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From the 1/21/2022 release of VAERS data:

Found 22,607 cases where Vaccine targets COVID-19 (COVID19) and Patient Died

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1995332 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-26
Onset:2021-04-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101804450

Write-up: died in sleep; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). A 58 year-old male patient received bnt162b2 (BNT162B2), administered in arm left, administration date 26Apr2021 15:30 (Lot number: EW0176) at the age of 58 years as dose 2, single for covid-19 immunisation. Relevant medical history included: "Diabetes" (unspecified if ongoing). The patient''s concomitant medications were not reported. Vaccination history included: Bnt162b2 (1st dose, Lot Number: ER8737, vaccine Location: left arm), administration date: 05Apr2021, when the patient was 58 years old, for COVID-19 immunization. The following information was reported: DEATH (death) with onset 28Apr2021, outcome "fatal", described as "died in sleep ". Therapeutic measures were not taken as a result of death. The patient date of death was 28Apr2021. The reported cause of death was "died in sleep ". No autopsy was performed.; Reported Cause(s) of Death: died in sleep


VAERS ID: 1995483 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-03-24
Onset:2021-03-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 - / OT

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: 2021-03-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211258857

Write-up: HEART ATTACK; DEATH; This spontaneous report received from a consumer concerned a 64 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 administration not reported, batch number: 1805022 expiry: 25-MAY-2021) dose was not reported, dose number in series was 1, 01 total, administered on 24-MAR-2021 on left arm for prophylactic vaccination. No concomitant medications were reported. On an unspecified date, the patient had a heart attack which was diagnosed by his primary care physician (PCP). On 29-MAR-2021, as per death certificate, the patient died from obesity, hypertension (HTN) and diabetes. Reportedly, he was driving at the time he passed away (dose number in series was 1). Autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of death was fatal and the outcome of heart attack was not reported. This report was serious (Death, and Other Medically Important Condition). .; Sender''s Comments: V0: 20211258857-Covid-19 vaccine ad26.cov2.s- Death, Heart attack. 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: OBESITY; HYPERTENSION (HTN); DIABETES


VAERS ID: 1995486 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211260953

Write-up: DIED; CATASTROPHIC INJURY; This spontaneous report received from a consumer via a company representative concerned multiple (48 patients) of unspecified race and ethnic origin. No past medical history or concurrent conditions were reported. The patients received covid-19 vaccine ad26.cov2.s (Dose number in series 1) (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 was unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. It was reported by the reporter that, "I personally know of 48 people who have either died from the experimental drug or who have suffered catastrophic injury from the experimental drug". On an unspecified date, the patients 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 patients died of death on an unspecified date, and the outcome of catastrophic injury was not reported. This report was serious (Death). This case, from the same reporter is linked to 20211260743, 20211261168 and 20211261664.; Sender''s Comments: V0:20211260953-COVID-19 VACCINE AD26.COV2.S-Died. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1995488 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / -

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: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211264458

Write-up: DIED; This spontaneous report received from a consumer via a company representative concerned a patient of unspecified age, sex, race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: unknown, expiry: unknown) dose, start therapy date were not reported, dose number in series 1, 1 total, 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 (Dose number in series 1). It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. On an unspecified date, the patient died from unknown cause of death. This report was serious (Death).; Sender''s Comments: V0: 20211264458-COVID-19 VACCINE AD26.COV2.S-Died. This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1995618 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-29
Onset:2021-10-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood disorder, Death, Dyspnoea, Resuscitation, Thrombosis, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Blood Disorder (diagnosed by MD)-Severe, Additional Details: Patient ended up with blood clots and died 10/7/21. Had no other side effects from the vaccine. Patient''s wife stated he was fine and had no issues until on 10/7 when he was having trouble breathing and then required CPR. He did not survive. Dr''s determined it was blood clots caused by the vaccine.


VAERS ID: 1995775 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-12-29
Onset:2021-12-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, General physical health deterioration, Hyperhidrosis, Hypotension, Inflammation, Pyrexia, Streptococcus test, Tachycardia, Tachypnoea, Throat irritation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Retane Eye Ointment, docusate sodium, miralax, tylenol, ergocalciferol, lacosemide, tamsulosin, senna, lisinopril, keppra, fluoxetine, finasteride, diazepam, sinemet, baby aspirin, oxycodone-acetaminophen, calcium carb-cholecalciferol, onda
Current Illness: right femur fracture, anxiety, HTN, constipation, vit D deficiency, unspecified intelliectual disability, depression, OCD, Parkinsons, seizures, dry eye, urinary incontinence, BPH, osteoarthritis, psychotic disorder,
Preexisting Conditions: See above
Allergies: NSAIDS
Diagnostic Lab Data: Rapid Strep test (no results are noted at this time)
CDC Split Type:

Write-up: Booster desired by way of consent signed on admission by resident representative. Janssen booster 0.5 mL given as consented to stable resident by LPN on 12/29/21 at approx 11:00am. On 12/30/21, resident status declined with rapid strep being done for fever, throat inflammation. Later resident was found to have low B/P, diaphoretic, unresponsive. Order received to send to local ER for eval. Resident left our facility with tachypnea, tachycardia, febrile and unresponsive and transported to local ER where he later was reported to have passed away in the ER.


VAERS ID: 1995801 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-15
Onset:2021-12-15
   Days after vaccination:334
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-22
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, Scopolamine
Current Illness:
Preexisting Conditions: Hypertension, carotid artery disease, dyslipidemia, GERD, anxiety, transient ischemic attack, sleep apnea, renal cancer
Allergies: Latex, amoxicillin, indocin, keflex
Diagnostic Lab Data: Patient reported COVID-19 test positive
CDC Split Type:

Write-up: Patient presented to emergency department from long term care facility on 12/15/2021 with shortness of breath. She was recently discharged from another hospital on 12/15/2021 for COVID-19 infection and condition worsened requiring additional care. Patient was treated with supplemental oxygen and dexamethasone. Patient was made comfort measures only on 12/18/2021. Patient expired on 12/22/2021


VAERS ID: 1995929 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-30
Onset:2021-12-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064H21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-02
   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: Metforim, Fish Oil, Fluoxentine, Atorvastatin, Metordlol, Guanfacine, Amlodipine, Eplerenone, Benazepril
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received the Moderna Booster on November 30. At 10:30 am on December 2nd, I found him unresponsive laying in the kitchen floor. I called 911, and the paramedics worked on him for over 45 minutes and could not revive him. He was pronounced dead around 11:45am.


VAERS ID: 1995949 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-12-08
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / N/A - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Suspected 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: 2021-12-21
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: suspect COVID breakthrough


VAERS ID: 1995969 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-09
Onset:2021-10-14
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042721A / 1 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardiac tamponade, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin d, Tylenol
Current Illness:
Preexisting Conditions: spine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death cardiac tamponade


VAERS ID: 1995984 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-08-09
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK AR / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chemotherapy, Death, Hypoaesthesia, Metastases to bone, Metastases to liver, Metastases to lung, Metastases to lymph nodes, Metastases to spine, Neck mass, Pain, Paraplegia, Radiotherapy, Sensory loss, Spinal cord neoplasm, Testicular germ cell cancer, Urinary incontinence
SMQs:, Peripheral neuropathy (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-22
   Days after onset: 135
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None. Was healthy for 28 years!
Preexisting Conditions: None . Was completely healthy, although overweight.
Allergies: None
Diagnostic Lab Data: Doctors ALL said they have never seen a cancer spread this aggressively before. Doctors have over 25+ years of expertise and experience. This cancer is very treatable!!!
CDC Split Type:

Write-up: Received 2 shots of Moderna. April and May 2021. By August 12th, patient was stage 4 germ cell/testicular after seeing lump neck. Spread to lungs, liver, spine, lymphnodes, bone. Had 4 rounds of aggressive inpatient chemo. Almost eliminated/reduced most tumors, new ones grew. Within 4 weeks after stopping chemo, cancer had more than doubled when he was diagnosed. Lost sensation in leg, and urinary function. (paralyzed from waist down due to spine tumors). Had 7 days of radiation + 1 day chemo. Continued to grow aggressively. He was in so much pain his final days. Was inpatient for all 4 rounds of chemo and his final 14 days as he became paralyzed as they began radiation. Diagnosis to death - 4 months!


VAERS ID: 1996149 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-27
Onset:2021-12-22
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 331308A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-24
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg tabs - 1/day by mouth COVID-19 Vaccine JANSSEN LOT 202A21A on 05/27/2021 - clinic site COVID 19 Vaccine Booster PFIZER LOT 331308A on 12/17/2021 - clinic site
Current Illness: Seasonal allergies
Preexisting Conditions: Seasonal allergies Died on 12/24/2021 -
Allergies: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death


VAERS ID: 1996537 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-05
Onset:2021-12-02
   Days after vaccination:300
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-14
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt admitted to hospital positive for COVID. He received 3 doses of Moderna on 1/8/21, 2/5/21, 11/24/21. Unfortunately he passed on 12/14/21


VAERS ID: 1996542 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-11
Onset:2021-11-09
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Blood culture negative, Cerebrovascular accident, Death, Echocardiogram, Embolic stroke, HIV test negative, Intracardiac thrombus
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), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-29
   Days after onset: 20
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Moderna vaccines 4/13 and 5/11/2021. On 11/9-11/16/2021, patient was admitted to hospital with strokes. TEE showing clot on Mitral valve. Initial blood cultures negative. HIV negative. Patient was discharged to home on Lovenox. Patient on 11/22 admitted with additional strokes, presumably cardioembolic from the clot on her mitral valve. On 11/25 she was evaluated by cardiac surgeon who deemed patient too unstable to undergo surgery. Emperic antibiotic started 11/25 and her repeat blood cultures (11/25 and 11/28) as well as her initial blood culture remained negative. Patient continued to experience debilitating strokes and she was made comfort care. Patient expired 11/29/2021.


VAERS ID: 1996546 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-26
Onset:2021-10-27
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Autonomic nervous system imbalance, Back pain, Bladder catheterisation, Cardio-respiratory arrest, Death, Endotracheal intubation, Intensive care, Lethargy, Lumbar puncture abnormal, Magnetic resonance imaging spinal abnormal, Myelitis, Neck pain, Pyrexia, Respiratory failure, Urinary retention, Ventricular tachycardia, Viral test negative, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-07
   Days after onset: 11
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: Received Moderna vaccine 2/26 and 3/26/2021. On 10/26 patient developed urinary retention and was seen in ED, where a catheter was placed and he was discharged. On 10/31, he was seen at another ED for fever up to 101 and vomiting. He was discharged. On 11/2, he returned to ED with progressive weakness and lethargy and another episode of urinary retention. Patient developed neck pain radiating down to lower back and on 11/4 had MRI that showed myelitis through the entire spine, from cervical region down to the conus medullaris. Viral panel negative. LP contaminated with skin flora. His symptoms continued to worsen despite maximal medical therapy. Due to impending respiratory failure, patient was transferred to ICU. He was intubated on 11/5. On 11/7 patient developed severe autonomic dystonia and developed fevers up to 109. He developed V tach, coded and expired.


VAERS ID: 1996743 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Cardiac disorder, Cerebrovascular accident, Death, Heart rate irregular, Neoplasm
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalopathy/delirium (broad), Cardiac arrhythmia terms, nonspecific (narrow), Non-haematological tumours of unspecified malignancy (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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211256750

Write-up: DEATH; STROKE; VACCINE WEAKENED THE HEART/HEART INFLAMED; HEARTBEATS IRREGULAR; TINY TUMORS; LOSING MEMORY SLOWLY; This spontaneous report received from a consumer via social media through company representative concerned a female of unspecified age race and ethnicity. The patient''s weight, height, and medical history were not reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin was not reported, batch number: unknown expiry : unknown) dose was not reported, 1 total, start therapy date was not reported for prophylactic vaccination (Dose number in series 1). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient had tiny tumors appear, and started losing her memory slowly, and soon after had a stroke. The reporter stated that the vaccine weakened the patient''s heart and the heart inflamed which led to an irregular heartbeat. On an unspecified date, the patient died from unknown cause of death. It was unknown if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient died of death on an unspecified date, and had not recovered from tiny tumors, losing memory slowly, stroke, heartbeats irregular, and vaccine weakened the heart/heart inflamed. This report was serious (Death, and Other Medically Important Condition). This case, from the same reporter is linked to 20211258139, 20211263643 and 20211263721.; Sender''s Comments: V0: 20211256750-covid-19 vaccine ad26.cov2.s-Death, stroke. 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: 1996747 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Maine  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, 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: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20211262948

Write-up: SUSPECTED COVID-19; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer concerned a patient of unspecified age, sex, 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 (dose number in series: 1) (suspension for injection, route of admin, and batch number were not reported) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, the patient experienced death from covid-19 (suspected covid-19 and suspected clinical vaccination failure). On an unspecified date, Laboratory data included: COVID-19 virus test (NR: not provided) positive. 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 suspected covid-19 on an unspecified date, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: 20211262948- Covid-19 vaccine ad26.cov2.s- Suspected 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. V0: 20211262948- Covid-19 vaccine ad26.cov2.s- Suspected covid 19. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: COVID-19


VAERS ID: 1996751 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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: USJNJFOC20211263721

Write-up: DROPPED DEAD; This spontaneous report received from a consumer via social media via a company representative concerned a patient of unspecified age, sex, 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, and batch number and expiry were not reported) dose, 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series 1). The batch number was not reported. The company is unable to perform follow-up to request batch/lot number. No concomitant medications were reported. On an unspecified date, the patient dropped dead from unknown cause. It was unspecified if an autopsy was performed. Reporter stated that, "It was more than my family who dropped dead. You got it wrong, people still dyeing fully vaccinated (contaminated) with the booster as well" The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death). This case is a duplicate of 20211263643. This case, from the same reporter is linked to 20211258139 and 20211256750.; Sender''s Comments: V0-20211263721-COVID-19 VACCINE AD26.COV2.S-Dropped Dead . This event(s) is considered unassessable. The event(s) has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: DROPPED DEAD


VAERS ID: 1996758 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

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: USJNJFOC20211265808

Write-up: BLOOD CLOTS; This spontaneous report received from a consumer via a company representative via social media concerned a patient of unspecified age and sex of an unspecified race and ethnic origin. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown, expiry: Unknown) dose, start therapy date were not reported, dose number in series was 1, 1 total for prophylactic vaccination. No concomitant medications were reported. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. On an unspecified date, reporter stated that patient died after the J&J vaccine from blood clots. It was unspecified if an autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of blood clots was fatal. This report was serious (Death).; Sender''s Comments: V0: 20211265808- COVID-19 VACCINE AD26.COV2.S- blood clots. 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: BLOOD CLOTS


VAERS ID: 1996867 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-04
Onset:2021-03-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, Blood pressure abnormal, Bone scan, Bursitis, Cardiac arrest, Chest X-ray, Computerised tomogram, Death, Echocardiogram, Electrocardiogram normal, Fatigue, Fistulogram, Gait disturbance, Inflammation, Magnetic resonance imaging abdominal, Magnetic resonance imaging spinal, Nausea, Neurological examination, Orthopaedic examination, Pain, Spinal X-ray, Spontaneous haemorrhage, Walking aid user, X-ray normal, X-ray of pelvis and hip, X-ray of pelvis and hip normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-02
   Days after onset: 56
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 23 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Norvasc, Aspirin, Coreg, Phoslo, Dialyvite, Synthroid, Vit D3, Probiotic, Turmeric, Omega 3 fish oil, Vit B Complex
Current Illness: None
Preexisting Conditions: High blood pressure (controlled), CHF (controlled), ESRD (In-Center Hemodialysis)
Allergies: Penicillin, Iodine, Lysinopril
Diagnostic Lab Data: See Continuation Page for timeline of events, lab results, treatment and outcomes.
CDC Split Type:

Write-up: The adverse events being reported and documented below are death from unexplained spontaneous bleeding (thinning of the blood) that followed acute inflammation and excruciating pain that began less than 48 hours after the second dose of the Moderna vaccine.Timeline of events from March 4 - May 2, 2021; 3/4/21 - Second dose of Moderna Covid-19 vaccine received. 3/5/21 - Mom) reported being very tired and nauseous. 3/6/21 - (Mom) reported being in extreme pain which turned into excruciating pain. Timeline of events from March 4 - May 2, 2021 Note: (Mom) had a very high tolerance for pain, evidenced by previous major falls & fractured bones (pelvis, hip, both femurs, 9 ribs, 3 cracked vertebrae), the lingering results of which she lived with every day without constant mention of the chronic pain. In contrast, the pain that began on March 6 was excruciating, incapacitating, and resulted in her barely being able to walk and was, therefore, new, noteworthy, different and unusual. 3/08/21 - Visit #1 to the ER for excruciating pain. - Pelvic x-ray done, nothing broken; IV morphine given. - Examination by ER physician. - Released from hospital; sent home with script for Norco for pain; did not take because it made her unable to function. Note: (Mom) identified the source of her excruciating pain to the ER physician as being in her lower left back region, just at the top of her left pelvic bone, as witnessed by a family member. 3/22/21 - Visit #2 to the ER Hospital for same excruciating pain (as March 8) and ultimately admitted. - EKG, CT scan, MRI spine, MRI pelvis and whole-body bone scan done during length of stay. No new findings, only evidence of old fractures and spondylolisthesis, all of which were known, old diagnoses. 3/23/21 - Examination by PA-C for Chief of Orthopedics and subsequently by Hospital. Note: Despite the fact that this was the second admission in three weeks for the same pain that was originating from the same source, the orthopedic specialists focused on old compression fractures, old pelvic fractures, and degenerative spinal changes, which (Mom) lived with every day with little complaint. The source of the excruciating pain that began on March 6, and that was reported on March 8 in the ER, appeared to have been excluded from consideration or discussion. 3/26/21 - Released from hospital with short course of steroids for pain; minute reduction in pain until steroid dose was weaned and the same excruciating pain, that began on March 6, immediately emerged again. 4/7/21 - Visit #3 to the ER for same excruciating pain (as March 8) and ultimately admitted. - Lumbar/AP spine and dorsal/thoracic spine x-rays, front pelvic & 2 view left hip x-rays, front chest & 3 bilateral rib x-rays, EKG, Echo done during length of stay. - Examination by Hospitalist Internal Medicine. - Examination by Orthopedic Surgeon. - Examination by Pain Management Specialist/Neurologist. 4/10/21 - (Mom''s) acute inflammation and excruciating pain were diagnosed as Trochanteric Bursitis. A Depo-Medrol steroid shot was given in left hip area by Pain Management Specialist/Neurologist for the acute inflammation and pain (Mom) had been experiencing for the five weeks since the second Covid-19 shot; pain relief within hours after the steroid shot. By the end of the day, she went from not being able to walk to walking to the end of the hallway within the hospital. 4/13/21 - (Mom) was to be transferred Hospital for rehab program, however, due to spontaneous bleeding of her fistula, she was kept at Hospital for observation. (Mom''s) Vascular Surgeon was called in to help stop the bleeding. Note: The spontaneous bleeding from (Mom''s) fistula seemed highly unusual as it had never occurred in six years of receiving dialysis. 4/15/21 - Fistulogram performed by Vascular & Interventional Radiology Specialist to ensure fistula was in good working order. Results showed no stenosis. 4/16/21 - Transferred to Hospital for inpatient physical therapy rehab program. 4/23/21 - Released from hospital after successful completion of the rehab program. (Mom) had a positive frame of mind and was looking forward to future plans. She was able to walk again with the aid of her walker and to function independently; in-home therapy began 4/29 to build up strength she had lost during the 5 weeks of excruciating pain and time spent in the hospital. 5/2/21 - Spontaneous bleeding from fistula, no blood pressure, heart stopped. Cause of death ruled (spontaneous) bleeding from fistula.


VAERS ID: 1997395 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-08-20
Onset:2021-09-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059EZIA / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, Pneumonia, Pyrexia, Seizure, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-16
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized for fever, seizure, pneumonia 9/3/21 Death by cardiac arrest from blood clot on September 16, 2021


VAERS ID: 1997432 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-12-02
Onset:2021-12-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / 1 UN / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Dyspnoea, Feeling abnormal, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-23
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: the only thing he took was acid reducer over the counter medication.
Current Illness: None
Preexisting Conditions: None
Allergies: Cats, ashtma
Diagnostic Lab Data: autopsy on 12/27/2021
CDC Split Type:

Write-up: Soon after getting J&J Booster, Patient started complaining about shortness of breath that would come and go. On 12/22/2021 he was feeling like "crap" and thought it was COVID and was waiting to get tested. We found him dead in his apartment, and the autopsy revealed pulmonary thrombo embolism.


VAERS ID: 1997533 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-26
Onset:2021-03-17
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 AR / -

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Cerebrovascular accident, Computerised tomogram, Death, Muscular weakness, Myocardial infarction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-11
   Days after onset: 116
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine Aspirin Breo Ellipta Cholecalciferol dutasteride-tamsulosin HCL oxybutynin pantoprazole simvastatin xarelto
Current Illness: no illnesses
Preexisting Conditions: Nonrheumatic mitral (valve) insufficiency - mild Pure hypercholesterolemia - controlled on statin Peripheral vascular disease, unspecified - stabler on statin, Xarelto Aneurysm of iliac artery - stable on aspirin and lipid lowering Transient cerebral ischemic attack, unspecified - follow Atherosclerotic heart disease of native coronary artery without angina pectoris - on aspirin and statin Other psoriatic arthropathy Nonrheumatic aortic (valve) insufficiency - mild Chronic obstructive pulmonary disease, unspecified - stable, no s/s exacerbatoin Obesity, unspecified Obstructive sleep apnea (adult) - using CPAP Occlusion and stenosis of bilateral carotid arteries - stable on aspirin and lipid lowering Occlusion and stenosis of right carotid artery - not requiring intervention on anti-platelet and lipid lowering Cerebral infarction due to thrombosis of unspecified cerebral artery - on aspirin and statin Essential (primary) hypertension - controlled Paroxysmal atrial fibrillation - controlled. On Xarelto Body mass index (BMI) 30.0-30.9 Vitamin B deficiency, unspecified Diverticulitis of large intestine without perforation or abscess without bleeding
Allergies: Penicillin Heparin
Diagnostic Lab Data: Bloodwork CT Scan Dr Visits My father was an active and young 85. Some individuals appear to be high risk for the vaccines and this needs to be looked into. I firmly believe my father would still be here if he did not receive the Moderna vaccine. There was a noticeable change in my father after he received the vaccine.
CDC Split Type:

Write-up: 1. 1st Moderna Injection on 2/26/21 (Lot 013A21A) 2. 3/17/21 - Unknown Bleeding around the left eye causing dark bruise 3. 2nd Moderna Injection on 3/26/21 (Lot 008B21A) 4. 5/18/21 - collapsed 5. week of 6/7/21 - legs felt weak, 6/12/21 - arms felt weak - went to emergency room 6. 6/12/21 - admitted to hospital mild heart attack 7. 6/12/21 - the night admitted to hospital - stroke 8. 7/11/21 - died


VAERS ID: 1997540 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray abnormal, Chest wall tumour, Computerised tomogram, Death, Hepatomegaly, Intensive care
SMQs:, Liver related investigations, signs and symptoms (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bumex, Cholecalciferol, Digoxin, Gabapentin, Robitussin, Norco, Motrin, Corlanor, Magnesium Oxide, Melatonin, Robaxin, Metolazone, Metoprolo XL, Protonix, KDUR, Pericolace, Zoloft
Current Illness: Malignant Mesothelioma
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: CT scans, Chest X-ray, blood work
CDC Split Type:

Write-up: Unprecedented and unexplained tumor growth throughout chest cavity. Liver 3 times normal size. Quotes from oncologist, thoracic surgeon, ICU doctor and cardiologist "I''ve never seen anything like this" "We thought we were looking at someone else''s scans" Vaccine given 9/9/2021, patient death 10/4/2021, less than 30 days post vaccine.


VAERS ID: 1997560 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-19
Onset:2021-11-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Succ ER 25 MG tab Lisinopril 20 MG tab Simvastatin 40 MG tab
Current Illness:
Preexisting Conditions: previous heart attach, stents inserted about 13 years earlier
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 11/25/21, 6 days after receiving the Moderna COVID Booster shot, Patient had a massive heart attach and died.


VAERS ID: 1997866 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-12-29
Onset:2022-01-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2022-01-02
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: 2022-01-01
   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: Patient was on hospice with death imminent. Family still requested covid booster . Resident died 1/1/22
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Resident died, It was an expected death. Resident on hospice but still requested Pfizer booster


VAERS ID: 1998426 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211266299

Write-up: HEART ATTACK; This spontaneous report received from a consumer via a company representative via social media concerned a 52 year old male unspecified race and ethnic origin. 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 administration not reported, batch number: unknown, expiry: unknown) dose was not reported, dose number in series was 1, 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 number. No concomitant medications were reported. On an unspecified date, the reporter stated that, the patient received the Johnson & Johnson (J&J) shot and died one month later from a heart attack (dose number in series was 1). It was unknown if autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the event heart attack was fatal. This report was serious (Death).; Sender''s Comments: V0: 20211266299-COVID-19 VACCINE AD26.COV2.S-Heart Attack. 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: HEART ATTACK


VAERS ID: 1998430 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211266789

Write-up: DIED; This spontaneous report received from a consumer via a company representative via social media concerned a patient of unspecified age, sex, race and ethnic origin. 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 administration not reported, batch number: unknown, expiry: unknown) dose, start therapy date were not reported, dose number in series was 1, 1 total administrated for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. The reported stated that, a family member died (date unspecified) after being fully vax (dose number in series was 1). It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. On an unspecified date, the patient died of an unknown cause. This report was serious (Death).; Sender''s Comments: V0: 20211266789-COVID-19 VACCINE AD26.COV2.S-died. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH


VAERS ID: 1998438 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-02-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Pulmonary haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   Days after onset: 2
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: Medical History/Concurrent Conditions: Renal cancer stage IV (He had stage 4 renal cancer but was stable.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: Internal bleeding in the lung; Fall down; This spontaneous case was reported by a consumer and describes the occurrence of PULMONARY HAEMORRHAGE (Internal bleeding in the lung) 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. The patient''s past medical history included Renal cancer stage IV (He had stage 4 renal cancer but was stable.). On 03-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Feb-2021, the patient experienced FALL (Fall down). On an unknown date, the patient experienced PULMONARY HAEMORRHAGE (Internal bleeding in the lung) (seriousness criteria death and medically significant). The patient died on 09-Feb-2021. The reported cause of death was internal bleeding in the lung. It is unknown if an autopsy was performed. At the time of death, FALL (Fall down) outcome was unknown. No concomitant medication information was mentioned by the reporter. It was reported that the patient was admitted to the emergency room (ER) on Sunday, 07-Feb-2021 after a fall down. It was non-serious as nothing broke. The ER admitted the patient for observation. He died on the 09-Feb-2021 from internal bleeding in the lung. The reporter felt that moderna vaccine was responsible for his death but of course there was no proof. No treatment medication information was mentioned by the reporter. Company Comment: This case refers to a male patient of unspecified age with a medical history of stage 4 renal cancer who experienced the unexpected serious event of Pulmonary hemorrhage approximately 4 days after the second dose of mRNA-1273 vaccine. The patient eventually died 2 days later. No causality assessment was provided by the reporter. The medical history of stage 4 renal cancer remains a confounder. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case refers to a male patient of unspecified age with a medical history of stage 4 renal cancer who experienced the unexpected serious event of Pulmonary hemorrhage approximately 4 days after the second dose of mRNA-1273 vaccine. No causality assessment was provided by the reporter. stage 4 renal cancer. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Internal bleeding in the lung


VAERS ID: 1998555 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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: USJNJFOC20211266689

Write-up: DEATH; This spontaneous report received from a consumer via media through a company representative concerned a male 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 and batch number: unknown, expiry: unknown) dose was not reported, 1 total, start therapy date was not reported for prophylactic vaccination (Dose number in series 1). The batch number was not reported. The company was unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, reporter stated that " Take a good look at my kids & their grandpa. He lived less than a mile from our house. He was a daily constant in our lives. You took him from us. Your little experiment has caused so much death, pain, and suffering". On an unspecified date, the patient died from unknown cause of death. It was unknown if autopsy was performed or not. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0 .20211266689-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: 1998571 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Hepatic failure
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic liver disease (chronic liver disease)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20214

Write-up: liver failure; receiving two shots of the booster.; This spontaneous case was reported by a consumer and describes the occurrence of HEPATIC FAILURE (liver failure) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Chronic liver disease (chronic liver disease). On an unknown date, the patient received fourth dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced HEPATIC FAILURE (liver failure) (seriousness criteria death, hospitalization and medically significant) and EXTRA DOSE ADMINISTERED (receiving two shots of the booster.). The patient died on an unknown date. The reported cause of death was Liver failure. It is unknown if an autopsy was performed. At the time of death, EXTRA DOSE ADMINISTERED (receiving two shots of the booster.) had resolved. Concomitant medication information was not provided by the reporter. Treatment medication information was not provided by the reporter. Reporter stated that a girl with chronic liver disease went into liver failure and had jaundice and also died in hospital after receiving two shots of the booster. Company comment: This is a spontaneous case concerning a female patient of an unknown age with concurrent medical condition of Chronic liver disease who experienced serious, unexpected event of hepatic failure. Vaccination dates and start date of the event were not provided. Reporter stated that a girl with chronic liver disease went into liver failure and had jaundice and also died in hospital after receiving two shots of the booster. Date of death was not disclosed. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. Further information has been requested. Concurrent medical condition of Chronic liver disease remains a confounder. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This is a spontaneous case concerning a female patient of an unknown age with concurrent medical condition of Chronic liver disease who experienced serious, unexpected event of hepatic failure. Vaccination dates and start date of the event were not provided. Reporter stated that a girl with chronic liver disease went into liver failure and had jaundice and also died in hospital after receiving two shots of the booster. Date of death was not disclosed. It is unknown if an autopsy was performed. Very limited information regarding this event has been provided at this time. Further information has been requested. Concurrent medical condition of Chronic liver disease remains a confounder. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Liver failure


VAERS ID: 1998967 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-11-26
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / IM

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

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Alzheimer''s Disease
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient was fully vaccinated against covid-19 and passed away on 11/26/2021.


VAERS ID: 1999006 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-12-14
   Days after vaccination:298
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: MS, Obesity, Osteoarthritis, Pre-diabetes
Allergies: Bee Venom
Diagnostic Lab Data: No actual lab report located to confirm covid-19 virus in patient''s system. Hospital notes state infection with covid-19.
CDC Split Type:

Write-up: Patient was fully vaccinated against covid-19 and passed away on 12/14/2021 as a probable death from covid-19. This patient also received her booster dose of the Pfizer vaccine on 11/19/2021, Lot # EW0183; administered by the County Health Department.


VAERS ID: 1999023 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-29
Onset:2021-12-24
   Days after vaccination:329
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Hypoxic-ischaemic encephalopathy, Resuscitation, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-24
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Schizophrenia Parkinson''s Diabetes Hypertension COPD Dyslipidemia Neuropathy
Allergies: Meperidine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient died in hospital on 12/24/21. She developed cardiopulmonary arrest and was resuscitated but developed severe anoxic encephalopathy and was unresponsive. Family withdrew life support.


VAERS ID: 1999063 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-06
Onset:2021-12-24
   Days after vaccination:293
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Hypotension, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Respiratory failure (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-24
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: CAD Atrial Fibrillation GERD Diabetes Chronic kidney disease Osteoarthritis
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt died in hospital on 12/24/21. Pt developed hypotension requiring pressors. Patient coded twice with successful resuscitation. Family changed code status to DNR and patient expired a short time later.


VAERS ID: 1999066 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-12
Onset:2021-12-28
   Days after vaccination:291
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cough, Death, Dyspnoea, Endotracheal intubation, Hypervolaemia, Hypotension, Hypoxia, Influenza like illness, Intensive care, Mechanical ventilation, Renal impairment, SARS-CoV-2 test positive, Sputum culture positive, Staphylococcal infection, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CVA with residual dysarthria, paroxysmal atrial fib
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PResented on 12/13 with shortness of breath and flu like symprtoms. Patient stated had tested + for Covid a couples days ago. Started on remdesevir and dexamethasone. Started O2 on 12/19 due to increasing oxygen requirements. Transferred to Critical care and intubated due to acute hypoxic respiratory failure secondary to Covid-19 on 12/22. Sputum culture showed MSSA and given ancef therapy. Started disursis due to fluid overload but was then held due to poor kidney function. 12/28 acutely decompensated after coughing episode. Began to be tachycardic, hypotensive and hypoxic. Required mutiple vasopressors and maximum ventilator settings. Family decided on comfort care and expires 12/28.


VAERS ID: 1999076 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-29
Onset:2021-12-18
   Days after vaccination:354
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 037K20A / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 025L20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal
SMQs:, Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, 325 mg, Oral, bid, PRN acetaminophen-oxycodone 325 mg-5 mg oral tablet, 1 Tablet(s), Oral, q6h, PRN amlodipine 5 mg oral tablet, 5 mg= 1 Tablet(s), Oral, Daily Aplisol 5 tuberculin units/0.1 mL intradermal solution, IntraD
Current Illness: COPD DM2 HYPOTHYROIDISM
Preexisting Conditions: ABOVE
Allergies: NKA
Diagnostic Lab Data: CXR: Grossly unchanged pulmonary findings consistent with known COVID-19 pneumonia.
CDC Split Type:

Write-up: COVID INFECTION 1 YEAR AFTER VACCINE SERIES COMPLETED HIGH FLOW NC OXYGEN WITH 100%


VAERS ID: 1999088 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-29
Onset:2021-12-29
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Brain stem haemorrhage, Cerebrovascular accident, Death, Respiratory failure, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Obesity Hypertension GERD
Allergies: Wound Dressing Adhesive
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt died in hospital on 12/29/21. Pt admitted due to respiratory failure/acute stroke with pontine hemorrhage. Pt remained unresponsive throughout stay. Family transitioned patient to comfort care and she expired.


VAERS ID: 1999130 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-27
Onset:2021-12-30
   Days after vaccination:306
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Atelectasis, Blood pressure decreased, Bronchoscopy abnormal, COVID-19, Chromaturia, Computerised tomogram thorax abnormal, Haematuria, Heart rate abnormal, Intensive care, Pleural effusion, Pneumonia, Pneumonia aspiration, Pneumothorax, Respiratory disorder, SARS-CoV-2 test positive, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHF, hypertension, COPD, CKD stage III, type 2 diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID + on 12/1 when admitted and then discharged on 12/17. Readmitted on 12/20 for sepsis due to aspiration pneumonia. Bronshoxcopy done and admitted to Critical care. Had pink urine since starting eliquis during last admission for acute PE. Converted to heoparin drip bu develiped gross hematuria , heparin stopped. Hematuria resolved on 12/27 and heparing restarted. Completed a full cours of antibiotics for pneumonia.Respiratory staus continued to decline. Decreasing BP and poorly controlled heart rate evaluated by cardiology. - metopralol and lasix given. CT thorax showed moderate bilateral effusions with atelectatic collapes of the lowe r and right middle lobe. Continued need fo hihg oxygenation. Patient requested comfort care 12/29.


VAERS ID: 1999163 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-18
Onset:2021-12-26
   Days after vaccination:283
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 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: 2021-12-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID 19 test collected 11/25/2021.
CDC Split Type:

Write-up: Patient tested positive for COVID 19 on 11/25/2021 and was hospitalized 11/26/2021 at Hospital and was transferred to different Hospital. Patient passed away 12/26/2021.


VAERS ID: 1999247 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-05
Onset:2021-07-30
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Death, Dyspnoea, Fatigue, General physical health deterioration, Interstitial lung disease, Malaise
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 20
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 59 y/o male, PMHx of CAD, CHF, CKD, DM, HTN, pulmonary edema, s/p CABG, and previous MI, admitted for cough, SOB, generalized malaise, and fatigue on 8/3/21. Chest x-ray on 8/3/21 shows bilateral interstitial and airspace disease concerning for pneumonia. Covid19 was treated with supportive measures and convalescent plasma as pt was not a candidate for remdesivir. Pt chose to pursue treatment with ivermectin. Pt''s condition deteriorated, and pt was placed on hospice and passed on 8/19/21.


VAERS ID: 1999303 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-12-27
   Days after vaccination:285
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

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: 2022-01-02
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHF, CAD, hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given 2/24/2021 Lot # EN6198 Pfizer Patient died at Hospital on 1/2/2022 Pt tested positive for Covid 19 on 12/24/2021, died from covid complications


VAERS ID: 1999335 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-12-13
Onset:2021-12-21
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Metoprolol, Aspirin
Current Illness:
Preexisting Conditions: Heart DIsease, CAD
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive Pulmonary Embolism, Death


VAERS ID: 1999347 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-05
Onset:2021-12-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33026BD / 3 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood creatinine normal, Blood potassium decreased, Blood sodium increased, Blood urea increased, Death, General physical health deterioration, Haemoglobin normal, Mean cell volume normal, White blood cell count normal
SMQs:, Acute renal failure (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-03
   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: VITAMIN B12 1000 MCG PO DAILY, ACETAMINOPHEN 650 MG PO 2X''S DAILY, MIRTAZAPINE 7.5 MG PO @ HS, IBUPROFEN 600MG PO Q 6 HOURS AS NEEDED, 2-CAL MED PASS 120ML 3XS DAILY, ORDERED 12/2/21 O2 2-4L PER NC FOR COMFORT CONT, ROXANOL 20MG/ML 0.5ML/
Current Illness: PT RECEIVED HER FIRST DOSE OF PFIZER ON 4/16/2021, SECOND VACCINE ON 05/07/2021, BOOSTER 11/05/2021. AUGUST 2021 INCREASED NEUROLOGICAL ISSUES TWITCHING/ JERKY MOVEMENTS, FREQ FALLS
Preexisting Conditions: AUGUST 2021 STARTED HAVING NEUROLOGICAL ISSUES, TWITCHING/ JERKING MOVEMENTS, DECREASE STRENGTH, UNABLE TO AMBULATE W/ WALKER AS PRIOR. AT HOME STARTED HAVING INCREASE CONF AND FALLS, PLACED IN SKILLED FACILITY THEN TRANSFERED TO US IN OCTOBER ACTIVELY WORKING W/ THEROPY, AFTER BOOSTER 3 WKS DECLINED QUICKLY AND EXPIRED 12/03/2021
Allergies: ACE INHIBITORS, BACTRIM, CIPRO, METFORMIN
Diagnostic Lab Data: 08/30/2021 NA 141, K+4.1, BUN 10, CR 0.6, WBC 5.1, HGB 12.2, MCV91.7 12/1/2021 NA 154, K+3.4, BUN 27 NO ADDITIONAL LABS TEST COMPLETED EITHER ON 08/30/2021 IN ED. AFTER 12/2/2021 PT/FAMILY DECIDED TO GO COMFORT CARE
CDC Split Type:

Write-up: AFTER PT RECEIVED INITIAL DOSES OF VACCINE IN AUG 2021 STARTED HAVING INCREASED NEUROLOGICAL ISSUES, DECREASED MOBILITY TWITCHING/ JERKY MOVEMENT W/ FREQ FALLS. AFTER RECEIVING HER BOOSTER 11/05/2021 PT BEGAN TO DECLINE AFTER 3 WKS. PLACED ON COMFORT CARE 12/2/2021 AND EXPIRED 12/03/2021


VAERS ID: 1999364 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-01
Onset:2021-12-27
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Chest pain, Hypoxia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hypoxia, chest pain, and then 3 episodes of cardiac arrest. No cardiac history. Patient stated she was fully vaccinated with 2 vaccines and the booster. Did not provide manufacturer.


VAERS ID: 1999423 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-24
Onset:2021-03-11
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Tylenol
Current Illness: None
Preexisting Conditions: Dizziness
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death during the night two weeks after second dose


VAERS ID: 1999427 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-09
Onset:2021-12-27
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Agitation, Angiogram pulmonary abnormal, Aortic arteriosclerosis, Aortic valve thickening, Arteriosclerosis, Atelectasis, Bronchiectasis, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Death, Deep vein thrombosis, Discomfort, Dyspnoea, Echocardiogram, Ejection fraction, Encephalopathy, Hiatus hernia, Hilar lymphadenopathy, Hypopnoea, Influenza A virus test negative, Influenza B virus test, Intensive care, Intentional medical device removal by patient, Interstitial lung disease, Lung consolidation, Lung opacity, Lymphadenopathy mediastinal, Mitral valve incompetence, Oxygen saturation decreased, Pericardial effusion, Pneumonia, Positive airway pressure therapy, Pulmonary artery dilatation, Pulmonary fibrosis, Pulmonary hypertension, Pulmonary oedema, Pulse waveform abnormal, Pyrexia, Renal atrophy, Respiratory syncytial virus test negative, Right atrial dilatation, Right ventricular dilatation, Right ventricular dysfunction, SARS-CoV-2 test positive, Scan with contrast abnormal, Splenic granuloma, Superficial vein thrombosis, Tricuspid valve incompetence, Ultrasound Doppler abnormal, Vasodilatation, Vasodilation procedure
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL, VENTOLIN, PROAIR) 108 (90 Base) MCG/ACT inhaler amLODIPine (NORVASC) 5 MG tablet Apoaequorin (PREVAGEN PO) APPLE CIDER VINEGAR PO aspirin 81 MG chewable tablet calcium carbonate (TUMS) 500 MG chewable tablet carvedilol
Current Illness: Stage 4 COPD
Preexisting Conditions: Respiratory Moderate COPD (chronic obstructive pulmonary disease) Multiple pulmonary nodules Dyspnea on exertion Acute respiratory failure with hypoxia Circulatory Essential hypertension Coronary artery disease involving native coronary artery of native heart without angina pectoris Non-ischemic cardiomyopathy Pulmonary hypertension Deep venous insufficiency Superficial vein thrombosis Pulmonary HTN digestive Hepatitis C Genitourinary ESRD on hemodialysis Endocrine/Metabolic History of prediabetes Dyslipidemia Other History of prostate cancer Renal transplant, status post
Allergies: No Known Allergies
Diagnostic Lab Data: USV Venous Upper Extremity Duplex Bilateral Resulted: 01/01/22 0946 Order Status: Completed Updated: 01/01/22 0948 Narrative: EXAMINATION: Complete Bilateral Upper Extremity Venous Duplex Doppler Ultrasound EXAM DATE: 1/1/2022 9:28 AM TECHNIQUE: Real-time B-mode imaging with and without compression was used to evaluate the right and left upper extremity for deep venous thrombosis (DVT). Duplex Doppler with color and spectral Doppler was used. INDICATION: fever COMPARISON: None _____________________ Right Upper Extremity Findings: Right Internal Jugular Vein: No thrombus. Right Subclavian Vein: No thrombus. Right Axillary Vein: No thrombus. Right Brachial Vein: No thrombus. Right Radial Vein: No thrombus. Right Ulnar Vein: No thrombus. Superficial Veins: Right Basilic Vein: No thrombus. Right Cephalic Vein: Dilation of the cephalic vein within the upper arm. Chronic appearing echogenic mural-based foci suggesting mural calcifications or chronic sequela of thrombophlebitis. Age-indeterminate thrombus within the right medial cubital vein. Left Upper Extremity Findings: Portion of the distal upper arm and elbow obscured by bandage. Left Internal Jugular Vein: No thrombus. Left Subclavian Vein: No thrombus. Left Axillary Vein: No thrombus. Left Brachial Vein: No thrombus. Left Radial Vein: No thrombus. Left Ulnar Vein: No thrombus. Superficial Veins: Left Basilic Vein: No thrombus. Left Cephalic Vein: Thrombosed within the distal upper arm. ADDITIONAL FINDINGS: Normal cardiac pulsatility is present in the subclavian veins. _____________________ Impression: There is no sonographic evidence for deep venous thrombosis in the visualized deep veins of the right or left upper extremity. Superficial thrombophlebitis of the left cephalic vein within the upper arm. Chronic appearing changes of the cephalic vein on the right with dilation within the upper arm and likely chronic wall calcifications or chronic thrombus. Age indeterminant thrombus present within the median cubital vein on the right. USV Venous Lower Extremity Duplex Bilateral Resulted: 01/01/22 0939 Order Status: Completed Updated: 01/01/22 0941 Narrative: EXAMINATION: Complete Right and Left Lower Extremity Venous Duplex Doppler Ultrasound EXAM DATE: 1/1/2022 9:29 AM TECHNIQUE: Real-time B-mode imaging with and without compression was used to evaluate the right and left lower extremity for deep venous thrombosis (DVT). Duplex Doppler with color and spectral Doppler was used. INDICATION: fever COMPARISON: None _____________________ Right Lower Extremity Findings: Right Common Femoral Vein: No DVT. Right Femoral Vein: No DVT. Right Popliteal Vein: No DVT. Right Posterior Tibial Veins: No DVT. Right Peroneal Veins: No DVT Right proximal Greater Saphenous Vein: No thrombus. Left Lower Extremity Findings: Left Common Femoral Vein: No DVT. Left Femoral Vein: No DVT. Left Popliteal Vein: No DVT. Left Posterior Tibial Veins: No DVT. Left Peroneal Veins: No DVT Left proximal Greater Saphenous Vein: No thrombus. Duplex Doppler: The common femoral vein waveforms are abnormally pulsatile. This finding may be seen with elevated central venous pressure from heart failure, tricuspid valve regurgitation, pulmonary hypertension, or right heart dysfunction. Additional Findings: None. _____________________p Impression: There is no sonographic evidence for deep venous thrombosis in the visualized deep veins of the right or left lower extremity. Reflected cardiac pulsations are present in the common femoral vein waveforms. This finding may be seen with elevated central venous pressure from heart failure, tricuspid valve regurgitation, pulmonary hypertension, and elevated right heart pressures or dysfunction. * DR CHEST SINGLE VIEW Resulted: 01/01/22 0758 Order Status: Completed Updated: 01/01/22 0800 Narrative: EXAMINATION: Single View Chest EXAM DATE: 1/1/2022 5:26 AM TECHNIQUE: Single view chest INDICATION: acute hypoxic respiratory failure COMPARISON: December 31, 2021 ENCOUNTER: Not applicable _________________________ FINDINGS: Bilateral lung opacifications continue appearing mildly improved about the right base. Blunting of the bilateral costophrenic angles just a small amount of bilateral pleural fluid. No visualized pneumothorax. Heart appears enlarged in similar fashion. Hilar and mediastinal borders appear grossly stable with atherosclerosis, limited evaluation due to adjacent opacification. No new tubes or catheters are evident. Overlying support devices limits evaluation. _________________________ Impression: Bilateral lung opacities continue, there appears to be mild clearing at the right base. Bilateral small pleural effusions are suspected. DR CHEST SINGLE VIEW Resulted: 12/31/21 2328 Order Status: Completed Updated: 12/31/21 2330 Narrative: EXAMINATION: Single View Chest EXAM DATE: 12/31/2021 11:22 PM TECHNIQUE: Single view chest INDICATION: acute hypoxic respiratory failure COMPARISON: Chest x-ray of 12/31/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: There is extensive bilateral pulmonary space consolidation, which has significantly increased since the prior exam. Cardiac size is within normal limits. No pneumothorax. No appreciable pleural fluid. Bones appear stable. _________________________ Impression: Extensive bilateral pulmonary space consolidation which has increased since the prior exam, consistent with worsening pneumonia. The Orange significant findings protocol was initiated at 12/31/2021 11:27 PM. DR CHEST SINGLE VIEW Resulted: 12/31/21 0906 Order Status: Completed Updated: 12/31/21 0908 Narrative: EXAMINATION: Single View Chest EXAM DATE: 12/31/2021 7:22 AM TECHNIQUE: Single view chest INDICATION: COVID pneumonia COMPARISON: 12/29/2021 12/28/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: Interstitial prominence minimal streaky changes. No significant change. No consolidation. Cardiac silhouette is stable. No pneumothorax. No definite pleural effusion. _________________________ Impression: No significant change. DR CHEST SINGLE VIEW Resulted: 12/29/21 0810 Order Status: Completed Updated: 12/29/21 0812 Narrative: EXAMINATION: Single View Chest EXAM DATE: 12/29/2021 7:05 AM TECHNIQUE: AP portable semiupright views chest INDICATION: resp failure hypoxemia COMPARISON: 12/28/2021 ENCOUNTER: Not applicable _________________________ FINDINGS: No supporting lines or tubes. There is no evidence of pneumothorax. Stable cardiomegaly. No change in the pulmonary vasculature or hilar regions. Stable aorta and superior mediastinum. Small left effusion without definite right effusion, essentially unchanged. Atelectasis at the peripheral left base improved. Mild increase in opacities in the medial left base retrocardiac region and right base, likely atelectasis. Mid to upper lungs unchanged. Osseous structures are unchanged. Multiple skinfolds demonstrated. _________________________ Impression: Minimal change in the chest. There is some improvement in peripheral left base atelectasis with slight increase in atelectasis elsewhere in the lung bases. Stable small left effusion. CV Echo Limited with Contrast Collected: 12/27/21 1810 Order Status: Completed Updated: 12/28/21 1717 Narrative: Heart Center LIMITED ECHOCARDIOGRAPHY REPORT Name: Study Date: 12/27/2021 MRN: Patient Location: DOB: Patient Class: Inpatient Gender: Male Ordering Physician: Age: 73 yrs Height: 178 cm Performed By: RDCS Weight: 64 kg Resting HR: 77 BSA: 1.8 m2 Resting BP: 141/92 mmHg Reason For Study: Pulmonary HTN History/Symptoms: Hypertension,Pulmonary Hypertension,Dyslipidemia,Former Smoker,Dyspnea on exertion (DOE),End stage Renal Disease (ESRD),Cardiomyopathy (non-ischemic),Coronary artery disease,Chronic Obstructive Pulmonary Disease,Covid 19,Renal transplant Electronically signed by: MD on 12/28/2021 05:16 PM Interpretation Summary The left ventricle size and thickness are normal. All wall segments contract normally. The left ventricular ejection fraction is 55%. The LV ejection fraction is normal. The left ventricular wall motion is normal. There is no thrombus. Right ventricle function is moderately decreased. The estimated right ventricular systolic pressure is 65 mmHg. There is severe pulmonary hypertension. There is moderate tricuspid regurgitation. There is mild to moderate aortic valve thickening. There is trace mitral regurgitation. No pericardial effusion. There is no comparison study available. STUDY PERFORMED/QUALITY: AORTIC VALVE: A two-dimensional transthoracic There is mild to moderate aortic valve echocardiogram with color flow and thickening. There is no aortic valve spectral flow Doppler was performed in stenosis. limited views only. The technical quality of the exam was limited due to MITRAL VALVE: suboptimal acoustic windows. The The mitral valve is normal in technical quality of the exam was structure and function. There is no fair. Location: Portable. Due to mitral valve stenosis. There is trace limited acoustic windows, Definity was mitral regurgitation. administered. LEFT VENTRICLE: TRICUSPID VALVE: The left ventricle size and thickness The tricuspid valve is normal in are normal. All wall segments contract structure and function. There is no normally. The LV ejection fraction was tricuspid stenosis. The estimated determined utilizing Simpson''s Biplane right ventricular systolic pressure is method. The left ventricular ejection 65 mmHg. There is severe pulmonary fraction is 55%. The LV ejection hypertension. There is moderate fraction is normal. The left tricuspid regurgitation. ventricular wall motion is normal. There is no thrombus. PULMONIC VALVE: The pulmonic valve is not well visualized. LEFT ATRIUM: The left atrium is not well visualized. The interatrial septum is not well visualized. RIGHT ATRIUM: The right atrium is moderately dilated. RIGHT VENTRICLE: The right ventricle is moderately dilated. Right ventricle function is moderately decreased. PERICARDIUM/PLEURAL: No pericardial effusion. No pleural effusion. AORTA/PULMONARY ARTERY: The aortic root is not dilated. INFERIOR VENA CAVA: The inferior vena cava was not visualized during the exam. Right Ventricle Tricuspid Valve TAPSE.: 1.6 cm TR max vel: 3.98 m/sec RVDs: 9.9 cm TR max PG: 63.6 mmHg RVFW S'' Max Vel: 0.08 m/sec ______________________________________________________________________________ Great Vessels IVC diam: 2.6 cm Reference Table: Normal Mild ModerateSevere Men LVEF $g 52% 41-51% 30-40% <30% Women LVEF $g 54% 41-53% 30-40% <30% Men LVIDd 4.2-5.8 5.9-6.3 6.4-6.8 $g6.8 Women LVIDd 3.8-5.2 5.3-5.6 5.7-6.1 $g6.1 LA Volume (ml/m^2) < 34 35-41 42-48 $g48 ______________________________________________________________________________ Electronically signed by: MD on 12/28/2021 05:16 PM All sources of data reside in the Cardiology EJECTION FRACTION ECHO Collected: 12/27/21 1810 Order Status: Completed Updated: 12/28/21 1717 EJECTION FRACTION ECHO 55 % DR CHEST SINGLE VIEW Resulted: 12/28/21 0719 Order Status: Completed Updated: 12/28/21 0721 Narrative: EXAMINATION: Single View Chest EXAM DATE: 12/28/2021 6:10 AM TECHNIQUE: Single view chest INDICATION: resp failure hypoxemia COMPARISON: Yesterday 1149 hours ENCOUNTER: Not applicable _________________________ FINDINGS: Inspiration is mildly more shallow. Heart is mildly enlarged with mildly prominent size of the central pulmonary arteries. Mildly increased central and basilar interstitial markings. Patchy and streaky atelectasis/infiltrate in the left mid and lower lung zone, mildly increased. Slight blunting of the left CP angle persists. _________________________ Impression: Mildly more shallow inspiration. Mildly increased probable subsegmental atelectasis in the left lower lung zone. CT ANGIO THORAX WITH IV CONTRAST Resulted: 12/27/21 1601 Order Status: Completed Updated: 12/27/21 1603 Narrative: EXAMINATION: CT Angiography of the Thorax EXAM DATE: 12/27/2021 3:24 PM TECHNIQUE: Standard protocol CT angiogram images were obtained through the chest following the administration of intravenous contrast. Coronal and sagittal MIP 3-D reformations were performed. CONTRAST: 80 mL Isovue 370 QPP DOCUMENTATION: At least one of the following dose reduction techniques was utilized: Iterative reconstruction, and/or Automatic Exposure Control, and/or mA/kV adjustment based on body size. INDICATION: PE suspected, high prob. Additional history: Covid-19 pneumonia with acute on chronic respiratory failure. COMPARISON: 8/11/2020, 5/26/2016 ENCOUNTER: Not applicable ____________________ FINDINGS: 1. Lungs/pleura: * Interval development of mild peripheral groundglass opacities and bibasilar subsegmental consolidation and atelectasis. * Minimal right pleural effusion. No diffuse septal thickening or centrilobular groundglass opacities. * Previous bibasilar subsegmental atelectasis/scarring is less well-visualized due to the acute changes but, probably unchanged. * Mild cylindrical bronchiectasis and mild mosaic attenuation. No centrilobular or suspicious random nodules. 2. Mediastinum: * No pulmonary embolus. Chronic pulmonary artery dilation compatible with pulmonary hypertension. No gross right heart strain. * Development of mild mediastinal and bilateral hilar lymphadenopathy. Coalescent right hilar nodes measure up to 20 mm. Subcarinal nodes 15 mm. Smaller nodes are seen along the lower right and left paratracheal, para-aortic and left hilum. * Trace pericardial effusion. Mild calcified aortic plaque without aneurysm. * Suspected small hiatal hernia without esophageal dilation. 3. Musculoskeletal/upper abdomen: * No significant bone lesions. * Bilateral chronic renal cortical atrophy. Calcified splenic granulomas. __________________________ Impression: 1. No pulmonary embolus. Chronic pulmonary hypertension. 2. Bilateral groundglass and lower lobe subsegmental consolidation/atelectasis compatible with Covid 19 pneumonia. Findings are superimposed on chronic lower lobe scarring/subsegmental atelectasis and cylindrical bronchiectasis. 3. Mild mediastinal and hilar lymphadenopathy is likely reactive. DR CHEST SINGLE VIEW Resulted: 12/27/21 1238 Order Status: Completed Updated: 12/27/21 1241 Narrative: EXAMINATION: Single View Chest EXAM DATE: 12/27/2021 12:05 PM TECHNIQUE: Single view chest INDICATION: SOB COMPARISON: Chest x-ray August 3, 2020 ENCOUNTER: Not applicable _________________________ FINDINGS: The heart is enlarged, mild pulmonary vascular prominence is present. Hyperaeration changes are again demonstrated. Subtle increase in ill-defined right greater than left basilar pulmonary opacities. Upper lungs appear clear. No large pleural effusion or pneumothorax. _________________________ Impression: 1. Mild bibasilar airspace disease. No dominant consolidation. 2. Mild cardiomegaly with mild pulmonary vascular prominence. 3. Hyperaeration changes. Collected: 12/27/21 1136 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 12/27/21 1240 COVID-19 PCR Detected Abnormal Not Detected Influenza A PCR Not Detected Not Detected Influenza B PCR Not Detected Not Detected RSV PCR Not Detected Not Detected
CDC Split Type:

Write-up: Patient expired after 5 days hospitalization. 73y Male pm hx ESRD/kidney transplant 2018, CAD, HTN, PHTN, DM-2 - Presented to BWED 12/27 w/dyspnea - dx''d COVID - HFNC/NRM. Imaging without significant infiltrates c/w COVID - suspect pHTN uncontrolled. Transferred to ICU 12/31 and placed on Veletri. Oxygenation worsened after Veletri increased from 30 to 50 ng - suspected secondary to developing pulmonary edema from increased vasodilation. Patient became encephalopathic - trying to pull off his mask. Code status changed to DNR/DNI. Respiratory status then improved after Veletri decreased back to 30 ng, placed on BiPAP and given a dose of Lasix. Precedex started for agitation. Now having fever - cultures ordered and antibiotics initiated. With his ongoing work of breathing and discomfort the patient''s family ultimately transitioned the patient to comfort care "to ease his suffering". Patient was pronounced dead on 1/1/22 at 18:30 p.m. Medical Examiner Case Assessment Select Applicable Patient Criteria: Does not meet any of the listed criteria


VAERS ID: 1999477 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-30
Onset:2021-12-25
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-25
   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:
Current Illness:
Preexisting Conditions: coronary artery disease, depression, gout, hyperlipidemia, hypertension, hypothyroidism
Allergies:
Diagnostic Lab Data: Tested Positive for COVID-19 on 12/13/2021
CDC Split Type:

Write-up: COVID-19 Positive on 12/13/2021, death due to COVID-19 on 12/25/2021


VAERS ID: 1999538 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-27
Onset:2021-12-31
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, General physical health deterioration
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   Days after onset: 0
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: past medical history significant for liver cancer, hypertension, hyperlipidemia, type 2 diabetes, CKD stage III
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: atient with past medical history significant for liver cancer, hypertension, hyperlipidemia, type 2 diabetes, CKD stage III who presents to ED complaining of dyspnea. Patient reports that she has been experiencing worsening shortness of breath over the past few days. placed on 15 L of high flow nasal cannula. She was evaluated by infectious disease and treated with remdesivir, baricitinib and steroids. Per patient wishes she was made DNR comfort. Patient steadily declined and expired on 12/31


VAERS ID: 1999589 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-03-25
Onset:2021-09-15
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Atrial fibrillation, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chills, Condition aggravated, Death, Dyspnoea, Dyspnoea exertional, Fatigue, Lung infiltration, Lymphocyte count, Malaise, Mucosal disorder, Oedema, Procalcitonin increased, Pyrexia, Respiratory symptom, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg EC tablet Take 81 mg by mouth Daily. atorvaSTATin (LIPITOR) 80 MG tablet TAKE ONE TABLET BY MOUTH ONCE DAILY IN THE EVENING LAB WORK IS NEEDED PLEASE CONTACT YOUR DOCTOR Patient taking differently: 40 mg . Blood Glucos
Current Illness: ? AAA (abdominal aortic aneurysm) 5/06/16: CTA- Infrarenal suprailiac 7.68 cm AAA 5/04/16: US Aorta- 8 cm saccular perirenal AAA Father had AAA; wife reports he had US back in 2002 at WMC which noted "issues with the aorta". ? Acid reflux disease ? Actinic keratosis ? Anemia ? Arthritis ? Asthma ? Atrial fibrillation ? CAD (coronary artery disease) ? Cataract bilat IOL ? Chest pain one cardiac stent ? Diabetes mellitus type 2, uncomplicated ? Dizzy spells ? Former smoker ? GERD (gastroesophageal reflux disease) ? Heart murmur ? Hyperlipidemia ? Hypertension ? Malignant neoplasm of rectum Dr ? Paroxysmal atrial flutter ? Plantar fasciitis ? Prostate cancer ? Reactive airway disease ? Sleep apnea uses a CPAP-will bring DOS ? Syncope and collapse
Preexisting Conditions: ? AAA (abdominal aortic aneurysm) 5/06/16: CTA- Infrarenal suprailiac 7.68 cm AAA 5/04/16: US Aorta- 8 cm saccular perirenal AAA Father had AAA; wife reports he had US back in 2002 at WMC which noted "issues with the aorta". ? Acid reflux disease ? Actinic keratosis ? Anemia ? Arthritis ? Asthma ? Atrial fibrillation ? CAD (coronary artery disease) ? Cataract bilat IOL ? Chest pain one cardiac stent ? Diabetes mellitus type 2, uncomplicated ? Dizzy spells ? Former smoker ? GERD (gastroesophageal reflux disease) ? Heart murmur ? Hyperlipidemia ? Hypertension ? Malignant neoplasm of rectum Dr ? Paroxysmal atrial flutter ? Plantar fasciitis ? Prostate cancer ? Reactive airway disease ? Sleep apnea uses a CPAP-will bring DOS ? Syncope and collapse
Allergies: No known allergies
Diagnostic Lab Data: Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: (LN LOINC)/ Status: Final Accession Number: Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX Specimen Collection Date/Time: 2021-09-15 12:08:00.0 Results: * Resulted Test: SARS-CoV-2 RNA Resp Ql NAA+probe Coded Result: DETECTED Numeric Result: Units: Text Result: Reference Range From: Not Detected Reference Range To: Performing Facility Details: Date/Time: 2021-09-15 13:20:46.0 Performing Facility: HOSPITAL Facility ID: Interpretation: Very abnormal Result Method: LAB DEVICE: SYSTEM Status: Final Test Code: (LN LOINC)/ Result Code: (SCT/
CDC Split Type:

Write-up: Case completed primary Covid vaccine series in March 2021, then was hospitalized for Covid in September 2021 and died of Covid in October 2021. Hospitalized: Hospital. Discharging physician: Dr. MD. Onset Covid symptoms 9/8/21 (fever, chills, shortness of breath, fatigue), tested positive 9/15/212, hospitalized 9/15 to 9/17/21 (for Covid pneumonia and acute respiratory failure), then again hospitalized 9/24 to 10/8/21, then hospitalized again 10/11 to 10/12/21 when he died. * Acute respiratory failure Assessment & Plan Presents with acute worsening shortness of breath day of admission. Was previously only requiring 1L oxygen, feeling improved, now with worsening shortness of breath, needing 4L on admission, requiring HFNC 9/25. CTA negative for PE but shows extensive bilateral patchy infiltrates and mucous plugging consistent with complications of recent covid 19 pneumonia. Suspect may have contribution of poor rate control afib and possible diastolic hear failure as well. Was taken off lasix at last hospitalization, worsening edema, but now dry for days by oct/4. IV lasix administered initially 9/25, oral lasix bid started 9/26 and later stopped around 2/oct due to bp. Increased metoprolol, dig loaded 9/25 and increased diltiazem 9/26 all with improved rate control. Baricitinib added for Covid as noted elsewhere and continued on dexamethasone for now (started 9/15)-complted. Also started on ceftriaxone 9/25 for possible superimposed bacterial pneumonia given elevated wbc and procalcitonin for an 8 day course of therapy. Goals of care d/w spouse 9/25 - he remains dnr with no further escalation of care. Wife, updated daily - continued with decadron completed 3/oct, baricitinib for covid for 12 doses - continue Xarelto (home med) - continued with ceftriaxone - stopped 2/oct after 8 days. -Doing well on 2 L NC at rest on discharge 10/8, but still very dyspneic with exertion. Pneumonia due to COVID-19 virus Assessment & Plan Symptom onset 9/8 with positive test 9/15. Was due to finish 10 days of decadron 9/25 but given worsening respiratory symptoms continued decadron for several more days. Only on 4L on admission however O2 needs rose quickly over first night, requiring HFNC. Increased up to 100% FiO2, now improving. Received some remdesivir previously, now out of window. Completed moderna vaccination series. CRP up to 29.9, now improved. - added baricitinib 9/25; hold baricitinib if absolute lymphocytes <200cells/mm3 - completed 10 days decadron 3/oct o2 needs decreasing for days through 4/oct


VAERS ID: 1999651 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-19
Onset:2022-01-01
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 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: 2022-01-01
   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: Hx of CLL; DM; COPD; a-fib; CAD; HLD; HTN; obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated covid related death


VAERS ID: 1999659 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-19
Onset:2021-12-08
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Fall, General physical health deterioration, Hypoxia, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-21
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, carvedilol, cholestyramine, clopidogrel, gabapenin, glipizide, levemir, levothyroxine, lisinopril/hctz, metformin, omeprazole, oxybutynin, venlafaxine
Current Illness:
Preexisting Conditions: DM2, GERD, HLD, HTN, morbid obesity hypothyroidism anxiety and depression
Allergies: codeine, statins,
Diagnostic Lab Data: 12/7/21 COVID 19: positive 12/7/21 Chest xray: negative 12/11/21 chest xray: Findings consistent with COVID pneumonia 12/13/21 CTA chest: Extensive multifocal atypical pneumonia concordant with history of COVID-19.
CDC Split Type:

Write-up: Presented to the ED on 12/7/21 via EMS after suffering 4 falls earlier today admitted for PT/OT and possibility of placement to a SNF. Found to be COVID positive on 12/7/21. She has been previously vaccinated with Moderna. Second dose was given in April 2021. Patient is overdue for her booster. Patient denies any loss of taste, smell, cough, shortness of breath or generalized fatigue. Upon admission she tested post to COVID-19 and was noted to be hypoxic and was requiring 7 L of oxygen initially though initial chest x-ray was negative for pneumonia. Subsequent chest imaging with CT angiogram done 12/15/21 did show extensive COVID-19 pneumonia without pulmonary emboli. She received appropriate treatments including Decadron, remdesivir and antibiotics. She was followed by the Pulmonary Service. Unfortunately, on 12/18/2021, her condition deteriorated while on BiPAP with FiO2 of 100%. She had a DNR status. Family decided to transition to comfort care on 12/20/21 which was done and she sadly expired on 12/21/21 at 0505 AM.


VAERS ID: 1999677 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-08-03
Onset:2021-12-09
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   Days after onset: 22
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: A fib and history of lymphoma
Allergies: Penicillin
Diagnostic Lab Data: Covid positive 12/9
CDC Split Type:

Write-up: Unknown


VAERS ID: 1999715 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Death, Dyspepsia, Malaise, Myocardial infarction, Myocardial rupture, Pain, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 150
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: Hydralazine, Isosorbide dinitrate Levothyroxine. Pravastatin, PredniSone, Valsartan
Current Illness: no
Preexisting Conditions: vasculitis
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: A few weeks after vaccine, patient began complaining of heart burn. She was taken to doctor, but nothing was diagnosed. It continues so she was taken to her cardiologist. He has treated her for some time. Except for a pacemaker, he had said her heart was very strong. This time he said she was having little heart attacks and was prescribed nitroglycerin. He subsequentially admitted her to hospital for procedure. She did not do well after. After a stay in rehab. she was sent home. The problems continued. She was hospitalized again in May. After several days. she was released to assisted living on May 31. I visited her that evening and she was still feeling ill, confused, and in pain. I received a call around 1:00 a.m that she has was not breathing and taken to hospital. Upon arrival at the hospital, I was told she passed away. Later, I was informed that her heart wall had ruptured. Up until this point patient was for her age very healthy and active. Her doctor had said that she had good healthy heart except for the pacemaker. Her rapid decline was I believe because of the vaccine.


VAERS ID: 1999726 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-17
Onset:2021-11-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cough, Death, Fall, Malaise, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-06
   Days after onset: 19
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: Was notified by patients husband that his wife originally received the Pfizer vaccine- He wanted her to have the booster shot and she received the booster of Moderna. Patient became very sick. Per husband she developed cough and became very weak. She fell down a couple days after dose due to weakness. Patient passed away 2 weeks later. Was told by corner that wife had massive heart attack but he feels it was due to booster shot.


VAERS ID: 1999762 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-07
Onset:2021-12-26
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anticoagulant therapy, Bradycardia, COVID-19, COVID-19 pneumonia, Cardio-respiratory arrest, Death, Dehydration, Endotracheal intubation, Hypernatraemia, Metabolic encephalopathy, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Noninfectious encephalopathy/delirium (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-30
   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: Trifluoperazine 5 mg BID, Metformin 500 mg QD, Lisinopril 40, mg QD, Linaclotide 145 mcg QD, Hydroxyzine 50 mg QID, Hydrochlorothiazide 25 mg QD, Clotrimazole cream BID, Benztropine 2 mg BID, Tamsulosin 0.4 mg QD, Potassium Chloride 20 mEq
Current Illness:
Preexisting Conditions: Anixety, Chronic kidney disease, hyperlipidemia, hypertension, paranoid schizophrenia, T2 diabetes mellitus
Allergies: Tolerodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/10/2021 and 4/7/2021. On 12/26/2021 presented to ED w/PMHx DM2, HTN and paranoid pschizophrenia brought by EMS from hospital for +Covid. Admitted for acute respiratory failure with hypoxia, sats in the 70s, Covid pneumonia and metabolic encephalopathy. Tx''d w/steroids, IVF, lovenox and HFNC O2. Condition c/b dehydration w/AKI and hypernatremia, respiratory status continued to decline requiring intubation. Once intubated developed bradycardia and arrested. Full code without ROSC.


VAERS ID: 1999832 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-26
Onset:2021-11-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: trazodone 50 1-2 HS, promethazine 25 1q4-6h, crestor 10 1daily, gabapentin 300 3tid, pramipexole 0.25 1hs, methocarbamate 750 1tid, percocet 10/325 1tid, meloxicam 15 1qd, amlodipine 10 1daily
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient got pfizer (booster for Janssen) on 10/26, he also got Fluzone Quad, about a week later he had a heart attack at 7:15 AM 11/2/21. After some CPR he was taken by ambulance to a local Hospital ER. He was later transported to another Hospital. He passed away the same day


VAERS ID: 1999879 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-17
Onset:2021-03-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O11A21A / 2 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O24M20A / 1 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Death, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy came back inconclusive
CDC Split Type:

Write-up: My mother had her second Covid vaccine on Wednesday. Had been feeling fine prior to getting injections. After receiving second injection she complained of her arm hurting. No one talked to her after that night I went to check on her Friday morning and she was deceased. Autopsy was performed and there still has been no known cause of death the only thing that makes sense would be the vaccine took her life.


VAERS ID: 2000204 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:2021-12-01
Onset:2021-12-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-01
   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.MOD20214

Write-up: Died the next day; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died the next day) 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. In December 2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. Death occurred on December 2021 The patient died in December 2021. The cause of death was not reported. It is unknown if an autopsy was performed. No concomitant medications were provided. No treatment medications were reported. The patient took the booster shot about 4 days ago and died the next day. The paramedics found the patient sitting upright dead with an oxygen mask on. This fatal spontaneous case concerns an unknown year-old, patient with no medical history who experienced the unexpected fatal events of DEATH The event occurred unknown days after third dose of Moderna Covid 19 vaccine. The cause of death was not reported. It is unknown if an autopsy was performed. The rechallenge is not applicable The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender''s Comments: This fatal spontaneous case concerns an unknown year-old, patient with no medical history who experienced the unexpected fatal events of DEATH The event occurred unknown days after third dose of Moderna Covid 19 vaccine. The cause of death was not reported. It is unknown if an autopsy was performed. The rechallenge is not applicable The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 2000206 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Mississippi  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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.MOD20214

Write-up: died of the Omicron variant 2-3 weeks ago; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (died of the variant 2-3 weeks ago) in a patient of an unknown age and 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. On an unknown date, the patient experienced COVID-19 (died of the variant 2-3 weeks ago) (seriousness criterion death). The reported cause of death was died of the variant. It is unknown if an autopsy was performed. Concomitant medications were not reported. It was reported that one person died of the variant 2-3 weeks ago, even after getting the vaccine. Reporter does not have more information on this person. Treatment details were not provided.; Sender''s Comments: This case concerns a patient (demographics not provided) with no relevant medical history, who experienced the unexpected event of COVID-19 (variant) and resulted in death. The event occurred at unspecified interval after a dose of mRNA-1273 (Moderna covid-19 vaccine). The rechallenge was not applicable as event occurred after a dose and resulted in death. The benefit-risk relationship of mRNA-1273 (Moderna covid-19 vaccine) in not affected by this report.; Reported Cause(s) of Death: died of the variant


VAERS ID: 2000637 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-21
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
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: USJNJFOC20220100225

Write-up: ACUTE PULMONARY EMBOLISM; This spontaneous report received from a parent via a company representative via social media concerned a 58 year old female of unspecified race. 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 (Dose number in series 1) (suspension for injection, route of admin was not reported, batch number was unknown and expiry date was unknown) dose was not reported, 1 total, administered on 21-SEP-2021 for prophylactic vaccination. The batch number was not reported. The Company was unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On an unspecified date, the patient had acute pulmonary embolism. On 01-OCT-2021, the patient died due to acute pulmonary embolism. It was unspecified if an autopsy was performed. As per the reporter "My daughter received the J&J vaccine 21-Sep-2021. Died 01-Oct-2021 due to an acute pulmonary embolism. She was 13 days from celebrating her 59th birthday." The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death).; Sender''s Comments: V0:20220100225-COVID-19 VACCINE AD26.COV2.S-Acute pulmonary embolism. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: ACUTE PULMONARY EMBOLISM


VAERS ID: 2001227 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-26
Onset:2021-11-09
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Bone scan abnormal, COVID-19, Decubitus ulcer, Localised infection, Osteomyelitis acute, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Osteonecrosis (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-20
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Neosporin
Diagnostic Lab Data: SarsCOV2 tested positive on Nov 11 2021
CDC Split Type:

Write-up: Presented to ED as per MD for infected left great toe which has not improved after 10 days of antibiotic treatment. had fever in ED. Acute osteomyelitis of toe. from bone scan. Admitted with infected toe, from pressure ulcer on plantar aspect. Was placed on vancomycin. Acute hypoxemic respiratory failure due to COVID-19 on O2 2L nasal cannula on Nov 19/2021


VAERS ID: 2001367 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-07-05
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFE BNT ER B732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Fluid retention, Heart rate decreased, Heart rate increased, Joint swelling
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-13
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline, Carbidopa Levodopa, Amantadine timed release (GOCOVERI), (Azopt, Timolol, Lumigan eye drops)
Current Illness: Parkinsons Disease, Glaucoma
Preexisting Conditions: Parkinsons Disease 2003 Glaucoma 1999
Allergies: NSAIDS
Diagnostic Lab Data: Treated by doctors
CDC Split Type:

Write-up: Breathing difficulty, low pulse, swollen ankles 7/5/21 7:00AM Admitted to Hospital 7/6/21 5:00PM Multiple treatments on patient Cardiology floor. Rapid heart rate, fluid retention 7/6/21-7/13/21 Patient died 7/13/21


VAERS ID: 2001509 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-04
Onset:2022-01-03
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 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: 2022-01-03
   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:
Current Illness:
Preexisting Conditions: Chronic hypoxic respiratory failure; asthma; HTN; morbid obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccinated-covid related death


VAERS ID: 2001694 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-12-24
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, Intensive care, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), 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 (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 67 years old male who was admitted to the hospital for the reason of COVID-19 infection. Patient was recently diagnosed of COVID-19 infection and tested positive about 3 days back and now comes into the hospital for the reason of severe shortness of breath was severely hypoxic. Patient was treated for the above and continued to decline and ultimately was placed on High-flow nasal cannula and is admitted to hospital intensive care unit. He denies any chest pain. Denies any palpitations. He does admit to cough with some scant sputum production. He denies any hemoptysis. He does admit to fevers and cough. He denies any other associated symptomatology.


VAERS ID: 2001727 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2022-01-03
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 - / -

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: 2022-01-04
   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:
Current Illness:
Preexisting Conditions: Coronary artery disease, DM
Allergies: Latex
Diagnostic Lab Data: Covid test: positive
CDC Split Type:

Write-up: Event occurred after vaccination. Patient tested positive for COVID Patient died


VAERS ID: 2001732 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-10-28
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Anticoagulant therapy, Asthenia, COVID-19, COVID-19 pneumonia, Cough, Death, Dyspnoea, Dysuria, Endotracheal intubation, Fibrin D dimer increased, Nausea, Pyrexia, Respiratory disorder, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 88 year old male patient presented with c/o fever, generalized weakness, nausea, trouble urinating and cough x 3 days. Pt with significant cardiac history, carotid stenosis, CAD, Hx of DVT, DM2, BPH presented for evaluation after feeling general weakness, cough and SOB for the past 3 days. Pt tested + for COVID on 10/28/2021. Pneumonia due to COVID-19, acute hypoxic respiratory failure. Elevated troponins 0.06, 0.71, 1.10. + fever. D-dimer 925. Required room air. 11/1 worsening respiratory status and required intubation. non ST elevation mycoardial infarction. acute kidney injury. Required steriods and antibiotics. Pressors, Levophed, Versed and heparin drip. Pt expired on 11/14/2021


VAERS ID: 2001766 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-12-08
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Ammonia increased, Anticoagulant therapy, Bronchoalveolar lavage abnormal, COVID-19, Computerised tomogram head normal, Computerised tomogram thorax abnormal, Culture urine positive, Death, Dialysis, Dyspnoea, Encephalopathy, Endotracheal intubation, Enterococcus test positive, Hyperammonaemia, Infectious pleural effusion, Mental status changes, Pneumonia, Pneumothorax, Pseudomonas infection, Pseudomonas test positive, SARS-CoV-2 test positive, Streptococcus test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), 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), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-27
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 300 mg daily, cartia XT 180 mg daily, vitamin B12, 1000 mcg daily, folic acid 400 mg, hydrochlorothiazide 25 mg daily, losartan 100 mg daily, valsartan-hydrochlorothiazide 320-25 mg daily
Current Illness:
Preexisting Conditions: Obesity, hyperlipidemia, hypertension, chronic kidney disease stage III, fatty liver disease, gout, neuropathy
Allergies: No known allergies
Diagnostic Lab Data: Enterococcus faecalis; 12/23/21: ammonia 109; No acute intracranial abnormality on head CT on 12/20/21 and 12/25/21.
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/18/2021 and 4/9/2021. On 12/8/2021 presented to ED for altered mental status. Also short of breath requiring HFNC. Admitted for acute respiratory failure due to COVID-19. Tx''d with dexamethasone, diuretics, heparin, hydrocortisone, broad spectrum antimicrobials, pressors, remdesivir, and dialysis. Developed pneumonia, pneumothorax, and para pneumonic effusion -$g grew pseudomonas tx''d w/meropenem. Resp. status cont. to decompensate requiring intubation and proning, status c/b AKI, hyperammonemia and encephalopathy. Expired 12/27/21. Patient transitioned to comfort care and expired 12/27/2021 at 1526.


VAERS ID: 2001781 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-12
Onset:2021-12-27
   Days after vaccination:318
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-30
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bumetanide 1 mg QD, Ciprofloxacin 500 mg BID, Divalproex 125 mg BID, Fluoxetine 20 mg QD, Culturelle QD, Levothyroxine 50 mcg QD, Risperidone 0.5 mg QAM and 1 mg QPM.
Current Illness:
Preexisting Conditions: Atrial fibrillation, Dementia, H/O MVR with bioprosthetic valve, Anemia, Aortic stenosis
Allergies: Codeine, Penicillin
Diagnostic Lab Data: Positive COVID-19 on 12/27/2021 using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/12/2021 and 3/12/2021. Presented to ED 12/27/2021 from nursing home for positive COVID-19 infection and sepsis with urinary tract infection. PMHx a-fib, mitral valve replacement, aortic stenosis and dementia. TX''D w/pressors, IVF, vancomycin and Aztreonam. DNR upon admission, expired 12/30/2021.


VAERS ID: 2001785 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-31
Onset:2021-12-20
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Death, Endotracheal intubation, Lung infiltration, Respiratory disorder, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-30
   Days after onset: 10
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: Abilify 10 mg daily, baclofen 10 mg 1-2 times daily, bupropion
Current Illness:
Preexisting Conditions: Arthritis, atrial fibrillation, coronary artery disease, chronic kidney disease, depression, hyperlipidemia,
Allergies: No known allergies
Diagnostic Lab Data: 12/20/21: COVID positive, Chest x-ray revealed severe, patchy bilateral infiltrates
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Received Moderna Vaccines on 2/11/21, 3/11/21, and 8/31/21. On 12/20/21 presented to ED referred by cardiologist for possible pleural effusion. Admitted for Acute respiratory failure with hypoxia and COVID PNA. PMHx CAD, HTN, CKD, and Waldenstroms Macroglubinemia. Respiratory status cont''d to decline -$g intubated. Tx''d w/dexamethasone, antibiotics, paralytics. Expired 12/30/21.


VAERS ID: 2001789 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-27
Onset:2021-12-17
   Days after vaccination:51
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cardiac failure, Cardiac failure acute, Cardiac failure congestive, Computerised tomogram thorax abnormal, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Haemoptysis, Hypotension, Inappropriate schedule of product administration, Lung opacity, Mental status changes, Pleural effusion, Pneumonia, Pulmonary oedema, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   Days after onset: 14
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: Aspirin 81 mg daily, coreg 25 mg twice daily, cholecalciferol, 25 mcg daily, atorvastatin 80 mg daily, calcitriol 0.25 mcg daily, cinacalcet 60 mg daily, darbepoetin alfa monthly, ezetimibe 10 mg daily, pepcid 20 mg daily, hydralazine 100 m
Current Illness:
Preexisting Conditions: Kidney transplant (5/2016), Anemia in end-stage renal disease, atrial fibrillation, congestive heart failure, Diabetes, mellitus, Focal segmental glomerulosclerosis with chronic glomerulonephritis, Hyperlipidemia, Hyperparathyroidism, Hypertension, Immunodeficiency due to treatment with immunosuppressive medication, Iron deficiency anemia, Morbid obesity, obstructive sleep apnea, osteopenia, cardiac pacemaker, Sick sinus syndrome, herniated nucleus pulposus, Peripheral autonomic neuropathy, tinnitus, hypothyroidism, Vitamin D deficiency
Allergies: Penicillins, codeine, grapefruit, pomegranate, raw fish
Diagnostic Lab Data: 12/17/21: COVID positive and CT chest revealed extensive bilateral groundglass opacities and trace pleural effusions
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 1/23/21, 3/2/21, and 10/27/21. PMHx CKD4, renal transplant, AF, DM2. Presented 12/17/21 for hemoptysis, SOB and AMS. Admitted for heart failure, COVID-19, pulmonary edema, acute on chronic CHF & acute on chronic renal failure. On 12/21/21 transferred due to worsening renal function, intubated 12/26/21 c/b L pneumo. Tx''d w/dexamethasone, diuretics, and antibiotics. Expired 12/31/21. Patient''s respiratory status declined requiring intubation on 12/26/21. Patient subsequently became hypotensive requiring multiple pressors and family ultimately decided to withdraw care. Code status changed to DNR-AND and the patient passed away at 00:48 on 12/31/21.


VAERS ID: 2001795 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-29
Onset:2021-12-27
   Days after vaccination:273
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cardiogenic shock, Condition aggravated, Cough, Death, Dyspnoea, General physical health deterioration, Interstitial lung disease, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-01
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 500 mg Q6H PRN, Apixaban 5 mg BID, Bupropion, 75 mg QD, Digoxin 0.125 mg QD, Furosemide 40mg QD, Gabapentin 900 mg TID, Metoprolol 25 mg BID, Omeprazole 40 mg QD, Potassium Chloride 20 mEq QD, Prednisone 40 mg QD, Saccharomyc
Current Illness:
Preexisting Conditions: Idiopathic pulmonary fibrosis, Hypertension, Hyperlipidemia, metabolic alkalosis, interstitial lung disease, diastolic congestive heart failure, chronic respiratory failure on supplemental oxygen at home, benign paroxysmal positional vertigo, anxiety, depression, cough variant asthma, colon polyp, GERD, irritable bowel syndrome, obesity, shingles, skin cancer.
Allergies: Penicillins, Influenza Vaccine, Nystatin, Statins, Toradol
Diagnostic Lab Data: COVID-19 positive on 12/27/2021 using the BioFire FilmArray.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/27/2021 and 3/29/2021. PMHx HTN, CHF, COPD on O2 at home and BPPV w/prior recent admission for cardiogenic shock. Presented to ED 12/27/2021 with worsening shortness of breath, dry cough, and nasal congestion that began on 12/23/2021 w/O2 sats 77% on room air, tx''d w/HFNC, methylprednisolone and remdesivir. Cont''d to decline, requiring maximum support on HFNC and NRB oxygen. Code status on admission was "Do Not Intubate". Expired 1/1/2022 due to acute on chronic respiratory failure from Covid-19 PNA and interstitial lung disease.


VAERS ID: 2001802 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-12-04
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, COVID-19 pneumonia, Death, Endotracheal intubation, Inappropriate schedule of product administration, Pneumonia bacterial, Respiratory disorder, Respiratory failure, Shock
SMQs:, Anaphylactic reaction (narrow), Angioedema (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), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Medication errors (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-19
   Days after onset: 15
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: Aspirin 81 mg daily, atorvastatin 80 mg daily, B-complex with vitamin C tablet daily, calcium-vitamin D 500 mg-200 mg tablet daily, co-enzyme Q-10 30 mg daily, colchicine 0.6 mg daily, folic ac/vit Bcomp,C/Zn/vit D3 (FA-VIT BCOMP-C-ZINC-V
Current Illness:
Preexisting Conditions: Coronary artery disease, Combined systolic and diastolic congestive heart failure, COPD, Diabetes mellitus, cardiac stent, Hyperlipidemia, Hypertension, Hypothyroidism, Myocardial infarction, Obesity, Seasonal allergies, obstructive sleep apnea, history of hodgkins disease
Allergies: Rosuvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/12/21 and 4/9/21. Admitted to Hospital on 12/4/21. On 12/9/21 intubated and transferred to another hospital for respiratory failure due to COVID-19 PNA. PMHx HTN, Hodgkin''s lymphoma, COPD, combined systolic & diastolic CHF. Developed secondary bacterial PNA and shock. Respiratory status cont''d to decline. Tx''d w/dexamethasone, pressors, broad spectrum antibiotics and therapeutic anticoagulation. Expired 12/19/2021.


VAERS ID: 2001837 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-22
Onset:2021-12-28
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Chronic kidney disease, Condition aggravated, Death, Metabolic encephalopathy, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-01
   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: Multivitamin QD, Memantine 10 mg BID, Quetiapine 25 mg QD
Current Illness:
Preexisting Conditions: CKD stage 3, Hypertension, Hyperlipidemia, Monocytosis, Hypothyroidism, vascular dementia
Allergies: NKDA
Diagnostic Lab Data: Positive COVID-19 on 12/29/2021 using PCR or equivalent Nucleic Acid Amplification(NAA)technology
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 12/30/20200, 1/20/2021, and 10/22/2021. Presented to ED on 12/28/2021 from a local Hospital for COVID-19+. c/b acute renal failure superimposed on stage 3 CKD with acute metabolic encephalopathy. PMHx HTN, vascular dementia, uinary retention. Inpatient hospice w/DNR status upon admission. Expired 1/1/2022.


VAERS ID: 2001853 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-21
Onset:2021-12-10
   Days after vaccination:323
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / IM

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: 2021-12-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine for Covid rec''d 1/21/21 and 2/10/21 Patient passed away from Covid on 12/10/2021


VAERS ID: 2001865 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-04
Onset:2021-09-10
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Cardioversion, Death, General physical health deterioration, Interchange of vaccine products, SARS-CoV-2 test
SMQs:, Supraventricular tachyarrhythmias (narrow), Medication errors (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-03
   Days after onset: 115
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 28 days
   Extended hospital stay? No
Previous Vaccinations: pfizer and johnson and johnson
Other Medications: Heart medication, Lasix, and oxygen
Current Illness: worsening COPD, Idiopathic Lung Disease, and Heart
Preexisting Conditions: Mild COPD, Coronary Heart Disease
Allergies: Cocconut
Diagnostic Lab Data: Hospital said he needed a stint for his heart, he was in AFIB, and they had to shock his heart also. All this started after the experimental jabs and Covid Swab
CDC Split Type:

Write-up: This man was in good health until the experimental jabs he received, also a Covid swab in the ER. His health declined rapid, and even the Nursing Home and Hospice gave him the Johnson and Johnson booster. Then he passed away. Lot number EN6206/EP6955.


VAERS ID: 2001867 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-27
Onset:2021-05-15
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Appendicitis, Cerebrovascular accident, Death, Gastrointestinal haemorrhage, Intensive care, Ischaemic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Amlodipine, Albuterol, (Blood Thinner)
Current Illness: N/A
Preexisting Conditions: HBP, Asthma, Hypertension
Allergies: N/A
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Pt.''s Daughter states that after receiving the 2nd dose of Moderna 03/27/2021, started experiencing symptoms 2hrs of Appendicitis with GI bleed. Hospitalized at Hospital (ICU 3 weeks) discharged to Rehabilitation. Suffered a Ischemic Stroke during being Hospitalized. Pt. suffered another Massive Stroke 05/13/2021 during Hospitalization due to Stroke D.O.D 05/15/2021.


VAERS ID: 2001883 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-01-20
Onset:2021-11-07
   Days after vaccination:291
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-14
   Days after onset: 7
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: Dementia, hypothyroidism, BPH, was a resident of a nursing home
Allergies:
Diagnostic Lab Data: Positive COVID-19 test on 11/07/2021 despite being fully vaccinated.
CDC Split Type:

Write-up: This is an instance of breakthrough COVID-19 disease after which a death occurred. The individual was vaccinated with the Moderna COVID-19 vaccine on 12/23/2020 and 01/20/2021. The individual was admitted to the hospital for respiratory failure on 11/07/2021 and tested positive for COVID-19 upon admission. The individual was discharged on 11/12/2021 to hospice care at the nursing home at which they were a resident. The individual died on 11/14/2021. Death Certificate Information is as follows: Part I Cause of Death: A. Chronic Respiratory Failure B. COVID 19 Pneumonia Part II Other Significant Conditions: Dementia


VAERS ID: 2001955 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-23
Onset:2021-12-16
   Days after vaccination:268
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram head, Death, Endotracheal intubation, Fall, Intensive care, Ischaemic stroke, Mental status changes, Pulmonary congestion, SARS-CoV-2 test positive, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-27
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg daily, atorvastatin 80 mg daily, clopidogreal 75mg daily, levothyroxine 75 mcg daily, lisinopril 40 mg daily, metoprolol 50 mg twice daily, naproxen 500 mg daily, ultracet 37.5-325 mg tablet every 6 hours as needed for chronic
Current Illness:
Preexisting Conditions: Calculus of kidney, Coronary artery disease, Enlarged prostate with lower urinary tract symptoms, hypertension, Enlarged prostate with lower urinary tract symptoms, hyperlipidemia, Male erectile dysfunction, Type 2 diabetes mellitus, Gastro-esophageal reflux disease without esophagitis, obesity, Chronic ischemic heart disease, obstructive sleep apnea
Allergies: Hydromorphone, Norco
Diagnostic Lab Data: 12/16/21: COVID positive, Head CT: Motion-degraded evaluation without acute intracranial abnormality identified, and Chest X-ray: Mild pulmonary vascular congestion with perihilar
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 3/2/2021 and 3/23/2021. PMHx CAD, HTN, severe obesity, DM2, Presented to the ED for AMS s/p fall 5 days prior w/progressive weakness. Admitted for COVID PNA and AKI. Altered mental status worsened along w/increased O2 demands requiring transfer to ICU and precedex. Intubated 12/21/2021, ischemic stroke and shock dx''d 12/23/21. Tx''d w/steroids, remdisivir, baricitinib, paralytics. and antibiotics. Expired 12/27/21.


VAERS ID: 2001962 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-12-29
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OC2C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Lethargy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-02
   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 10 mg QD, Ascorbic Acid 500 mg BID, Atorvastatin 40 mg QD, Cholecalciferol 2000 units BID, Cyanocobalamin 2500 mcg QD, Diclofenac gel BID, Dicolfenac 75 mg BID, Misoprostol 200 mcg BID, Esomeprazole 40 mg BID, Estradiol 0.5 mg Q
Current Illness:
Preexisting Conditions: Anxiety, Arthritis, Chronic pain, Depression, GERD, Hyperlipidemia, Hypertension, H/O Malignant Neoplasm Colon
Allergies: Celecoxib, Lisinoprl, Rofecoxib, Sulfonamide Antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 4/19/2021 and 5/17/2021. Presented to ED 12/29/2021 with new onset lethargy, SOB, and COVID + on 12/25/2021 from ER. Admitted for severe Covid PNA. Started on supplemental oxygen and steroids. PMHx colon cancer and HTN. O2 requirements escalated. DNR upon admission. Patient expired on 1/2/2022.


VAERS ID: 2002129 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-12-19
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Condition aggravated, Death, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), 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), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-19
   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: Blood pressure medications
Current Illness: High blood pressure
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: Had high blood pressure which resulted in a stroke and passed away in the hospital.


VAERS ID: 2002153 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-04-21
Onset:2021-05-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 25 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Rheumatoid arthritis; History of atrial fibrillation, hypertension, history of traumatic brain injury,
Allergies:
Diagnostic Lab Data: Positive PCR tests for COVID-19 x2 despite being fully vaccinated.
CDC Split Type:

Write-up: This is an instance of breakthrough disease after which death occurred. The individual was vaccinated with the Pfizer COVID-19 vaccine on 03/30/2021 and 04/21/2021. The individual became symptomatic for COVID-19 disease on 05/01/2021 and tested positive via PCR on 05/04/2021. The individual was admitted to the hospital on 05/04/2021, stabalized, and discharged 05/08/2021. The individual was then re-admitted on 05/12/2021. An additional PCR test was positive on 05/16/2021. The individual remained hospitalized until their death on 06/02/2021. Death Certificate details are as follows: Part I: Cause of Death: A. Acute Hypoxic Respiratory Failure B. Septic Shock C. Cardiogenic Shock D. COVID-10 Part II: Other Significant Conditions: None Listed


VAERS ID: 2002387 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-18
Onset:2021-12-23
   Days after vaccination:280
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Aspartate aminotransferase increased, Asymptomatic COVID-19, Blood bicarbonate normal, Blood creatinine increased, Blood gases, Blood pH normal, Blood sodium increased, Blood urea increased, COVID-19 pneumonia, Cough, Death, Haematocrit decreased, Haemoglobin decreased, Hypotension, Hypoxia, International normalised ratio increased, Laboratory test, Leukopenia, Lung disorder, Lung opacity, PCO2 normal, PO2 decreased, Pulmonary artery dilatation, Pulmonary embolism, Respiratory distress, SARS-CoV-2 test positive, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-02
   Days after onset: 10
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 PRN, amlodipine, ascorbic acid, aspirin, atorvastatin, carvedilol, cyanocobalamin, docusate, fenofibrate, folic acid, hydrochlorothiazide, metformin, quinapril
Current Illness:
Preexisting Conditions: Diagnosis Date ? Arthritis ? Carcinoma (HCC) lung ? CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min (HCC) ? Diabetic nephropathy (HCC) ? Dysphagia ? GERD (gastroesophageal reflux disease) ? Hepatomegaly ? Hypercholesteremia ? Hypertension ? Hypertensive nephrosclerosis ? Odynophagia ? Polyneuropathy due to drugs (Allergies: none
Diagnostic Lab Data: 12/23/21 COVID 19: positive 12/23/21 CTA chest: Fairly extensive pulmonary embolic disease is seen within the right chest as described above. There is flattening of the interventricular septum with borderline RV to LV ratio suggesting some mild right heart strain. Main pulmonary artery is also somewhat dilated but this is not significantly changed. 2. Multifocal bilateral ground-glass opacities and airspace disease most consistent with COVID-19 pneumonia.
CDC Split Type:

Write-up: Presented to the emergency room on 12/23/21 after his blood pressure was taken by his home health nurse. Patient states that his blood pressure was low, he was not able to tell me how low his blood pressure was. EMS arrived at his home and patient was found to be hypoxic on room air. He was placed on 2 L nasal cannula. Patient is asymptomatic. He denies any headache, dizziness, seizures, numbness or tingling, tremor or syncope. He denies any chest pain, or shortness of breath. He does have a cough that he states is chronic in nature. Denies any fever chills or night sweats. Upon arrival to the emergency room patient underwent routine labs. Patient was found to be COVID positive. He had a sodium of 146, BUN and creatinine of 58 and 1.4. Leukopenia with a white blood cell count 3.43. Hemoglobin hematocrit of 11.1 and 34.6. He had an ABG performed. Patient was found to have a PO2 of 51.4, pCO2 of 40.9, pH of 7.415, bicarbonate of 26.2. INR 1.2. AST of 41. Found to have an extensive PE. Received ceftriaxone, dexamethasone, zosyn and remdesivir. Passed on 1/2/21 due to respiratory distress and hypotension.


VAERS ID: 2002658 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-29
Onset:2021-10-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2022-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-31
   Days after onset: 62
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metolazone pregabalin cyclobenzaprine norco potassium clindamycin
Current Illness: unknown if patient had other illnesses leading up to time of vaccination.
Preexisting Conditions: heartburn, high blood pressure, neuropathy, pain, heart arrhythmia, hypothyroidism
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: daughter of Pt stopped by the pharmacy and reported to pharmacy staff that her father had passed away days after receiving the Moderna shot. Tried calling Pt family back to obtain additional details but have not recd a response. date of death as listed below is estimated and exact date is not known.


VAERS ID: 2005485 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-08-01
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Death, Incisional drainage, Localised infection, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHF
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: per nursing home records, pt was admitted to nursing home with a diagnosis of CHF and post-op care after incision and drainage of an infected foot; pt tested positive for COVID and died in the nursing home of a respiratory infection from COVID 19 virus


VAERS ID: 2005491 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-15
Onset:2021-06-04
   Days after vaccination:50
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031 A 21A / 1 AR / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039 A 21A / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death 06-04-2021 heart failure


VAERS ID: 2005521 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-11-03
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Death, Dyspnoea, Endotracheal intubation, Fibrin D dimer increased, Hyponatraemia, Hypoxia, Intensive care, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (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), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-10
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 72-year-old gentleman with significant past medical history for prostate cancer, GERD/coronary artery disease/hypertension, presented due to complaintof shortness of breath. Covid + test on 11/3/2021. Admission dx pneumonia due to COVID-19, acute hypoxic respiratory failure. AKI on presentation. D-dimer elevated. Hyponatrimia. RRT called for hypoxia SpO2 71-82%. pt intubated on 11/4/2021. Treatment: barcitinib, remdisivir, ICU management, decadron, Lovenox to heparin. Pt expired.


VAERS ID: 2005523 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-12-25
   Days after vaccination:302
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Death, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-01
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: age $g80
Allergies:
Diagnostic Lab Data: nasal PCR swab + COVID 19
CDC Split Type:

Write-up: came to ER 12/25/21 after 1-2 wk h/o cough DC home 12/27/21 as was felt stable only to return to ER 12/29/21 in resp distress and died on 1/1/22


VAERS ID: 2005543 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-17
Onset:2021-12-25
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 UN / UN

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2022-01-04
   Days after onset: 10
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: unknown
Current Illness: unknown
Preexisting Conditions: post CABG, hypertension, hypothyroidism
Allergies: unknown
Diagnostic Lab Data: Sars COV2 -Positive- 12/25/2021
CDC Split Type:

Write-up: 12/25/2021: Event occurred after 2nd vaccine. 83-year-old male who comes emergency department today for shortness of breath. as feeling okay and then today became short of breath and he went to the ER to be evaluated.


VAERS ID: 2005603 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-23
Onset:2021-11-26
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Mechanical ventilation, Pneumonia, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-08
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes, hypertension, severe obesity
Allergies: unknown
Diagnostic Lab Data: positive COVID Test 11-25-2021
CDC Split Type:

Write-up: pneumonia, acute respiratory distress syndrome, mechanical ventilation


VAERS ID: 2005666 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-11-30
   Days after vaccination:300
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), 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: 2021-12-17
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: myasthenia gravis, severe obesity
Allergies: unknown
Diagnostic Lab Data: Positive for COVID 19 on 11-30-2021
CDC Split Type:

Write-up: hospitalized for COVID pneumonia, and acute respiratory failure with hypoxia and hypercapnia on 11-30-2021


VAERS ID: 2005680 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-12-29
Onset:2022-01-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 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: 2022-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Acute UTI; cellulitis; COPD; asthma; DM2; CKD stage 3; CAD; HTN; HLD; morbid obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccinated-covid related death


VAERS ID: 2005802 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-10
Onset:1954-11-03
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, COVID-19, Death, Dyspnoea, Endotracheal intubation, Pulse absent, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-11-13
   Days after onset: 24482
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 67-year-old female who presented to ED with worsening SOB. Pt tested + for COVID on 11/3. Comorbidities of COPD and obesity. Patient also had diabetes. The patient presented on November 4th and progressively worsened throughout stay. Treatment with decadron, remesivir and proning. She continually required more and more oxygen and then she was required to be intubated. On 11/13, the patient lost her pulse early in the morning and this was after her pressures continually decreased despite multiple pressors. Pt expired.


VAERS ID: 2005849 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-24
Onset:2021-12-15
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-12-29
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol; allopurinol; aspirin; cyanocobalamin; cyclophosphamide; dexamethasone; duloxetine; ergocalciferol; fenofibrate; fentanyl; gabapentin; glipizide; Januvia; probiotic; levemir; novolog; oxycodone; pantoprazole; rosuvastatin;
Current Illness: Coronary Artery Disease; Diabetes Mellitus; diverticulitis; enlarged prostate; gout; hypercholestrolem8ia; hypertension; immunosuppression; metastatic prostate cancer spread to bone
Preexisting Conditions: Coronary Artery Disease; Diabetes Mellitus; diverticulitis; enlarged prostate; gout; hypercholestrolem8ia; hypertension; immunosuppression; metastatic prostate cancer spread to bone
Allergies: Augmentin; Erythomycin; Keflex, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough hospitalization in patient with completed series and booster


VAERS ID: 2005918 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-08
Onset:2021-12-20
   Days after vaccination:256
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, Blood lactic acid increased, COVID-19, Cardiac arrest, Chest X-ray abnormal, Chest tube insertion, Continuous haemodiafiltration, Cough, Death, Decreased appetite, Hypertension, Life support, Lung opacity, Oxygen saturation decreased, Pain, Pneumothorax, Renal impairment, SARS-CoV-2 test positive, Sepsis, Septic shock, Somnolence, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2022-01-04
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, aspirin, atorvastatin, clopidogrel, vitamin B12, ferrous sulfate, furosemide, isosorbide dinitrate, losartan, metoprolol tartrate,l multivitamin, nifedipine, nitro PRN, omeprazole, pramipexole, sildenafil, testosterone, tramadol
Current Illness:
Preexisting Conditions: Past Medical History Positives Diagnosis Date ? CAD (coronary artery disease) ? CVA (cerebral vascular accident) 9/4/2020 ? GERD (gastroesophageal reflux disease) ? Hyperlipidemia ? Hypertension ? RLS (restless legs syndrome) ? Sleep apnea ? Stroke
Allergies: None
Diagnostic Lab Data: 12/20/21 COVID 19: positive 12/22/21 chest xray: Areas of patchy opacification in the left mid and lower lung and right lower lung. Some of this may be infectious/inflammatory such as pneumonia. Some of this may be atelectatic. 12/27/21 US: Study positive for nonocclusive calf vein thrombus right lower extremity posterior tibial and peroneal distributions.
CDC Split Type:

Write-up: Presented to ER on 12/22/21. Positive for COVID on 12/20/21. on Thursday he began to develop achy pains and feeling sleepy. When his symptoms did not improve he decided to call his primary care doctor on Monday. Patient thought he had a urinary tract infection. He was tested for COVID and was positive. He states since that time he has been monitoring his O2 saturations. On his pulse ox at home his O2 saturations are dropping below 90%. Patient arrived into the emergency room at 88% on room air. He was requiring 5 L nasal cannula to maintain his O2 saturations greater than 92%. He states that he has had decreased appetite, a nonproductive cough. He reports that he took his a.m. medications. Placed on dexamethasone, ceftriaxone, azithromycin and remdesivir. On 1/4/21, patient continued to be hypertensive overnight and required increased pressor therapy. He also had a small right-sided pneumothorax that was treated with a right-sided chest tube yesterday with resolution of the pneumothorax.He continued to be hemodynamically unstable from the COVID sepsis/septic shock also possible PE with elevated lactate. His kidney function worsened and he needed CVVH overnight. In the morning of 1/4/21 he had cardiac arrest with ROSC after 3 cycles of ACLS. Passed away on 1/4/21


VAERS ID: 2005922 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-08
Onset:2021-08-01
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt died @ home per death certificate; cause of death COVID pneumonia; unable to obtain medical records from physician who signed the death certificate


VAERS ID: 2005958 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-10
Onset:2021-11-04
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Chronic left ventricular failure, Death, Dyspnoea, Endotracheal intubation, Pyrexia, SARS-CoV-2 test positive, Sepsis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-11-10
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is a know COPD and dementia who presented with severe sepsis with COVID pneumonia with acute respiratory failure. Pt is COVID + on 11/4/2021 at admission. Pt admitted with atrial fibrillation with RVR, SOB, elevated troponin, fever, COVID and acute chronic respiratory failure with hypoxia. Treatment IV cardizem, Lovenox, IV Decadron, Breo inhaler, albuterol nebulizer, Metoprolol with chronic systolic congestive heart failure. Pt required intubation, pressors, broad-spectrum IV antibiotics. Patient developed acute kidney injury. Patient Expired.


VAERS ID: 2006040 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-08-13
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19 pneumonia, Condition aggravated, Death, Endotracheal intubation, General physical health deterioration, Hypoxia, Mechanical ventilation, Positive airway pressure therapy, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-04
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: grossly obese; DMT2, HTN, chronic HRF secondary to COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: admitted to hospital earlier in the week for COVID pneumonia, was dc''d to home and returning back to ED via EMS; hypoxia (O2 sats 70-80s on RA); placed on BiPAP; developed PE; AKI; RF secondary to COVID pneumonia; on dexamethasone, antibiotics and steroids; condition worsened eventually requiring intubation with mechanical ventilation; pt''s condition deteriorated and she passed away in the hospital


VAERS ID: 2006066 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-14
Onset:2021-12-21
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Coma scale, Endotracheal intubation, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2022-01-02
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: rheumatoid arthritis
Allergies: Codeine, aspirin, Actonel, denosumab, meloxicam, tramadol, simvastin
Diagnostic Lab Data: 12/21/2021: Covid positive done externally. Not tested
CDC Split Type:

Write-up: 12/21/2021: 77-year-old female with a history of rheumatoid arthritis presents to our ED as a transfer. Patient was found unresponsive today by family, taken to Hospital. There she had a GCS of 6, was intubated for airway protection. She tested positive for COVID-19. Chest x-ray consistent with what could have possibly been a superimposed pneumonia


VAERS ID: 2006075 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2022-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, 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: 2022-01-03
   Days after onset: 299
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: hypertension, CVA, heart disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 given 2/10/2021 Moderna lot # 024M20A Patient died at Medical Center on 1/3/2022 from brain bleed. This was not a covid related death.


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