to stimuli, Upper respiratory tract infection, Urine analysis, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (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) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine Besylate 10 MG take 1 tablet by mouth once daily Celecoxib 200 MG take 1 capsule by mouth once daily Nebivolol HCl 5 mg Oral Daily traMADol HCl 50 MG take 1 tablet by mouth every 8 hours if needed for pain
Current Illness: 11/8/2021 - office visit with PCP for inguinal hernia - referral to general surg 11/18/2021 - office visit with PCP for pansinusitis, URI, COVID 11/18 - +COVID
Preexisting Conditions: Pre-Existing Active Problems Diagnosis Date Noted POA ? Coronary artery disease involving native coronary artery of native heart without angina pectoris 06/24/2021 Unknown ? Non-rheumatic mitral regurgitation 06/24/2021 Unknown ? Frequent PVCs 02/12/2019 Unknown ? Non-ischemic cardiomyopathy 02/12/2019 Unknown ? Hypertension, benign Unknown ? Non-sustained ventricular tachycardia 11/29/2018 Unknown ? Primary osteoarthritis involving multiple joints 05/24/2017 Unknown ? Erectile disorder due to medical condition in male patient 11/18/2016 Unknown ? Prediabetes 03/30/2015 Unknown ? Dyslipidemia Unknown ? Statin intolerance
Allergies: cozaar - hydralazine - headaches lisinopril - arm pain metoprolol - weak morphine - Nausea/vomiting naprosyn - bleeding ulcer norco - feelings of "crazy" mycins - anaphylaxis - tolerates azithromycin statins - weakness
Diagnostic Lab Data: PERTINENT LABS & DIAGNOSTIC STUDIES: Lab Results Component Value Date WBC 5.33 11/21/2021 RBC 4.20 (L) 11/21/2021 HGB 12.4 (L) 11/21/2021 HCT 38.7 (L) 11/21/2021 MCV 92.1 11/21/2021 PLATELET 192 11/21/2021 NEUTABSOLU 4.24 11/21/2021 Lab Results Component Value Date GLUCOSE 161 (H) 11/21/2021 SODIUM 134 11/21/2021 POTASSIUM 3.9 11/21/2021 CHLORIDE 98 11/21/2021 HCO3 20 (L) 11/21/2021 ANIONGAP 16 11/21/2021 BUN 38 (H) 11/21/2021 CREATININE 1.54 (H) 11/21/2021 EGFR 43 (L) 11/21/2021 D-dimer: 1440 CRP: pending BNP: 2272 Procal: 0.43 Blood cultures: pending Sputum cultures: pending UA: pending
CDC Split Type:

Write-up: "Deceased (11.25.21); Hospitalized (11.11.21); COVID-19 positive (11.18.21); Fully vaccinated with moderna x2 H&P: I have personally interviewed and examined the patient on 11/21/2021. Management was discussed with MD. I agree with the documented findings and plan of care in his/her note. Brief exam: Vitals: 11/21/21 1545 BP: 136/65 Pulse: 114 Resp: 18 Temp: General appearance: Alert, no acute distress HEENT: Oral mucosa moist Respiratory: Normal work of breathing, no wheezes crackles or rhonchi Cardiac: Regular rate and rhythm no murmurs rubs or gallops Abdomen: Nontender, nondistended no hepatosplenomegaly Extremities: No peripheral edema, normal range of motion Integument: No rash Brief history and medical decision making: Patient is an 85-year-old man with history of chronic obstructive pulmonary disease and who was vaccinated against COVID-19 in April 2021. He presented to the hospital with increasing shortness of breath and was tested positive for COVID-19 3 days ago on 11/18. Patient said he was about to get his posterior but became ill before then. When he presented to the emergency department his oxygen saturation was only 25%. Patient was placed on high-flow nasal cannula at 100% and has been saturating in the mid 90s. I had a discussion with him and his wife about code status. Patient would prefer to be do not resuscitate/DNI. If he continues to worsen he would like to be awake and able to visit with his wife as he passes away rather than on a ventilator. Patient is very dehydrated and has not been able to drink water last several days and has had several bouts of diarrhea. Patient was started on normal saline which will continue over the next 15 hours. Will reassess and monitor closely for fluid overload in the setting of COVID-19 pneumonia. History & Physical CHIEF COMPLAINT: Chief Complaint Patient presents with ? COUGH cough, fever, fatigue, weakness x 2 days. Subjective HISTORY OF PRESENT ILLNESS: Patient is a 85 y.o. male who presents with 7 days of symptoms including shortness of breath, productive cough, subjective fever, fatigue, weakness, chills. He states he went to his PCP on Thursday 11/18/2021 and thought he just had a really bad sinus infection. He was diagnosed with pansinusitis acute suppurative otitis media, and an acute upper respiratory tract infection and prescribed Augmentin. He was also tested for COVID-19 and his PCP encouraged him to go to the emergency department for chest x-ray and COVID testing. Patient stated at the time that he would go if he declined. As symptoms worsened over the next few days, his wife drove him to the emergency department today. Upon presentation, his pulse ox in room was 25% with a good waveform. He was escalated to high-flow nasal cannula and was initially able to maintain sats in the low 90s high 80s. Labs were obtained including CMP, BNP, procalcitonin, complete blood count, D-dimer, peripheral blood cultures. CMP showed stable creatinine and GFR from outpatient records, otherwise relatively unremarkable. Complete blood count with no leukocytosis. Procalcitonin was elevated at 0.43, BNP was elevated at 2272, and D-dimer was elevated at 1440. The patient was started on gentle hydration with normal saline infusion per emergency department provider. He was given a dose of dexamethasone and subsequently call was placed to admit the patient to the hospitalist service. Upon my evaluation, spouse is at bedside and patient is lying on his left side with high-flow nasal cannula in place. Despite max FiO2 and high-flow nasal cannula, patient is mildly dyspneic at rest. He is using accessory muscles for respiration and discussion is talking only in 3-5 word sentences, often taking a break to take several breaths through his nose. He endorses same symptoms as described above except for he says his diarrhea is no longer occurring. We have a detailed discussion of code status and patient initially elects to be full code, designating his wife to make decisions if he is incapacitated. Attending provider had further discussion with patient and after he was able to discuss this with his spouse and attending, decision was made to switch patient to DNR/DNI status. He was subsequently admitted to general medicine service in guarded condition. ED Course: IV Dexamethasone 6 mg Review of Systems Constitutional: Positive for activity change, chills, fatigue and fever. Negative for diaphoresis. HENT: Negative for congestion, rhinorrhea and sore throat. Eyes: Negative for visual disturbance. Respiratory: Positive for cough, shortness of breath and sputum production. Negative for wheezing and chest tightness. Cardiovascular: Negative for chest pain and palpitations. Gastrointestinal: Positive for diarrhea. Negative for nausea, vomiting, abdominal pain, constipation and blood in stool. Genitourinary: Negative for dysuria and hematuria. Musculoskeletal: Positive for joint pain (Left hip, chronic). Negative for edema. Neurological: Positive for weakness. Negative for headaches and dizziness. Endo/Heme/Allergy: Negative for easy bleeding or bruising. Skin: Negative for rash. Reviewed 10 systems, pertinent findings included in HPI, all other systems are negative. Objective OBJECTIVE: BP 118/77 | Pulse 103 | Temp 99.5 ?F (37.5 ?C) (Rectal) | Resp 17 | SpO2 96% FIO2 (%): 100 % Physical Exam Vitals reviewed. Constitutional: General: He is not in acute distress. Appearance: He is ill-appearing. He is not toxic-appearing or diaphoretic. HENT: Head: Normocephalic and atraumatic. Right Ear: External ear normal. Left Ear: External ear normal. Nose: Nose normal. Mouth/Throat: Mouth: Mucous membranes are dry. Pharynx: No posterior oropharyngeal erythema. Eyes: General: Right eye: No discharge. Left eye: No discharge. Extraocular Movements: Extraocular movements intact. Cardiovascular: Rate and Rhythm: Tachycardia present. Rhythm irregular. Pulses: Normal pulses. Heart sounds: Normal heart sounds. No murmur heard. No friction rub. No gallop. Pulmonary: Effort: Respiratory distress present. Breath sounds: No wheezing or rhonchi. Comments: Tachypneic, coarse crackles bilaterally, using accessory muscles. Only able to talk in short sentences without taking a deep breath through his nose with high-flow nasal cannula. Chest: Chest wall: No tenderness. Abdominal: General: Abdomen is flat. Bowel sounds are normal. There is no distension. Palpations: Abdomen is soft. Tenderness: There is no abdominal tenderness. Musculoskeletal: Right lower leg: No edema. Left lower leg: No edema. Lymphadenopathy: Cervical: No cervical adenopathy. Skin: General: Skin is warm and dry. Capillary Refill: Capillary refill takes less than 2 seconds. Coloration: Skin is not pale. Findings: No rash. Neurological: General: No focal deficit present. Mental Status: He is alert. Comments: Tremor noted right upper extremity, lower face and chin Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. ASSESSMENT/PLAN: COVID 19 Pneumonia Acute Hypoxic Respiratory Failure Sepsis Concern for superimposed bacterial PNA Presenting symptoms: Shortness of breath, productive cough, subjective fever, fatigue, weakness, chills. SIRS criteria met, tachycardia, tachypnea COVID 19 detected by PCR: 11/18/2021. Symptomatic day: 7 (symptoms started 11/15) CXR with findings of moderately extensive left greater than right bilateral pulmonary opacities.. Received Decadron 6 mg x1 in ED. Procalcitonin 0.43 Current oxygen saturation 88%, oxygen requirement high-flow nasal cannula 100% FiO2 -Severe Respiratory isolation -Dexamethasone 6 mg oral daily 1/10 days -Remdisivir day 1. Will need daily CMP monitoring for liver and renal toxicities. -Daily labs CBC with differential, CMP, D-dimer -Ins/Outs: Goal even to net negative -recent diarrhea, appears dry on exam -will provide 100 mL/hour x15 hours -Continuous pulse oximetry and telemetry -VTE prophylaxis subQ heparin -CAP abx coverage: start ceftriaxone and azithromycin x5 days Chronic obstructive pulmonary disease No oxygen at baseline, no wheezing on exam Home: Albuterol p.r.n. -Continue albuterol prn Hypertension CAD Nonischemic cardiomyopathy Acute on chronic systolic and diastolic heart failure Frequent PVCs Follows was Cardiology Last echo 09/21/2020: EF 49%, global hypokinesis, mild concentric LVH, grade 2 diastolic dysfunction. Also noted moderate mitral regurg, mild AR, mild tricuspid regurg, mild pulmonary hypertension, severe left atrial enlargement and mild right atrial enlargement. LHC 2018: 30-40% left anterior descending artery, left circumflex artery and right coronary artery diseae BNP on arrival 2272 Home: Amlodipine 10 mg daily -continue home amlodipine -update echo CKD 3 Baseline creatinine 1.1-1.6, GFR 40-55 On arrival, creatinine 1.54, GFR 43 Prediabetes Last A1 c 08/05/2021 was 6.1% No home meds -will start VLD CSI in setting of initiation of steroids for COVID as above Dyslipidemia Noted per chart review, no statin Osteoarthritis Noted per chart review, uses tylenol prn at home Peptic ulcer disease Noted per chart review, no meds at home -Will provide Protonix given initiation of PO steroids S/p left hip replacement Noted Familial benign essential tremor Noted, patient states this is unchanged since symptoms started 7 days ago DVT: subq heparin GI: protonix Diet: general IVF: was placed on NS 125 ml/hr in ED -$g will change to 100 mL/hour x15 hours Code status: DNR/DNI Discharge /Deceased Summary: BRIEF OVERVIEW: Discharge Provider: MD Primary Care Physician at Discharge: PA-C Admission Date: 11/21/2021 Active Hospital Problems Diagnosis Date Noted POA ? Acute hypoxemic respiratory failure due to COVID-19 11/21/2021 Unknown Resolved Hospital Problems No resolved problems to display. Pre-Existing Active Problems Diagnosis Date Noted POA ? Coronary artery disease involving native coronary artery of native heart without angina pectoris 06/24/2021 Unknown ? Non-rheumatic mitral regurgitation 06/24/2021 Unknown ? Frequent PVCs 02/12/2019 Unknown ? Non-ischemic cardiomyopathy 02/12/2019 Unknown ? Hypertension, benign Unknown ? Non-sustained ventricular tachycardia 11/29/2018 Unknown ? Primary osteoarthritis involving multiple joints 05/24/2017 Unknown ? Erectile disorder due to medical condition in male patient 11/18/2016 Unknown ? Prediabetes 03/30/2015 Unknown ? Dyslipidemia Unknown ? Statin intolerance Unknown Date of Death: 11/25/21 Time of Death: 11:32 AM Preliminary Cause of Death: Respiratory failure Discharge Disposition: Deceased DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute respiratory failure with hypoxia [J96.01] Acute hypoxemic respiratory failure due to COVID-19 [U07.1, J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient has a history of COPD, vaccinated with COVID in April, and presented to the hospital with acute hypoxic respiratory failure due secondary to COVID-19. He wished to be DNR/DNI. He was on CPAP with 100% FiO2 and unable to maintain his saturations. He was treated with decadron and remdesivir. He was also covered for community acquired pneumonia with azithromycin and ceftriaxone. His oxygenation continued to decline throughout his stay. He had a difficult time eating or drinking due to desaturations without CPAP. Discussed a feeding tube and he declined, but was given IV fluids for hydration. Due to continued decline, family decided to make him comfort measures the morning of 11/25. He passed shortly after. Death Pronouncement Resident Team was called to bedside to pronounce patient death on 11/25/2021 Patient was unresponsive to voice, nail bed pressure No cartoid or peripheral pulses were palpapable No visible chest rise noted Heart sounds were not heard Lung auscultation absent for any breath sounds Pupils were fixed, nonreactive to light Corneal reflexes were negative Time of death was 11:32 on 11/25/2021 Chaplain Services were offered: family declined Family was at bedside


VAERS ID: 1906237 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-02
Onset:2021-10-26
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Death, Polyuria, Positive airway pressure therapy, Renal impairment, Respiratory symptom, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-06
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol (ZYLOPRIM) 100 mg tablet Take 1 tablet by mouth Daily. 8/3/21 aspirin 81 mg EC tablet Take 81 mg by mouth Daily. 5/1/08 calcium-vitamin D (OSCAL) 500 mg-200 units per tablet Take 1 tablet by mouth Daily. With dinner 1/1/
Current Illness: ? Acute diastolic CHF (congestive heart failure) (HCC) 6/11/2015 ? Acute kidney failure, unspecified (HCC) ? Acute respiratory failure with hypoxia (HCC) 6/15/2015 ? Aortic valve stenosis, severe/S/P AVR 06/15/2015 TEE: Bioprosthetic aortic valve present w trivial aortic insufficiency; EF-70% 12/26/2013 TTE: EF~62%. Prosthesis, aortic position, functioning normally 02/20/2013 Limited echocardiogram: EF~65.8%. Normally functioning bioprosthesis w mean gradient 12 mm mercury and no aortic insuff 10/11/2012 Tissue aortic valve replacement/21 mm Edwards pericardial valve ? Arthritis ? Atrial fibrillation (HCC) 6/13/15 RVR 110s-130s, on metoprolol ? CAD (coronary artery disease) 10/11/2012 cardiopulmonary bypass and aortic valve replacement; 5/07/2008 coronary artery bypass graft ; 5/02/2008 LHC ? Cataract ? CHF (congestive heart failure) (HCC) 2008 following CABG 2008 ? Cholecystitis, chronic ? CKD (chronic kidney disease), stage III (HCC) ? Diabetes mellitus type 1 (HCC) has insulin pump ? Diabetic gastroparesis (HCC) longstanding, had to stop metoclopramide because of extrapyramidal symptoms ? Diastolic dysfunction, left ventricle grade I on echo 12/2013; normal LVEF 70% 6/13/15 ? ? Dyslipidemia ? ? ? Environmental allergies ? Environmental allergies ? Febrile illness, acute ? Gangrene of toe (HCC) left side ? GERD (gastroesophageal reflux disease) ? Gout ? HTN (hypertension) ? Hyperlipidemia LDL goal <70 ? Hyponatremia ? Hypoxemia ? Insulin pump fitting or adjustment 10/14/2015 ? Nausea ? Neuromuscular disorder (HCC) ? Peripheral neuropathy ? Polyneuropathy in diabetes(357.2) feet, hands affected ? Retinopathy numerous laser treatments ? Ruptured eardrum 1/2015 Bilateral ? S/P aortic valve replacement with bioprosthetic valve October 2012 Not significant on echo 6/13/15, 10/1/2012 TTE severe aortic valvular aortic stenosis, EF 60-65% at that time, had AV replacement ? Shingles ? Solitary pulmonary nodule on lung CT ? Transaminitis
Preexisting Conditions: ? Acute diastolic CHF (congestive heart failure) (HCC) 6/11/2015 ? Acute kidney failure, unspecified (HCC) ? Acute respiratory failure with hypoxia (HCC) 6/15/2015 ? Aortic valve stenosis, severe/S/P AVR 06/15/2015 TEE: Bioprosthetic aortic valve present w trivial aortic insufficiency; EF-70% 12/26/2013 TTE: EF~62%. Prosthesis, aortic position, functioning normally 02/20/2013 Limited echocardiogram: EF~65.8%. Normally functioning bioprosthesis w mean gradient 12 mm mercury and no aortic insuff 10/11/2012 Tissue aortic valve replacement/21 mm Edwards pericardial valve ? Arthritis ? Atrial fibrillation (HCC) 6/13/15 RVR 110s-130s, on metoprolol ? CAD (coronary artery disease) 10/11/2012 cardiopulmonary bypass and aortic valve replacement; 5/07/2008 coronary artery bypass graft ; 5/02/2008 LHC ? Cataract ? CHF (congestive heart failure) (HCC) 2008 following CABG 2008 ? Cholecystitis, chronic ? CKD (chronic kidney disease), stage III (HCC) ? Diabetes mellitus type 1 (HCC) has insulin pump ? Diabetic gastroparesis (HCC) longstanding, had to stop metoclopramide because of extrapyramidal symptoms ? Diastolic dysfunction, left ventricle grade I on echo 12/2013; normal LVEF 70% 6/13/15 ? ? Dyslipidemia ? ? ? Environmental allergies ? Environmental allergies ? Febrile illness, acute ? Gangrene of toe (HCC) left side ? GERD (gastroesophageal reflux disease) ? Gout ? HTN (hypertension) ? Hyperlipidemia LDL goal <70 ? Hyponatremia ? Hypoxemia ? Insulin pump fitting or adjustment 10/14/2015 ? Nausea ? Neuromuscular disorder (HCC) ? Peripheral neuropathy ? Polyneuropathy in diabetes(357.2) feet, hands affected ? Retinopathy numerous laser treatments ? Ruptured eardrum 1/2015 Bilateral ? S/P aortic valve replacement with bioprosthetic valve October 2012 Not significant on echo 6/13/15, 10/1/2012 TTE severe aortic valvular aortic stenosis, EF 60-65% at that time, had AV replacement ? Shingles ? Solitary pulmonary nodule on lung CT ? Transaminitis
Allergies: Penicillins, Reglan
Diagnostic Lab Data: Ordered Test: No Information Given Accession Number: Specimen Source: Nose (nasal passage) Specimen Site: Specimen Collection Date/Time: 10/20/2021 Results: * Resulted Test: SARS-CoV-2 Ag Resp Ql IA.rapid Coded Result: detected Numeric Result: Units: Text Result: Reference Range From: Reference Range To: Status: Final
CDC Split Type: 885599

Write-up: Case was hospitalized and died from Covid 6 months after completing Covid vaccine series. Was admitted 10/26 with onset of URI symptoms 10/18. Was already on chronic 4 L NC O2 prior to illness. Required high flow nasal cannula oxygen immediately upon admission. Was treated with full course of dexamethasone with some initial improvement in oxygenation. Then began to decompensate again and failed attempts at diuresis with worsening renal function. He wanted to go home on hospice, but was requiring too much supplemental O2 to make this feasible, and probably would have been in florid respiratory distress before leaving the hospital. He further decompensated and his family was called into the hospital. He removed his bipap and placed 15 L mask so could talk with his family. Then he removed the mask and quickly drifted to sleep. Time of death 1620.


VAERS ID: 1906259 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-03
Onset:2021-08-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Full blood count, Organ failure, Sepsis
SMQs:, 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), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-17
   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: None
Current Illness: None
Preexisting Conditions: Prior hypotension and type II diabetes
Allergies: None
Diagnostic Lab Data: 8/16/2021 hospitalized with sepsis, organ failure, etc. Complete CBC. Records available for review.
CDC Split Type:

Write-up: Death


VAERS ID: 1906913 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-10-01
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Extra dose administered, Pneumonia, Respiration abnormal, X-ray
SMQs:, Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-19
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, Albuterol, amlodipine, calcium, Vit B12, cayanocobalamin, docusate, tramadol, levothyroxine, loperamide, Losartan, omeprazole, furosemide, fish oil hydroxychloroquine, prednisone,
Current Illness: Pulmonary Fibrous from RA
Preexisting Conditions: RA
Allergies: codeine, leflunomide, morphine, sulfamethoxazole, trimethoprime, sulfa antibiotics, lactose
Diagnostic Lab Data: X-rays
CDC Split Type:

Write-up: 3 weeks after 3 shot Patient started to experience more breathing issues, ended up with phenomena x2 and passed away


VAERS ID: 1908321 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-30
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: None of the patients had prior issues.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211154617

Write-up: DEATH; This spontaneous report received from a consumer via social media via a company representative concerned two patients of unspecified age, race and ethnicity. The patients height, and weight were not reported. None of the patients had prior issues. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown expiry: Unknown) dose, 1 total, 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, the patients died from unknown cause of death. One patient died within less than 48 hours and another died 5 days after. It was unspecified if an autopsy was performed. As per the reporter, "3 people within 2 miles of me died after the jab. One less than 48 hours. One 28 years old and the other 5 days after. None had prior issues" The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case, from the same reporter is linked to 20211154559.; Sender''s Comments: V0: 20211154617-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: 1908569 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-23
Onset:2021-11-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ9620 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: 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: 2021-11-25
   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: Tylenol, amlodipine, lisinopril, Ativan, sinemet, Pepcid, fluticasone, gabapentin, ibuprofen, oevsin, loratidine, mvi, zofran, tramadol, trazodone, vitamin d, voltaren topical
Current Illness: Parkinsons, dementia, hypertension, heart block, pacemaker,
Preexisting Conditions: Parkinsons, dementia, hypertension, heart block, pacemaker,
Allergies: penicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sudden Death


VAERS ID: 1908584 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-30
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 INC202101595038

Write-up: BOOSTER; suddenly dies in his sleep 2 weeks after 3rd covid jab; This is a spontaneous report received from non-contactable Consumer. A 52-year-old male patient received bnt162b2 (BNT162B2) (Batch/Lot number: unknown) as dose 3 (booster), single for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (Dose number: 1, Primary Immunization series complete but unknown manufacturer), for COVID-19 immunization; Covid-19 vaccine (Dose number: 2, Primary Immunization series complete but unknown manufacturer), for COVID-19 immunization. The prominent (Institution) Cardiologist suddenly died in his sleep just two weeks after getting his 3rd covid jab. The cardiologist who said he ''won''t cry at funeral'' for "selfish" unvaccinated people. The following information was reported: IMMUNISATION (death), outcome "fatal", described as "BOOSTER"; DEATH (death), outcome "fatal", described as "suddenly dies in his sleep 2 weeks after 3rd covid jab". The patient date of death was unknown. The reported cause of death was "suddenly dies in his sleep 2 weeks after 3rd covid jab", immunisation. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: BOOSTER; suddenly dies in his sleep 2 weeks after 3rd covid jab


VAERS ID: 1908805 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
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: USJNJFOC20211161441

Write-up: COVID PNEUMONIA; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer via social media via a company representative concerned a female of unspecified age, 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 numbers. Dose number in series one. No concomitant medications were reported. On an unspecified date, the patient had covid pneumonia and Suspected clinical vaccination failure. On SEP-2021, the patient died from covid pneumonia. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the covid pneumonia was fatal and outcome of the suspected clinical vaccination failure was not reported. This report was serious (Death). This report was associated with product quality complaint: 90000204396.; Sender''s Comments: V0: 20211161441-Covid-19 vaccine ad26.cov2.s-Covid pneumonia. 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). 2021161441-Covid-19 vaccine ad26.cov2.s- Suspected clinical vaccination failure. This event is considered not related. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS; Reported Cause(s) of Death: COVID PNEUMONIA


VAERS ID: 1908939 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-11-22
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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: USMODERNATX, INC.MOD20213

Write-up: There was a man I knew that didn''t take his 2nd dose of the Moderna Covid-19 vaccine who died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (There was a man I knew that didn''t take his 2nd dose of the Moderna Covid-19 vaccine who died) 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. Death occurred on 22-Nov-2021 The patient died on 22-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication were not reported Treatment medication were not reported Company Comment: This is a fatal case that concerns a male patient of an unknown age, with no relevant medical history reported, who experienced the unexpected fatal event of DEATH. He died on 22-Nov-2021, after an unknown time interval after the dose of the mRNA-1273. The cause of death was not reported. The rechallenge was not applicable as no additional dose is going to be administered. The benefit-risk relationship of mRNA-1273 is not affected by this report. This case was linked to MOD-2021-395669.; Sender''s Comments: This is a fatal case that concerns a male patient of an unknown age, with no relevant medical history reported, who experienced the unexpected fatal event of DEATH. He died on 22-Nov-2021, after an unknown time interval after the dose of the mRNA-1273. The cause of death was not reported. The rechallenge was not applicable as no additional dose is going to be administered. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1908956 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, Guillain-Barre syndrome, Thrombosis with thrombocytopenia syndrome
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (narrow), Demyelination (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211154358

Write-up: POTENTIALLY FATAL SIDE EFFECTS; THROMBOSIS WITH THROMBOCYTOPENIA SYNDROME; GUILLAIN-BARRE SYNDROME; This spontaneous report was received from literature: Parents are not so sure THERE''S NO HARM IN COVID-19 [VACCINE] TRYING. This report concerned multiple patients. No past medical history or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin were not reported, batch number: Unknown and expiry: UNKNOWN) dose, start therapy date were not reported,1 total administered for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. It was reported that there were 47 patients experienced blood clots - thrombosis with thrombocytopenia syndrome (TTS), a rare and serious adverse event, after the administration of the JANSSEN COVID VACCINE. It also reported that some people who received the JANSSEN COVID VACCINE had Guillain-Barre Syndrome (GBS), a rare disorder where the body''s immune system damages nerve cells, causing muscle weakness and sometimes paralysis. Most people recovered completely from GBS (Guillain-Barre Syndrome), but some had permanent nerve damage. A former journalist, started looking for vaccine studies after her appointment to receive the J&J/Janssen dose was cancelled in the spring when reports about potentially fatal side effects appeared (that suspension was eventually lifted by the healthcare authorities). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of potentially fatal side effects on an unspecified date, and the outcome of thrombosis with thrombocytopenia syndrome and guillain-barre syndrome was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0 : 20211154358-COVID-19 VACCINE AD26.COV2.S -thrombosis with thrombocytopenia syndrome and guillain-barre syndrome. This event(s) is labeled per Regulatory Authority and is therefore considered potentially related. 20211154358-COVID-19 VACCINE AD26.COV2.S -potentially fatal side effects. 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: 1908971 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: I knew 2 girls that didn''t take their 2nd dose & died.; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (I knew 2 girls that didn''t take their 2nd dose & died.) in a female 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 first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were reported. No treatment medications were reported. Company''s comment: This is a spontaneous report concerning a female patient of unknown age and medical history. The reporter mentions that knew the patient and that she hadn''t taken the second dose of the vaccine and died. The date of vaccination and manufacturer were not reported, nor was cause of death. No further information was disclosed. A query was raised requesting any information that can be provided to further elucidate this case. This case was linked to MOD-2021-395669 (Patient Link).; Sender''s Comments: This is a spontaneous report concerning a female patient of unknown age and medical history. The reporter mentions that knew the patient and that she hadn''t taken the second dose of the vaccine and died. The date of vaccination and manufacturer were not reported, nor was cause of death. No further information was disclosed. A query was raised requesting any information that can be provided to further elucidate this case.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1909167 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-01
Onset:2021-03-01
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: CSF oligoclonal band present, CSF test abnormal, Death, Electromyogram abnormal, Inflammatory marker increased, Motor neurone disease, Nerve conduction studies abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-24
   Days after onset: 268
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: The patient underwent EMGs and nerve conduction studies, the results of which were consistent with motor neuron disease. She had elevated inflammatory markers in serum and in her CSF including the presence of oligoclonal bands, very unusual for a typical motor neuron disorder such as ALS.
CDC Split Type:

Write-up: The patient developed a rapidly progressive lower motor neuron disorder beginning in March 2021 and progressing from her legs to her arms to her bulbar and respiratory muscles, resulting in death in November 2021.


VAERS ID: 1909176 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-11-29
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna on 2/2 and 3/4. Positive on 11/28


VAERS ID: 1909270 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-05
Onset:2021-11-29
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER9737 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested positive for COVID on 11/23/2021 and died on 11/29/2021


VAERS ID: 1909307 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-27
Onset:2021-11-16
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arteriosclerosis, 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: 2021-11-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Cardiovascular Disease (Known)
Preexisting Conditions: Cardiovascular Disease (Known)
Allergies: Unknown
Diagnostic Lab Data: +PCR Covid 11/16/2021
CDC Split Type:

Write-up: I am the epidemiologist reporting on behalf of 73-year-old male LTCF patient. The patient received their first dose of the Pfizer vaccine on 1/06/21. The patient tested positive for COVID-19 on 1/26/21 via PCR (20 days post dose 1). The patient received their second dose of the Pfizer vaccine on 5/26/21 and their third dose of the Pfizer vaccine on 10/27/21. The patient tested positive for COVID-19 a second time via PCR on 11/16/21. On 11/27/21 (one-month post dose-3 and 11 days post positive test) the patient expired (listed as COVID-19 death). The cause of death listed on the death certificate is atherosclerosis (3 years). Known patient history includes cardiovascular disease. This is the first instance I have observed within my home county of a person with a repeat infection, fully vaccinated + boosted, passing away with COVID.


VAERS ID: 1909441 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-13
Onset:2021-02-16
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bedridden, Confusional state, Dysphagia, Dyspnoea, Productive cough, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-08
   Days after onset: 265
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit d, potassium, Lasix, mirtazapine 15 mg, over counter Tylenol, Norfax Amlodipine 7.5 mg, Colace, metoprolol, levothyroxine 25 mg, citrulline 25 mg, eye drops tobramycin .3%, nitroglycerin patch once daily
Current Illness: Cellulitis in her leg
Preexisting Conditions: diabetes type 2, kidney disease stage 3, diabetic neuropathy
Allergies: peanuts
Diagnostic Lab Data: I don''t know, probably a lot.
CDC Split Type: vsafe

Write-up: By the time I came back and saw my mother on Thursday she was short of breath and her lungs were filling with fluid, She was coughing up pink frothy fluid. She called ambulance they gave her shot of oxygen. We took her to hospital because she needed oxygen. They put her on 3 liters of oxygen and 3 days later sent her home on hospice with 3.5 liters of oxygen and round clock care and totally bed bound. She started to get confused, I was requesting for her to get more Lasix, She stopped swallowing. It was a long decline she got weaker and weaker. I think the vaccine was too much for her frail system.


VAERS ID: 1909487 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Death, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, heart medications (this person is a friend of mine, he had health issues but not sure what meds he was on)
Current Illness: None
Preexisting Conditions: Juvenile onset diabetes, cardiac disease, congestive heart failure
Allergies: None that I know of
Diagnostic Lab Data: None, no autopsy done.
CDC Split Type:

Write-up: Patient developed symptoms the following morning, fever, chills, body aches. He told his neighbor about it and she suggested he lie down and rest. He went to bed and was unable to be reached later in the day. She went to his condo around 7:30 p.m. and found him dead.


VAERS ID: 1909502 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-23
Onset:2021-10-21
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 24
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: non-Hodgkin''s lymphoma
Preexisting Conditions: non-Hodgkin''s lymphoma
Allergies: Unknown
Diagnostic Lab Data: 1st Dose of Moderna COVID-19 Vaccine: 2/23/21 2nd Dose of Moderna COVID-19 Vaccine: 3/23/2021 Positive COVID-19 PCR on 10/21/21 Patient died on 11/14/2021
CDC Split Type:

Write-up: Client fully vaccinated for COVID-19 and tested positive via PCR on 10/21/21. Client died on 11/14/2021 from COVID-19


VAERS ID: 1909512 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-27
Onset:2021-11-13
   Days after vaccination:290
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asymptomatic COVID-19, 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: 2021-11-24
   Days after onset: 11
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: Unknown
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Patient was admitted to the hospital on November 13, 2021, and tested positive for COVID-19. Patient was asymptomatic as a patient in a long-term care facility. Patient was discharged back to the nursing home a few days later. Community talk indicated that patient died on November 24, 2021.


VAERS ID: 1909519 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-11-22
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-22
   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: CAD, CHF, COPD, DM, CKD4
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated, covid related death


VAERS ID: 1909565 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-20
Onset:2021-11-24
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, HTN, DM2, CKD4
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated covid related death


VAERS ID: 1909570 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-24
Onset:2021-11-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33030BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Fatigue, Malaise, Pyrexia, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   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: PATIENT USES local PHARMACY - PRESCRIPTION HISTORY UNKNOWN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT AND MOTHER CAME IN WEDNESDAY 11.24.21 AFTERNOON FOR COVID BOOSTER. MOTHER REPORTED TO PHARMACY ON FRIDAY 11.26.21 (DEPARTMENT CLOSED THURSDAY 11.25.21) THAT PATIENT HAD STARTED FEELING "UNWELL" (FEVER/TIREDNESS) LATE 11.24.21 / EARLY 11.25.21. MOTHER REPORTED DIDNT THINK MUCH OF IT BUT THAT HER SON (PATIENT) WAS GOING TO REST. MOTHER REPORTED THAT LATER IN THE DAY SON WENT INTO THE BATHROOM AND WAS IN THERE FOR SOME TIME, WHEN SHE WENT TO CHECK ON HIM, SHE COULD NOT GET THE DOOR OPEN. UPON OPENING THE DOOR, SON WAS FOUND UNRESPONSIVE. ATTEMPTS TO REVIVE SON BY MEDICAL PERSONEL WERE UNSUCCESSFUL. PER MOTHER AN AUTOPSY IS SCHEDULED BUT AS OF REPORTING NO CAUSE OF DEATH HAS BEEN LISTED.


VAERS ID: 1909574 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-15
Onset:2021-11-26
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Computerised tomogram head abnormal, Death
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-26
   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: SPIRIVA BREO OXYBUTYNIN
Current Illness: COPD
Preexisting Conditions: COPD
Allergies: NONE REPORTED
Diagnostic Lab Data: CT scan showing bleeding completed at hospital
CDC Split Type:

Write-up: Patient had brain hemorrhage 11 days following 0.25ml Moderna booster vaccination and died


VAERS ID: 1909575 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-23
Onset:2021-11-28
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Atrial fibrillation, COVID-19, Culture, Diarrhoea, Dyspnoea, Haematuria, Hypotension, Hypoxia, Intensive care, Oropharyngeal pain, Pancytopenia, Pollakiuria, Resuscitation, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Agranulocytosis (narrow), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Myelodysplastic syndrome (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acidophilus-pectin, citrus 25 million cell-100 mg Tablet Directions: 1 tablet oral daily (Active) amiodarone 200 mg Tablet Directions: 1 tablet oral twice a day (Active) ciprofloxacin HCl 250 mg Tablet Directions: 1 tablet oral every t
Current Illness:
Preexisting Conditions: GERD, HTN. chronic back pain Significant Surg Hx None. Smoking Status Never Smoker
Allergies:
Diagnostic Lab Data: SARS-CoV-2 ANtigen (+) on 11/28/2021
CDC Split Type:

Write-up: This is a 61-year-old female with history of chronic back pain, hypertension, GERD who was recently discharged after being admitted to hospital for acute kidney injury, monomorphic V-tach, paroxysmal atrial fibrillation, hematuria and pancytopenia with UTI. She was at the subacute rehabilitation center Bartley. She was doing okay until last few days when she started having some diarrhea, and urinary frequency, urine analysis and cultures were sent and she was started empirically on ciprofloxacin. Yesterday in the morning patient became acutely short of breath and had severe sore throat with acute hypoxia down to 70s and hypotension with systolic blood pressure in 70s as well hence she was referred to the ER. Her covid test came out positive. In the ER patient was started on empiric antibiotics as per sepsis protocol after cultures were sent, she did not respond to fluid resuscitation hence she was started on Levophed and admitted to ICU.


VAERS ID: 1909619 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-16
Onset:2021-10-26
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, COVID-19, Death, Encephalopathy, General physical health deterioration, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-31
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt had recent hospitalization for being positive for COVID; dc''d to SNF on 10/20/21; to ED with altered LOC on 10/26/2021 with worsening O2 sats; acute encephalopathy and ARF; supplemented with O2; pt''s condition worsened; family decided to have pt return to SNF on comfort care; pt was dc''d from hosp on 10/27/21 to SNF; pt''s condition never improved and she died in the SNF


VAERS ID: 1909675 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-15
Onset:2021-11-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Abdominal pain upper, Aspiration, Colectomy, Colostomy, Death, Diarrhoea, Exploratory operation, Gastrointestinal inflammation, Volvulus
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Son states: 11/15/21: Both father and mother received Moderna booster. They both started having stomach issues and diarrhea some time later. The wife''s symptoms resolved in about 3 days. The husband''s symptoms continued. 11/22 or 11/23/21 His father was complaining of intense stomach pain and his abdomen was distended, so his wife took him to the ER. He was admitted to Medical Center and stayed for 5 days They performed exploratory surgery on his father and it was decided they would remove his colon because his small intestine was swollen and twisted on itself. He had the surgery and a colostomy. 11/26/21: The surgery did not resolve his symptoms and his GI system continued to swell until he aspirated on his stomach contents. 11/27/21: Date of death.


VAERS ID: 1909805 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-11
Onset:2021-09-27
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Clostridium difficile infection, Death, Hypercapnia, Myopathy, Positive airway pressure therapy, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 38 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medication ? acetaminophen (TYLENOL) 500 MG tablet ? amiodarone (PACERONE) 200 MG tablet ? blood sugar diagnostic (FREESTYLE LITE) Strp strips ? docusate (COLACE) 100 mg tablet ? FA/MV,CA,IRON,MIN/LYCOPENE/LUT (MULTIVITAL ORAL) ? hydrocorti
Current Illness: Unknown
Preexisting Conditions: Diagnosis Date ? Cataract ? Diabetes mellitus ? Hypertensive disorder ? PAF (paroxysmal atrial fibrillation) ? Renal insufficiency ? Sleep apnea Patient Active Problem List Diagnosis ? Presbyopia ? Obstructive sleep apnea syndrome ? Glaucoma ? Type 2 diabetes mellitus with renal complication ? Bipolar disorder ? CKD (chronic kidney disease) ? Congestive heart failure ? Paroxysmal atrial fibrillation ? Hemorrhoids ? Hypertension ? CHF (congestive heart failure), NYHA class I, chronic, diastolic ? Mass of right hand
Allergies: ? Atenolol Swelling ? Colchicine ? Metformin Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Brief Summary/Assessment: 68M PMH myopathy (bed bound, most c/w colchicine-induced myopathy, started 8/2021), HFpEF, HTN, CKD, AF (rivarox), DM, bipolar, gout, OSA (CPAP), sacral ulcer with chronic OM, p/w hypercarbic respiratory failure which resolved with BiPAP. Course c/b Cdiff and nosocomial COVID infection. Patient died


VAERS ID: 1909882 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-16
Onset:2021-05-03
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tums
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of heart attack on May 3.


VAERS ID: 1909908 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-11-05
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 02/02/2021 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 02/23/21 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 10/06/21 / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram normal, Anticoagulant therapy, Blood creatinine increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Death, Dyspnoea, Enteral nutrition, Hypotension, Intensive care, Oliguria, Pneumomediastinum, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive, Shock, Subcutaneous emphysema, Unresponsive to stimuli
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xanax, Amoxil, Colchicine, colace, Efudex, flonase, multivitamin, zofran, protonix, pravastatin, flomax.
Current Illness:
Preexisting Conditions: Follicular lymphoma grade IIIa of intra-abdominal lymph nodes (*) OSA (obstructive sleep apnea) BPH (benign prostatic hyperplasia) Hyperlipidemia Unilateral congenital absence of kidney History of total hip arthroplasty, right Left groin mass Encounter for antineoplastic chemotherapy and immunotherapy Squamous cell carcinoma in situ (SCCIS) of skin Normocytic anemia Hyperchloremia Hyperglycemia Subcutaneous emphysema (*) Severe protein-calorie malnutrition (*) Hypernatremia
Allergies: NKDA
Diagnostic Lab Data: COVID positive test 10/18/2021.
CDC Split Type:

Write-up: Fully vaccinated patient (2 doses plus booster) admitted for COVID pneumonia and subsequently died. Provider discharge note below: "67 yo male, with PMH significant for follicular lymphoma s/p chemotherapy, HLD, OSA, and hx of one kidney (born that way), who presented to ED on 10/18/21 after testing positive for COVID. He had received all 3 COVID vaccinations, though is immunocompromised from recent completion of follicular lymphoma and chemotherapy. CTA was done on day of admission and was negative for PE. Respiratory failure with hypoxia from covid pneumonia was initially managed on HFNC but respiratory status worsened and he was transferred to CCU on 10/27/21. BiPAP therapy was started and pt required precedex and fentanyl gtts to tolerate BiPAP. He was treated with decadron and was fully anticoagulated with lovenox. Remdesivir was declined by pt due to having only 1 kidney. Regeneron was given on 11/3/21. No improvement in respiratory status, and oxygenation was marginal despite BiPAP with 100% O2 with pressures of 18/12. Intubation was considered, but pt did not want to be intubated. The pt developed SQ emphysema. Imaging did not show pneumothorax, but pneumomediastinum was seen on CXR 10/28/21. Tube feedings were initiated for nutritional support. Pt intermittently required pressor support for circulatory shock, initially with phenylephrine, then later with norepinephrine. Ongoing discussions regarding goals of care and code status were held with pt and family throughout hospitalization. Pt continued to decline intubation. Code status was changed to DNR/DNI but continue aggressive care. Clinical condition continued to decline. PRN morphine was started for air hunger and comfort. By 11/4/21, the pt was unresponsive, hypotensive and requiring norepi for BP support, oliguric with rising creat. Increased work of breathing on maximum BiPAP support with O2 sats ranging from low 70''s to low 90''s. Wife was informed that pt actively dying and no escalation of care added to code status. The pt died on 11/5/21 at 1336 with wife at bedside. "


VAERS ID: 1909938 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-18
Onset:2021-11-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 069F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-25
   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: aspirin, simvastatin, albuterol, acetaminophen, lisinopril, niacin, terazosin
Current Illness: None
Preexisting Conditions: COPD, DM-2, HTN
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Unforeseen death on 11/25/2021


VAERS ID: 1910018 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-24
Onset:2021-11-17
   Days after vaccination:266
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation, Bronchoscopy, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, Hypoxia, Lactic acidosis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-26
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol MDI PRN, Apixaban 5 mg BID, Aspirin 81 mg QD, Symbicort 160/4.5 mcg BID, Cetirizine 10 mg QD, Cholecalciferol 125 mcg QD, Cyanocobalamin 100 mcg QD, Norco 10/325 PRN, Probiotic QD, Multivitamin QD, Potassium Chloride 10 mEq QD, Qu
Current Illness:
Preexisting Conditions: Cirrhosis, COPD, CAD, Dysrhythmia, H/O Angioplasty, Hepatitis C, History of MI, Osteoarthritis
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive test on 11/17/2021 analyzed on the Luminex Aries platform using RT-PCR technology.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient rec''d Pfizer Vaccines on 2/3/2021 and 2/24/2021. PMHx of cirrhosis, COPD, CAD w/stent, osteoarthritis sepsis and repiratory failure requiring tracheostomy in the past. Presented to ED one week ago c/o SOB. COVID negative, s/p bronchoscopy on 11/12, tx''d w/abx, d/c''d home on O2 via NC. Per pt. 2nd Covid test + prior to d/c. Presented to ED on 11/17 w/SPO2 in the 30s on NC. Admitted for ACRF w/hypoxia, Covid pneumonia, A-fib, and lactic acidosis. Intubated on 11/22. Tx''d w/dexamethasone, tocilizumab, inhaled epoprostenol. Remained severely hypoxic and expired 11/26/21.


VAERS ID: 1910053 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-27
Onset:2021-11-22
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32020BD / 3 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypotension, Intensive care, Oxygen saturation decreased, Pneumonia, Pulmonary thrombosis, Respiratory rate increased, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-26
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin for Type 1 Diabetes
Current Illness:
Preexisting Conditions: Type 1 Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Double pneumonia with blood clots in lungs. Sepsis. Extremely low oxygen levels in blood. Extremely low blood pressure. Rapid breathing - over 60 per minute. 5-day ICU stay at Hospital. Death.


VAERS ID: 1910821 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-06
Onset:2021-08-01
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm repair, Cardio-respiratory arrest, Computerised tomogram abnormal, Death, Ear pain, Haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-06
   Days after onset: 97
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: History of laryngeal cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient w/ history of laryngeal cancer; has a total laryngectomy with reconstructive surgery in April 2021; recovered; took the vaccine in june/July. in August 2021, presented with ear pain again, like when first diagnosed; CT revealed recurrence; pt then had a bleed and possible carotid blow out; presented to hospital for embolization; pt coded and died a few days later


VAERS ID: 1943199 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-11
Onset:2021-08-29
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Aphasia, Asthenia, Cognitive disorder, Death, Dysphagia, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 87yo male in home hospice care died on 8/29/2021. Pt had a hx of a debilitating hemorrhagic stroke in May that results in weakness, dysphagia, cognitive impairment, and aphasia. Patient had a prolonged hospitalization and then completed short-term rehab. He was readmitted to facility on 8/11/21. He then transfered to home hospice on 8/25/21 and died on 8/29/21. Pt had received covid 19 vaccines on 4/13/21 & 5/11/21. Death is not related to vaccines.


VAERS ID: 1943202 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-13
Onset:2021-09-23
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Death
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 76 yo male with metastatic prostate cancer to various bones, CAD s/p CABG, HTN, HLP, OSA on CPAP, bilateral carotid artery stenosis (50-69% stenosis bilaterally), NAFLD w/ cirrhosis, T2DM with neuropathy, OA, depression, PVD, hx of pulmonary nodules present to the hospital with chest pain on 08/10/2021. He was found to have NSTEMI. He was medically treated and d/c''ed home Hosparice on 9/7/21. Pt died at home in home hospice care on 9/24/21. Pt has received covid vaccines 2/14/21 & 3/13/21. This death is likely not related to vaccinations due to comorbidities, age, and length of time from vaccine administration.


VAERS ID: 1943203 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-09-18
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow)

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

Write-up: Narrative: 71yo patient receiving only mental health from facility died on 9/18/2021. Pt was receiving cancer therapy from outside cancer center. No mention of type of cancer however pt was concerned would be dying soon based on mental notes in chart. Pt also had received covid vaccines on 1/27/21 & 2/24/21 from outside hospital. Likely this death is not related given patient''s age, comorbidities, and long length of time between date of vaccines and date of death.


VAERS ID: 1943205 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-08-09
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Coronary artery disease, Death, Dyspnoea, Hepatic cirrhosis, Nausea, Syncope, Varices oesophageal, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 69yo male with the following problem list: Nausea and vomiting (SCT 16932000) (ICD-10-CM 07/21/2021 R11.2) Hepatic encephalopathy (SCT 13920009) (ICD-10-CM 01/20/2021 G93.49) Ascites (SCT 38926000) (ICD-10-CM R18.8) 01/20/2021 Cirrhosis of liver (SCT 19943007) (ICD-10-CM 10/21/2021 K74.60) Esophageal varices (SCT 28670008) (ICD-10-CM 11/12/2018 I85.00) Coronary atherosclerosis (SCT 443502000) 08/29/2018 (ICD-10-CM I25.84) Arteriosclerosis of autologous coronary artery 08/29/2018 bypass graft (SCT 285151000119108) (ICD-10-CM Z95.1) Paroxysmal atrial fibrillation (SCT 282825002) 08/29/2018 (ICD-10-CM I48.0) Hypercholesterolemia (SCT 13644009) (ICD-10-CM 06/29/2017 E78.00) History of colonoscopy (SCT 851000119109) 06/29/2017 (ICD-10-CM R69.) 10/2013- tics, no polyps Other chronic nonalcoholic liver disease (SCT 01/27/2016 442685003) (ICD-9-CM 719.41); Pain in joint involving 04/09/2013 shoulder region (ICD-9-CM 719.41) (ICD-9-CM 302.72); Male erectile disorder 11/10/2010 (ICD-9-CM 302.72/607.84) (ICD-10-CM I10.); Essential hypertension (01/27/2016 59621000) (ICD-10-CM K21.9); Gastroesophageal reflux 01/27/2016 disease ( CT 235595009) (ICD-9-CM 724.2) (ICD-9-CM 305.1) Tobacco user 12/13/2006 received his first moderna covid vaccine dose on 7/21/2021. On 7/28/2021 pt went to ER outside of facility with chief complaint of Syncope and collapse. Pt was discharged on 7/30/2021 with the following diagnosis: DC dx: Cirrhosis, CAD, COVID 19. Pt had not been fully vaccinated. On 8/2/21 pt presented to ER at same facility with Chief complaint: Shortness of Breath. Pt remained inpatient with covid infection. Pt died on 8/9/21 at facility from complications associated with covid infection.


VAERS ID: 1943209 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-07-10
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

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

Write-up: Narrative: 88yo male died on 07/10/2021. No information available about pt''s death. Pt had hx of cad/cardiomyopathy/chf(fluid restriction)/6v cabg/pacer-aicd,DM,HTN,TIA,tremor,anemia(MGUS),BCC. Pt had covid vaccines on 2/26/21 & 3/26/21. Likely pt''s death is not related to vaccines given pt''s age & comorbidities & time in-between vaccines admin & date of death.


VAERS ID: 1947345 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-08-21
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cardiac failure congestive, Chronic left ventricular failure, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 78yo male home hospice pt with Hospice Diagnosis:Chronic Systolic (Congestive) Heart Failure died at home on 8/21/2021. Pt had received covid vaccines on 1/29/2021 & 3/1/2021. Death is not related to vaccines


VAERS ID: 1947348 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-04
Onset:2021-08-20
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 82yo male presented to ER at community hospital on 8/16/21. Pt was admitted with covid positive infection. Pt was treated inpatient with remdesivir & decadron & iv antiviotic. Pt died on 8/20/21 at this hospital. Pt had been vaccinated with covid vaccine on 1/11/21 & 2/4/21.


VAERS ID: 1947349 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-08-28
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Drug use disorder
SMQs:, Drug abuse and dependence (narrow), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 55yo male died of unknown causes found by family in his home with suspicion for drug use as cause of death. Patient had received covid vaccines on 4/7/21 & 5/7/21. Death does not appear to be related to vaccines. Pt''s problem list below: PROBLEM LAST MOD PROVIDER Methamphetamine dependence (SCT 426873000) 02/27/2020 (ICD-10-CM F15.222) Sleep apnea (SCT 73430006) (ICD-10-CM G47.30) 02/25/2019 History of cocaine abuse (SCT 288791000119106) 02/25/2019 (ICD-10-CM F14.10) Chronic hepatitis C (SCT 128302006) (ICD-10-CM 02/25/2019 B18.2) Nicotine dependence (SCT 56294008) (ICD-10-CM F17.200) Hypertensive disorder (SCT 38341003) (ICD-10-CM 01/25/2019 I10.) Paranoid schizophrenia (SCT 64905009) (ICD-10-CM 01/25/2019 F20.0)


VAERS ID: 1947356 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-08-24
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Idiopathic pulmonary fibrosis
SMQs:, Interstitial lung disease (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 84yo patient died at home on 8/24/21. Pt was admitted to home hospice on 6/29/21. He had received covid vaccines on 1/11/21 & 2/8/21.Hospice DX: Idiopathic pulmonary fibrosis ICD10). Death not related to vaccinations.


VAERS ID: 1947357 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-08-24
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: HBPC 64yo male with hx of: PROBLEM LIST: *Malnutrition Obstructive sleep apnea of adult Spasticity Constipation Chronic obstructive lung disease Wound Multiple environmental allergies Seen by palliative care service Amyotrophic lateral sclerosis Abnormal findings on diagnostic imaging Sciatic neuropathy Cyst of pancreas Peripheral vascular disease Prediabetes Chronic low back pain Osteoarthritis of knee Degeneration of lumbar intervertebral dis Essential hypertension Hyperlipidemia Gastroesophageal reflux disease Pt was in HBPC as unable to care for self. Pt''s family was waiting nursing home placement. Pt DIED at home on 8/24/21. Pt had received covid vaccines on 2/4/21 & 3/8/21. Likely pt''s death is not related to vaccines.


VAERS ID: 1947362 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-08-27
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Debridement, Genital erythema, Scrotal pain, Scrotal swelling, Sepsis
SMQs:, Angioedema (broad), Hypersensitivity (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: Per inpatient hospice note on 8/26/27: "67 yo male with PMHx of DM, CAD, PVD w/ right BKA and removal of toes on L foot, HTN, chronic combined systolic and diastolic heart failure, HBV, h/o CVA, and ESRD on HD, who presented to the ED on 8/3/21 d/t redness, swelling, and pain of his scrotum debridement on 8/5/21. Palliative care was consulted for Goals of care, Assistance with Advance Directive. Per SW as the patient''s NOL/ decision maker. A family meeting was undertaken with the patient and daughter decided to proceed with end of life/comfort care and transfer to the inpt hospice unit. They decided to change the veteran''s code status to DNAR with no LST if needed. Defibrillator was deactivated per their request." Pt died on 8/27/21 in inpatient hospice care. Cause of death per inpatient death note was sepsis. Pt had received covid vaccines on 1/6/21 & 2/3/21. Death is not related to covid vaccines.


VAERS ID: 1947365 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-22
Onset:2021-08-24
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 82yo died at outside community hospital on 8/24/21. Pt was in active treatment for prostate cancer with plan for hospice care but pt had died before hospice was set up. Pt had received covid vaccines on 1/25/21 & 2/22/21. Vaccines are not related to pt''s death.


VAERS ID: 1947366 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-08-26
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Condition aggravated, Death, Mantle cell lymphoma, Septic shock
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Malignant lymphomas (narrow), Respiratory failure (narrow), Haematological malignant tumours (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Narrative: 71yo pt with hx of cancer, Mantle cell lymphoma of the colon died on healthcare professional 8/26/2021 during inpatient admission. Per Md''s death note, "Death was caused by Acute hypoxic respiratory failure secondary to septic shock and worsening malignancy after palliative extubation (consent from family). "Pt had received covid vaccines on 1/27/21 & 3/3/21 from outside hospital. Death is not related to vaccines.


VAERS ID: 1912249 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-29
Onset:2021-10-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CHLORTHALIDONE; VIT D [ERGOCALCIFEROL]; ACETAMINOPHEN; OMEPRAZOLE; LOPRESSOR; METFORMIN; TRAMADOL; METAMUCIL [PLANTAGO OVATA]; HUMALOG; WARFARIN; KCL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Activated protein C resistance; Chronic pain; DVT; Gastrointestinal neoplasm malignant; GERD; Hypertension; Malignant neoplasm of uterus, part unspecified; Neoplasm breast; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101589632

Write-up: Patient died approximately 20 minutes after receiving booster dose.; booster dose; This is a spontaneous report received from contactable reporter (Pharmacist). The reporter is the patient. A 92-year-old female patient (not pregnant) received bnt162b2 (PFIZER COVID-19 VACCINE), intramuscular, administered in arm left, administration date 29Oct2021 09:10 (Lot number: FD0810) at the age of 92 years as dose 3 (booster), single for covid-19 immunisation. Relevant medical history included: "Chronic pain"; "GERD"; "HTN"; "DM II"; "hx DVT"; "hx. malignant neoplasm of other digestive organs"; "activated protein C resistance"; "hx of malignant neoplasm of breast"; "hx malignant neoplasm of other parts uterus"; all unspecified if ongoing. It was unknown if patient diagnosed with COVID-19 prior vaccination. Patient had not been tested for COVID-19 post vaccination. The patient did not receive other vaccines within 4 weeks prior to the COVID vaccine. Concomitant medications included: chlorthalidone; ergocalciferol (VIT D); acetaminophen; omeprazole; metoprolol tartrate (LOPRESSOR); metformin; tramadol; plantago ovata (METAMUCIL); insulin lispro (HUMALOG); warfarin; kcl. Past drug history included: Morphine, reaction: "Known allegies: Morphine"; Meperidine, reaction: "Known allegies: Meperidine"; Metoprolol, reaction: "Known allegies: Metoprolol"; Lisinopril, reaction: "Known allegies: Lisinopril"; Aleve, reaction: "Known allegies:Aleve"; Altace, reaction: "Known allegies:Altace"; Boniva, reaction: "Known allegies:Boniva"; Doxycycline, reaction: "Known allegies:Doxycycline"; Oxycodone, reaction: "Known allegies:Oxycodone". Vaccination history included: Bnt162b2 (Dose Number: 2, Lot No: EL9269, Location of injection: Arm Left, Route of Administration: Intramuscular), administration date: 09Feb2021, when the patient was 91 years old, for COVID-19 immunization; Bnt162b2 (Dose Number: 1, Lot No: EJ1686, Location of injection: Arm Left, Route of Administration: Intramuscular), administration date: 19Jan2021, when the patient was 91 years old, for COVID-19 immunization. The following information was reported: IMMUNISATION (death) with onset 29Oct2021, outcome "fatal", described as "booster dose"; DEATH (death, medically significant) with onset 29Oct2021 09:30, outcome "fatal", described as "Patient died approximately 20 minutes after receiving booster dose". Therapeutic measures were not taken as a result of death. The patient date of death was 29Oct2021. The reported cause of death was "Patient died approximately 20 minutes after receiving booster dose". No autopsy was performed. Clinical course: Patient died approximately 20 minutes after receiving booster dose.; Sender''s Comments: Based on the limited information available and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of events immunization and death cannot be totally excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Patient died approximately 20 minutes after receiving booster dose.


VAERS ID: 1912255 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-01
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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101596091

Write-up: died after taking the Pfizer COVID-19 vaccine with "no other health issues"; This is a spontaneous report received from non-contactable reporters (Consumers or other non HCPs) from medical information team. A 27 year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) (Batch/Lot number: unknown) as dose number unknown, single for covid-19 immunisation. The patient had no relevant medical history. The patient''s concomitant medications were not reported. The following information was reported: DEATH (death), outcome "fatal", described as "died after taking the Pfizer COVID-19 vaccine with "no other health issues"". The patient''s date of death was unknown. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: There is very limited information provided in this report to make a robust medical judgment regarding the causality of the event. This consumer report lacks confirmation from a healthcare professional. Confirmation from the patient''s treating physician would be helpful. Information regarding the patient''s significant medical history and use concomitant medications. An autopsy report would be useful if this was done. This case will be reassessed upon receipt of follow-up information. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: died after taking the Pfizer COVID-19 vaccine with "no other health issues"


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=91&PERPAGE=100&VAX=COVID19&VAXTYPES=COVID-19&DIED=Yes


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166