National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

Found 102 cases where Vaccine is COVID19 and Manufacturer is MODERNA and Symptom is Aortic thrombosis or Arterial thrombosis or Arterial thrombosis limb or Atrial thrombosis or Axillary vein thrombosis or Basilar artery thrombosis or Brachiocephalic vein thrombosis or Carotid artery thrombosis or Cavernous sinus thrombosis or Cerebral artery thrombosis or Cerebral thrombosis or Cerebral venous sinus thrombosis or Cerebral venous thrombosis or Coronary artery thrombosis or Deep vein thrombosis or Hepatic vein thrombosis or Iliac artery thrombosis or Injection site thrombosis or Intracranial venous sinus thrombosis or Jugular vein thrombosis or Mesenteric vein thrombosis or Ophthalmic artery thrombosis or Ophthalmic vein thrombosis or Pelvic venous thrombosis or Peripheral artery thrombosis or Portal vein thrombosis or Postpartum venous thrombosis or Pulmonary artery thrombosis or Pulmonary thrombosis or Retinal artery thrombosis or Retinal vascular thrombosis or Retinal vein thrombosis or Spinal artery thrombosis or Splenic vein thrombosis or Subclavian vein thrombosis or Superior sagittal sinus thrombosis or Thrombosis or Thrombosis in device or Transverse sinus thrombosis or Truncus coeliacus thrombosis or Umbilical cord thrombosis or Vena cava thrombosis or Venous thrombosis or Venous thrombosis limb and Patient Died

Table

   
AgeCountPercent
17-44 Years54.9%
44-65 Years2322.55%
65-75 Years3029.41%
75+ Years3635.29%
Unknown87.84%
TOTAL102100%



Case Details

VAERS ID: 1053191 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-08
Onset:2021-02-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 AR / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Communication disorder, Contusion, Death, Thrombocytopenia, Thrombosis
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine administered 02/08/2021 , by Thursday 02/11/2021 patient almost nonverbal, by Monday 02/15/2021 patient went to the hospital with bruising, sores on her stomach and clots reported as thrombocytopenia, deceased by Friday 02/19/2021.


VAERS ID: 1056011 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-07
Onset:2021-02-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiovascular disorder, Cerebrovascular accident, Death, Dyspnoea, Endotracheal intubation, Feeling abnormal, Hemiparesis, Sedation, Thrombosis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication, cholesterol medication, some other vitamins and supplements.
Current Illness: Kidney disease
Preexisting Conditions: Kidney disease
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: My grandpa had a stroke on the 15th of February. He claimed he had been feeling "off" for a few days, but didn''t say anything. A blood clot had formed in his brain. He was doing better and about to go to rehab to strength his right side of his body. On the 22nd he took a turn for the worst. He was having trouble breathing and they sedated and partially paralyzed him to put a tube in his mouth. I believe another blood clot had formed and oxygen wasn''t properly going through his body. They could not stabilize him, and he passed away the same day.


VAERS ID: 1056972 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-01-29
Onset:2021-02-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Acute myocardial infarction, Antiphospholipid syndrome, Atrial fibrillation, Biliary dilatation, Cerebrovascular accident, Diarrhoea, Dysphagia, Electrocardiogram QT prolonged, Encephalopathy, Endoscopy, Gastrointestinal oedema, Hepatic cirrhosis, Imaging procedure, Intestinal angioedema, Intestinal mass, Intracranial mass, Laboratory test, Leukocytosis, Malaise, Oesophageal varices haemorrhage, Peritonitis bacterial, Supraventricular tachycardia, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Torsade de pointes, shock-associated conditions (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal perforation (narrow), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-27
   Days after onset: 23
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen
Current Illness:
Preexisting Conditions: Depression Hyperlipidemia Anxiety disorder Elevated BP without diagnosis of hypertension Alcohol abuse Osteopenia Tubular adenoma of colon Serrated adenoma of colon Cyst of left breast
Allergies: Ampicillin-nausea
Diagnostic Lab Data: Pt. has had multiple lab tests, imaging studies, endoscopic procedures. Too numerous to list here. Current Hospital diagnoses as of 02/26/2021 Hospital SVT (supraventricular tachycardia) Thrombus Acute encephalopathy Dysphagia, unspecified Non-ST elevation (NSTEMI) myocardial infarction Prolonged Q-T interval on ECG Leukocytosis A-fib Common bile duct dilation Duodenal mass Cirrhosis Small bowel edema Stroke Bleeding esophageal varices SBP (spontaneous bacterial peritonitis) Catastrophic antiphospholipid syndrome
CDC Split Type:

Write-up: 5-6 days after receiving first Moderna covid vaccine pt. began not feeling well. On 02/10/2021 she saw a provider in an office for eval of abdominal pain and diarrhea and sent home. On 02/15/2021 she presented to a local ED with continuing symptoms, transferred to Medical Center. She is currently an inpatient there with a diagnosis of multiple blood clots in abdomen and brain and antiphospholipid syndrome.


VAERS ID: 1069009 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-21
Onset:2021-01-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Atelectasis, Axillary vein thrombosis, Chest X-ray abnormal, Erythema, Pleural effusion, Pneumonia
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Swollen hands
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Chest X ray
CDC Split Type: PR-46-21

Write-up: Several days after vaccination his left arm turned red. He was taken to the hospital where he was evaluated and admitted with a diagnosis of left axillary vein thrombosis. A chest X-ray was taken and he presented bibasilar atelectasis and pneumonia with pleural effusions.


VAERS ID: 1107735 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-19
Onset:2021-03-07
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral thrombosis, Computerised tomogram, Death, Electrocardiogram
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 1
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: Thyrogin, 2 blood pressure medications (sorry, don''t have names), D3, Multivitamins, Lutein
Current Illness: Annual exam had resulted in a clean bill of health the Friday prior to his death.
Preexisting Conditions: High blood pressure, thyroid.
Allergies: none
Diagnostic Lab Data: EKG and CAT scan, perhaps others.
CDC Split Type:

Write-up: Death on March 8 due to a large blood clot at the base of his brain. This was 16 days after innoculation.


VAERS ID: 1108470 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-15
Onset:2021-02-12
Submitted: 0000-00-00
Entered: 2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute left ventricular failure, Deep vein thrombosis, Pleural effusion, Pulmonary embolism
SMQs:, Cardiac failure (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-23
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary Embolism Narrative: Patient was hospitalized with acute pulmonary embolis on 2/12/2021. Was started on Eloquis and discharged on 2/15/2021, with primary diagnosis of acute PE and BLE DVT. Secondary diagnosis of acute systolic heart failure with bilateral pleural effusions. On 2/17 we got notification that patient was placed on hospital.


VAERS ID: 1120842 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal behaviour, Brain operation, Death, Endotracheal intubation, Lung disorder, Mechanical ventilation, Renal disorder, Seizure, Thrombosis
SMQs:, Angioedema (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-16
   Days after onset: 42
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: none known of
Preexisting Conditions: type 2 diabetes, other unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: this is all per family, 4 to 5 days after 2nd COVID vaccine he was acting unusual and was taken to the hospital. He had a clot in his brain and underwent brain surgery. He experienced seizures after the surgery, but it was ultimately reported the surgery went well. He remained intubated and on a ventilator after surgery. He developed complications of his lungs and kidneys while on the ventilator. Ventilator was removed 3/16/2021 and he passed away that day. The hospital providers thought the clot in the brain may have been from hitting his head over a month ago. From my understanding he was A&O, independent with ADLs, and lived in his private residence prior to these complications.


VAERS ID: 1122080 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-12
Onset:2021-03-19
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Agonal respiration, Angiogram pulmonary abnormal, Areflexia, Blood lactic acid increased, Cardiac arrest, Complication associated with device, Corneal reflex decreased, Cyanosis, Death, Device malfunction, Disseminated intravascular coagulation, Dyspnoea, Fatigue, Intensive care, Loss of consciousness, Lung assist device therapy, Malaise, Metabolic acidosis, Mobility decreased, Presyncope, Pulmonary embolism, Pulseless electrical activity, Pupillary reflex impaired, Pyrexia, Respiratory acidosis, Resuscitation, Therapy cessation, Thrombectomy, Unresponsive to stimuli, Vena cava thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Lactic acidosis (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Corneal disorders (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 2
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: Xulane birth control patch Prescribed prednisone the day prior to presentation
Current Illness: None
Preexisting Conditions: None
Allergies: Augmentin-itching
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: Patient''s received 2nd dose of Moderna vaccine Friday 3/12. Her husband reported she had not unexpected fatigue, malaise, and fever for 1 day but better after that. On Monday she began complaining of shortness of breath. This progressively worsened and she started having presyncopal episodes. On Saturday she was unable to come down the stairs in the house so husband planned to take her to the hospital but she stood up and passed out and woke up quickly. He decided to call EMS. By the time she presented to our hospital she was cyanotic and agonal breathing. On moving her from EMS stretcher to ED bed she had PEA cardiac arrest. She underwent mechanical device CPR with only brief (<1 min) ROSC x1. She at some point did have a shockable rhythm. Cath lab was notified and she was taken emergently to the cath lab with ongoing mechanical device CPR. Peripheral VA ECMO was placed after about 1.5 hours. Pulmonary angiogram was done which showed massive saddle PE with near complete obliteration of the right pulmonary tree and some filling defects in the left tree as well. At that time she had severe mixed respiratory and metabolic acidosis with a lactate of 24. She also had no gag or corneal reflex, minimally responsive pupils, and no response to noxious stimuli. Mechanical thrombectomy was attempted with some result. She was transferred to the SICU with increasing pressor requirement, and DIC. Ultimately, the venous catheter of the ECMO circuit malfunctioned thought to be secondary propagating IVC thrombosis. Family decided to withdraw care and she passed away.


VAERS ID: 1126609 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-03-17
Onset:2021-03-19
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Drug screen negative, Haemoglobin normal, Platelet count decreased, Red blood cell count normal, Thrombosis, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none known by family who showed up at ED.
Current Illness: ETOH ABUSE, TOBACCO ABUSE, DIABETES,
Preexisting Conditions: DIABETES, TOBACCO AND ETOH ABUSE, SOME UNKNOWN LIVER DISEASE BY FAMILY REPORT-ON ONE KNOWS THE NAME OF IT.
Allergies: none known
Diagnostic Lab Data: CBC: WBC 12.8, RBC 4.82, HGB,15.0, HCT 46.0, PLATELETS 29 (LL)-BLOOD WAS CLOTTED, PT WAS DOA. DRUG SCREEN ALL NEGATIVE
CDC Split Type:

Write-up: CARDIOPULMONARY ARREST 2 DAYS AFTER RECIEVING SECOND MODERNA DOSE


VAERS ID: 1127468 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Acute kidney injury, Blood test normal, Confusional state, Death, Decreased appetite, Dizziness, Echocardiogram normal, Lethargy, Malaise, Nausea, Retinal vascular thrombosis, Somnolence, Ultrasound kidney normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Retinal disorders (narrow), Vestibular disorders (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 6
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: LOSARTAN 100 MG HYDRALAZINE 50 MG LOVASTATIN 20 MG METFORMIN 1000 MG OMEPRAZOLE 20 MG FUROSEMIDE 20 MG INSULIN GLARGINE 100 UNIT/ML
Current Illness: NONE
Preexisting Conditions: DIABETES HIGH BLOOD PRESSURE POSTHERPETIC NEURALGIA SCIATICA
Allergies: NONE
Diagnostic Lab Data: She had just had a heart ultrasound and kidney ultrasound and blood work less than a month before her vaccine and they both showed normal function. She went into complete renal failure in a less than a week.
CDC Split Type:

Write-up: Severe lethargy after receiving the shot. Constant sleepiness and malaise, nausea, confusion, loss of appetite, dizziness, Blood vessels/clots formed in her eyes. Acute renal failure and eventually death on March 18, 2021.


VAERS ID: 1127847 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-15
Onset:2021-01-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cognitive disorder, Cough, Death, Deep vein thrombosis, Dyspnoea, Endotracheal intubation, Flushing, Full blood count, Hyperkalaemia, Hypoxia, Metabolic function test, Multiple organ dysfunction syndrome, Myalgia, Paralysis, Polyuria, Pyrexia, Respiratory failure, Sepsis, Unresponsive to stimuli, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 36 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: see attached
Current Illness: COPD. DM HTN, sinusitis obesity, h/o stroke, hyperlipidemia,
Preexisting Conditions: broken nose, COPD, Diabetes Mellitus II, seasonal allergies with rhiniits, cervical degenerative disease
Allergies: NKDA
Diagnostic Lab Data: 1/20/21 x-rays, CBC. CMP --refer to hospital notes.
CDC Split Type:

Write-up: Participant felt flushed, feverish, fatigued with general aches and dry cough over the weekend after receiving injection, took acetaminophen and cough syrup on Monday. He became short of breath on 1/20/2021 and was hypoxic on oximeter check, was sent to the ER. He was intubated in ER and went into respiratory failure with sepsis due to COVID19. He was treated with tocilzumab, became paralyzed and DVT in left lower extremity was found. HE required pressors and diuresis, he developed AKI and hyperkalemia. On 2/21 he was in multi-organ failure. His level of cognition decreased until he was no longer responsive and he died on 2/24/2021.


VAERS ID: 1143895 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-01-13
Onset:2021-01-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram abnormal, Headache, Magnetic resonance imaging abnormal, Neurological symptom, SARS-CoV-2 test positive, Seizure, Venous thrombosis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplements: Magnesium, Vitamin C, Vitamin D, Fish oil. Prescription Medication: sertraline, atorvastatin, topiramate
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan, MRID scan, Covid Test (PCR)
CDC Split Type:

Write-up: 13th of January received first Moderna shot. 18-19th began to have headaches 22nd headaches worsened 25th at the doctor''s (tested negative nose swab) home till 28th (28th tested positive for corona after having her first shot at Advent) stroke symptoms at school 28th Advent did CT scan MRI venous thrombosis diagnosis, from front to back, hemorrage in the northern hemisphere 29th blood thinner administered to attempt to drain clot, seizures 31st passed away


VAERS ID: 1163967 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-26
Onset:2021-03-30
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Death, Feeling abnormal, International normalised ratio increased, Thrombosis
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 1
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: Coumadin
Current Illness:
Preexisting Conditions: A fib
Allergies: None
Diagnostic Lab Data: CT scans in ER on 3/30+3/31
CDC Split Type:

Write-up: Felt crummy on day one and two better on day three and on day four developed four blood clots on Coumadin with an INR of 4.5 and died the next day on 3/31/2021.


VAERS ID: 1194290 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-12
Onset:2021-03-17
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Cardiac disorder, Death, Pulmonary thrombosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: b12 krill oil vitamin d
Current Illness: none
Preexisting Conditions: depression
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: my mother collapsed in the kitchen she was rushed to hospital via ambulance she passed away, doctor said her heart was having a hard time he said there was a blood cot by lung


VAERS ID: 1198032 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-01-27
Onset:2021-01-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaemia, Cardiac disorder, Cerebral small vessel ischaemic disease, Chronic obstructive pulmonary disease, Condition aggravated, Hepatic enzyme abnormal, Hypertension, Hypokalaemia, Hypothyroidism, Malnutrition, Mental disorder, Thrombosis, Tremor
SMQs:, Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypothyroidism (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: L leg blood clot
Preexisting Conditions: Hypertension, Anemia, heart disease, electrlite imbalance, liver enzyme off, hypokalemia, low protein, poor nutrition, tremors, hypothyrodism, COPD, small vessel disease of the brain, bipolar, parkinson, GERD, multiple mental co-morbity.
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient has had L leg blood clot and multiple mental co-morbity-Anemia, hypertension, heart disease, hypokalemia, liver enzyme off per MD, poor nutrition, tremors, hypothyrodism, COPD, small vessel disease of the brain


VAERS ID: 1202649 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-01
Onset:2021-03-31
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Lupus
Preexisting Conditions: Lupus, diabetic
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots then death


VAERS ID: 1205036 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-19
Onset:2021-03-30
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Biopsy bone marrow, Blood test, Dyspnoea exertional, Electrocardiogram, Headache, Hypotension, Intensive care, Intracardiac thrombus, Platelet count decreased, Pulmonary embolism, SARS-CoV-2 test negative, Thrombosis
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Pulmonary hypertension (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 17
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood work EKG Oxygen Bone Marrow Tested
CDC Split Type:

Write-up: On March 30th started with headaches then progressed to shortness of breath while moving. Then on April 4th transport to hospital via EMT was tested for Covid 19 results was negative. It was determined that blood clots where found in Right leg & Left leg and both lungs and now blood clot was found in heart. PT has low platelets, low blood pressure. While in the hospital pt was given herapin . Patient has remained in ICU since the 4th to present time.


VAERS ID: 1205392 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-02-16
Onset:2021-02-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Dyspnoea, Oxygen saturation decreased, Pulmonary embolism, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin and water pill
Current Illness: chest cold 2/1-2/7, told almost had pneumonia on 2/7 and given Zpack and inhaler. Improved some by 2/14. Returned to work on 2/16 after 2 weeks off sick and got 2nd vaccine shot because it was the last day to get it or would have to restart. Became hard to breathe again on 2/19 and hospitalized from lack of oxygen on 2/21. Blood clots discovered 2/22, died 2/24 from pulmonary embolism
Preexisting Conditions: diabetes, high blood pressure and varicose viens.
Allergies: none
Diagnostic Lab Data: Would have to ask ICU
CDC Split Type:

Write-up: blood clots in left leg and both lungs diagnosed on 2/22, died 2/24


VAERS ID: 1208579 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-31
Onset:2021-02-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test, Brain stem thrombosis, Computerised tomogram head abnormal, Death, Intracardiac thrombus, Magnetic resonance imaging head abnormal, Magnetic resonance imaging heart, Thrombosis
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-10
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75mg, Metoprolol 125mg, Montelukast 10mg, Simvastatin 40mg, Synthroid 50mcg, Vitamin D3 50mcg, Biotin 5000mcg
Current Illness: None
Preexisting Conditions: COPD, Hypothyroid, TIA 10 years ago
Allergies: Codeine, Shellfish
Diagnostic Lab Data: Multiple CT scans, MRIs and blood work between 2/4/21-2/10/21.
CDC Split Type:

Write-up: Developed blood clot in heart -- $g went into Atrial Fibrilation with no prior history of A FIb -- $g Large clot was thrown from the heart into the brain splitting into two clots, one blocking brain stem and one blocking right hemisphere -- $g Death on 2/10/21


VAERS ID: 1209441 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-01-20
Onset:2021-01-31
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Brain injury, Death, Deep vein thrombosis, Peripheral swelling, Pulmonary embolism, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: Generic lipitor medication for polymyalgia rheumatica
Current Illness: None
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My mother and I received the Moderna vaccine on January 20th. About two weeks later on January 31st, she complained about her leg. It was swollen. Later on that day, she collapsed, was rushed to the hospital. Died on February 4th due to anoxic brain injury due to DVT that caused a massive pulmonary embolism.


VAERS ID: 1213364 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-02-19
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Atrial fibrillation, Bacteraemia, Chills, Death, Deep vein thrombosis, Hypertension, Neutropenia, Platelet count decreased, Productive cough, Pyrexia, Sputum discoloured, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Narrative: Patient received Moderna COVID #1 vaccine on 1/28/21. On 2/3/21, he was admitted to a facility for fever, weakness, chills and rigor. Noted history of B cell lymphoma not on chemotherapy at the time. He also had reports of productive cough with thick brown/green sputum. He was admitted to the hospital and given 1 round of methotrexate and Rituxan. Hospital course was complicated with bacteremia (given vancomycin and cefepime), A fib, AKI, HTN, neutropenia (received Neupogen), acute popliteal VT (unable to anticoagulated due to thrombocytopenia - platelets as low as 20). No bleeding issues noted. On 2/18/21, family opted to change his status to DNR with hospice/comfort care and he passed on 2/19/21. No autopsy results available. 22 days from date of vaccine to date of death.


VAERS ID: 1215882 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Deep vein thrombosis, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hyperactive airway disease
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: fatal pulmonary embolism from RLE DVT


VAERS ID: 1219828 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-19
Onset:2021-03-01
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 LA / IM

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-15
   Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, furosemide
Current Illness:
Preexisting Conditions:
Allergies: no known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his first Moderna vaccine 3-19-21. He was due for his 2nd dose 4-16-21. We followed up with his sister due to missed appointment and was informed that he passed away 4-15-21 due to a blood clot.


VAERS ID: 1221916 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-02-27
Onset:2021-03-29
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001821A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Brain death, Cerebral thrombosis, Loss of consciousness, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (no medical history reported)
Allergies:
Diagnostic Lab Data: Test Date: 20210330; Test Name: x-ray; Test Result: Positive ; Result Unstructured Data: x-rays revealed blood clot in his brain
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: blood clot in his brain; Patient collapsed on the floor at night 2 days after receiving 2nd dose; brain was dead; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of BRAIN DEATH (brain was dead), CEREBRAL THROMBOSIS (blood clot in his brain) and LOSS OF CONSCIOUSNESS (Patient collapsed on the floor at night 2 days after receiving 2nd dose) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 0021B21A and 001821A) for COVID-19 vaccination. The patient''s past medical history included No adverse event (no medical history reported). On 27-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 27-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 29-Mar-2021, the patient experienced LOSS OF CONSCIOUSNESS (Patient collapsed on the floor at night 2 days after receiving 2nd dose) (seriousness criterion hospitalization prolonged). On 30-Mar-2021, the patient experienced CEREBRAL THROMBOSIS (blood clot in his brain) (seriousness criteria death and hospitalization prolonged). The patient died on 08-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, LOSS OF CONSCIOUSNESS (Patient collapsed on the floor at night 2 days after receiving 2nd dose) outcome was unknown. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-Mar-2021, X-ray: blood clot (Positive) x-rays revealed blood clot in his brain. No concomitant medications were reported. After the 2nd dose, On 29Mar2021, at night, he collapsed on the floor and was taken at the hospital on same night by ambulance. So he was hospitalized on 30Mar2021 and upon doing tests and x-rays, they found blood clot in his brain. He stayed in hospital through out and transferred to hospice center on 06Apr2021 where he passed away on 08Apr2021. His brain was dead and never recovered from the clot. Unknown treatment medications were given at the hospital. Very limited information regarding these events have been provided at this time. No further information is expected.; Sender''s Comments: Very limited information regarding these events have been provided at this time. No further information is expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1223056 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-26
Onset:2021-03-14
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cerebral haemorrhage, Death, Fall, Loss of consciousness, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-22
   Days after onset: 7
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: Topiramate-Eliquis-Montelukast-Fluticas-Gabapentin-Effexor-Buspirone-Diazepam-Trazodone-Aripiprazole-Dexilant-Linzess-Potassium-Rosuvastatin-Hydralazine-Hydrochlorothiazide-Norvasc-Propranolol-Folic Acid
Current Illness: Had prior strokes
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: See Hospital report
CDC Split Type:

Write-up: My wife started to fall and pass out had no strength to get up this happened two to three times cinch she got the shot the last time she past out in the shower and i rushed her to hospital were she pasted away from blood clots to the right side of the neck and stated bleed on the brain


VAERS ID: 1245371 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac disorder, Cerebrovascular accident, Coma, Dyspnoea, Fatigue, Headache, Heart rate increased, Muscular weakness, Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (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), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-17
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ELIQUIS; ENTRESTO; METOPROLOL
Current Illness: AFib; Heart disease, unspecified; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: irritated her heart condition; Clot blood; weakness in legs, couldnt walk with legs; Coma; couldn''t breathe; stroke/massive stroke in left side of her brain; Irritated her heart condition, rapid heart beat; Headache; Tiredness; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (stroke/massive stroke in left side of her brain), CARDIAC DISORDER (irritated her heart condition), DYSPNOEA (couldn''t breathe), THROMBOSIS (Clot blood), COMA (Coma) and MUSCULAR WEAKNESS (weakness in legs, couldnt walk with legs) in a 95-year-old female patient 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 Heart disease, unspecified, Hypertension and AFib. Concomitant products included APIXABAN (ELIQUIS) for Anticoagulant therapy, SACUBITRIL VALSARTAN SODIUM HYDRATE (ENTRESTO) for Hypertension, METOPROLOL for an unknown indication. On 10-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Mar-2021, the patient experienced HEADACHE (Headache) and FATIGUE (Tiredness). On 12-Mar-2021, the patient experienced MUSCULAR WEAKNESS (weakness in legs, couldnt walk with legs) (seriousness criterion hospitalization). On 13-Mar-2021, the patient experienced CARDIAC DISORDER (irritated her heart condition) (seriousness criterion hospitalization), THROMBOSIS (Clot blood) (seriousness criterion hospitalization) and HEART RATE INCREASED (Irritated her heart condition, rapid heart beat). On 15-Mar-2021, the patient experienced CEREBROVASCULAR ACCIDENT (stroke/massive stroke in left side of her brain) (seriousness criteria death and medically significant). On 16-Mar-2021, the patient experienced DYSPNOEA (couldn''t breathe) (seriousness criterion hospitalization prolonged) and COMA (Coma) (seriousness criterion hospitalization prolonged). The patient was hospitalized on 13-Mar-2021 due to CARDIAC DISORDER, COMA, DYSPNOEA, MUSCULAR WEAKNESS and THROMBOSIS. The patient died on 17-Mar-2021. The reported cause of death was massive stroke in left side of her brain. It is unknown if an autopsy was performed. At the time of death, CARDIAC DISORDER (irritated her heart condition), DYSPNOEA (couldn''t breathe), THROMBOSIS (Clot blood), COMA (Coma), MUSCULAR WEAKNESS (weakness in legs, couldnt walk with legs), HEART RATE INCREASED (Irritated her heart condition, rapid heart beat), HEADACHE (Headache) and FATIGUE (Tiredness) outcome was unknown. Action taken with mRNA-1273 in response to the events was not Applicable. This case concerns an 95 year old female patient, with medical history of A Fib, Heart disease, Hypertension who experienced a serious unexpected event of Death 8 days after receiving 1st dose of mRNA- 1273 . Very limited information regarding these events has been provided at this time. However, the patient''s advance age, multiple co-morbidities, may remain as risk factors. Further information is requested. This case was linked to MOD-2021-074814 (Patient Link).; Sender''s Comments: This case concerns an 95 year old female patient, with medical history of A Fib, Heart disease, Hypertension who experienced a serious unexpected event of Death 8 days after receiving 1st dose of mRNA- 1273 . Very limited information regarding these events has been provided at this time. However, the patient''s advance age, multiple co-morbidities, may remain as risk factors. Further information is requested.; Reported Cause(s) of Death: massive stroke in left side of her brain


VAERS ID: 1248086 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-02-05
Onset:2021-04-06
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood immunoglobulin G, Cardiac arrest, Death, Deep vein thrombosis, Haematocrit decreased, Haemoglobin decreased, Platelet count decreased, Pulmonary embolism, Resuscitation, Thrombocytopenia, Transfusion
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   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: amoxicillin, apple cider vinegar, Excedrin migraine, atorvastatin, chlorthalidone, vitamin D3, cyclobenzaprine, doxycycline, escitalopram, ferrous sulfate, gabapentin, ginseng, ibuprofen, lisinopril, loratadine, potassium, teriparatide, Tob
Current Illness: progressive lower extremity paresthesias/myelopathies and gait/balance abnormalities, severe T11-12 stenosis (thoracic decompression 3/30/21)
Preexisting Conditions: anemia, osteoporosis, hyperlipidemia, hypertesnion, low testosterone, sleep apnea, spondylosis of lumbar region, hepatitis, obesity, history of spinal osteomyelitis, deep vein thrombosis
Allergies: lamotrigine, rifampin, tramadol
Diagnostic Lab Data: Heparin-induced thrombocytopenia antibody: negative (three days after surgery) Heparin induced IGG antibody, IA: positive (thirteen days after surgery) Prior to surgery: platelets 307 10*9/L, hemoglobin 13.3 g/dL, hematocrit 41.7% Intraoperative: Platelet: 89 10*9/L Fibribnogen: 223 mg/dL INR: 1.2 Immediately after surgery: Platelets: 5 10*9/L, hemoglobin: 3.2 g/dL, hematocrit: 10.1%
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: patient underwent L1-2 corpectomy, pedicle subtraction osteotomy, and extension of fusion from T4 to the pelvis two months after vaccination. During surgery patient became thrombocytopenic and required massive transfusion. Thirteen days after surgery found to have bilateral pulmonary embolisms and deep vein thromboses and placed on anticoagulation. Patient subsequently suffered cardiac arrest and was unable to be resuscitated.


VAERS ID: 1254028 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hypotension, Thrombosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Dehydration (broad), Hypokalaemia (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: Medical History/Concurrent Conditions: No adverse event
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATXINC.MOD2021083

Write-up: Patient passed away; patient had blood clots in his brain/ Legs/ Lungs/ Arms; Severe hypotension; This spontaneous case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (Patient passed away), THROMBOSIS (patient had blood clots in his brain/ Legs/ Lungs/ Arms) and HYPOTENSION (Severe hypotension) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event. 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 DEATH (Patient passed away) (seriousness criterion death), THROMBOSIS (patient had blood clots in his brain/ Legs/ Lungs/ Arms) (seriousness criterion death) and HYPOTENSION (Severe hypotension) (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment information was not provided. Company comment: This case concerns the death of a patient of unknown age and gender after administration of mrna-1273 ()LOT UNKNOWN). Very limited information regarding this event/s has been provided at this time. Further information has been requested. Critical details such as the mRNA-1273 date of administration, onset of any signs an d symptoms, and date of death is lacking.; Sender''s Comments: This case concerns the death of a patient of unknown age and gender after administration of mrna-1273 ()LOT UNKNOWN) . Very limited information regarding this event/s has been provided at this time. Further information has been requested. Critical details such as the mRNA-1273 date of administration, onset of any signs an d symptoms, and date of death is lacking.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1267593 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-30
Onset:2021-02-08
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Fatigue, Headache, Thrombosis
SMQs:, Anaphylactic reaction (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: 2021-03-03
   Days after onset: 23
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tagamet as needed Advil as needed
Current Illness: None
Preexisting Conditions: None Recurring injury to weak ankle
Allergies: Skin allergy to products with fragrance
Diagnostic Lab Data: Details available upon request.
CDC Split Type:

Write-up: Headache, Increasing fatigue and difficulty breathing over two weeks before 2nd dose -- exacerbated by 2nd dose. Worsening condition led to visit to Primary Care In office tests indicated presence of blood clots and need for emergency hospital treatment. Emergency surgery to remove blood clots throughout her body and attempt to put her on ECMO were unsuccessful and patient succumbed at 12:06 AM 3/3/21.


VAERS ID: 1272201 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-05
Onset:2021-04-04
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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: METFORMIN
Current Illness: Diabetes; Memory loss; Prostate cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Pulmonary embolism; died - autopsy showed multiple blood clots all over his body - pelvic area, hearts,arteries, lungs; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (died - autopsy showed multiple blood clots all over his body - pelvic area, hearts,arteries, lungs) and PULMONARY EMBOLISM (Pulmonary embolism) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039A21A and 003A21A) for COVID-19 vaccination. Concurrent medical conditions included Diabetes, Prostate cancer and Memory loss. Concomitant products included METFORMIN for Diabetes. On 05-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 04-Apr-2021, the patient experienced THROMBOSIS (died - autopsy showed multiple blood clots all over his body - pelvic area, hearts,arteries, lungs) (seriousness criterion death). On an unknown date, the patient experienced PULMONARY EMBOLISM (Pulmonary embolism) (seriousness criterion death). The patient died on 04-Apr-2021. The reported cause of death was Pulmonary embolism. An autopsy was performed. The autopsy-determined cause of death was multiple blood clots. Action taken with mRNA-1273 in response to the event was not applicable Other concomitant medications were reported included unspecified medications for memory loss and diabetes. No treatment information was provided.; Sender''s Comments: This is an 83-year-old, male patient who received mRNA-1273 Vaccine who experienced multiple thrombosis and died, 2 days after receiving second dose of vaccine. Medical history includes Diabetes, and Prostate cancer. Conmeds including some unspecified medications for memory loss and diabetes. The autopsy-determined cause of death was multiple blood clots. Very limited information has been reported at this time. Further information is expected,; Reported Cause(s) of Death: Pulmonary embolism; Autopsy-determined Cause(s) of Death: multiple blood clots


VAERS ID: 1276796 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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:

Write-up: blood clot; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (blood clot) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (blood clot) (seriousness criterion death). The reported cause of death was Clot blood. It is unknown if an autopsy was performed. The reporter stated that his wife had recently passed away from a blood clot after receiving a second dose of the Moderna COVID-19 vaccine. Treatment information was not provided. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Clot blood


VAERS ID: 1284727 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-18
Onset:2021-03-23
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: heart attack; Bood clot; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of MYOCARDIAL INFARCTION (heart attack) and THROMBOSIS (Bood clot) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (heart attack) (seriousness criteria death and medically significant) and THROMBOSIS (Bood clot) (seriousness criterion death). The patient died on 23-Mar-2021. The reported cause of death was Heart attack and Clot blood. It is unknown if an autopsy was performed. Not Provided No concomitant medication were reported. No treatment information was provided.; Reported Cause(s) of Death: Heart attack; Clot blood


VAERS ID: 1285872 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-04-24
Onset:2021-04-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 5 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Abdominal wall haematoma, Activated partial thromboplastin time normal, Alanine aminotransferase increased, Arrhythmia, Aspartate aminotransferase increased, Asthenia, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Coagulation test, Computerised tomogram, Deep vein thrombosis, Dyspnoea, Electrocardiogram abnormal, Heart rate increased, Hypotension, Hypovolaemic shock, International normalised ratio increased, Lung infiltration, Metabolic acidosis, Metabolic function test, Pneumonitis, Protein total normal, Prothrombin time prolonged, Retroperitoneal haemorrhage, SARS-CoV-2 test negative, Sinus tachycardia, Troponin normal, Vomiting, White blood cell count increased
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), Acute pancreatitis (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Hypovolaemic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-03
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metropolol 25mg pO Daily Zantaz 300mg pO Daily Verapamil 120mg PO Daily
Current Illness: present to er due to abdominal pain epigastric with rioght upper with mild shortness of breath vomiting weaknees
Preexisting Conditions: Arthritis, GERD, Hyperlipidemia, Hypertension
Allergies: Ciproflaxacin, penicillina
Diagnostic Lab Data: Patient seen, record review, on empiric treatment that according to clinical findings is well address FOR SEPSIS WERE GALLBLADDERDS NEEDS TO R/O AS THE CAUSE OF ABD PAIN AND ALTERED LFTS BKP : CAP / ATYPICAL INFECTION R/O UTI PX DEBUT WITH ACS/ CARDIAC ARRHYTMIAS WERE ACUTE EVENT NEEDS TO R/O TROPONIN LEVELS NEG UP TO NOW NEEDS TO R/O PRIOR CARDIAC PROBLEMS PX WITH PARTIAL VACCINATION : NEEDS TO R/O COVID INFECTION NEEDS TO R/O PART OF ABN SX SECONDARY OT VACCINE SE on exaM 4/30 REFERS FEELING SOMEWAY BETTER: NO RESP DISTRESS , STILL WITH CARDIAC ARRHYTHMIAS WORK UP BY CT CONFIRM BKP ON ABD EXAM, STILL WITH RUQ PAIN UPON PALPATION U/C CAME NEG CARDEX REVIEW: CHANGE TO MEREM SEEN BY SX AND RECOMENDATIONS SEEN ON EXAM TODAY, PX COMPLICATED : FOUND ON MV DUE TO IRF WERE CAUSES IS MULTIFACTORIAL ; INCLUDING SEVERE METABOLIC ACIDOSIS, HYPOVOLEMIC SHOCK SECONDARY TO RETROPERITONEAL BLLEDING/ ABD WALL HEMATOMA causing HYPOTENSION THAT REQUIRED INOTROPICS WORK UP ALSO POSITIVE FOR BIL LE DVT REASON FOR BLEEDING COMPLICATIONS NEEDS TO ASSEST INCLUDING VACC SIDE EFFECT INCLUDING COVID ACTIVE INFECTION RESULTADOS DE PCR Y NAAT NEGATIVOS Comprehensive Metabolic Panel Sodium 138 mmol/L (137-145) 05/01/21 11:30 Potassium 4.0 mmol/L (3.5-5.1) 05/01/21 11:30 Chloride 101 mmol/L (98-107) 05/01/21 11:30 Carbon Dioxide 20 mmol/L (22-30) L 05/01/21 11:30 BUN 58 mg/dL (7-17) H 05/01/21 11:30 Creatinine 1.41 mg/dL (0.52-1.04) H 05/01/21 11:30 Glucose 327 mg/dL (74.0-100.0) H 05/01/21 11:30 Calcium 8.4 mg/dL (8.4-10.2) 05/01/21 11:30 Total Bilirubin 0.8 mg/dL (0.20-1.30) 04/28/21 02:50 AST 67 U/L (15-46) H 04/28/21 02:50 ALT 79 U/L (0-50) H 04/28/21 02:50 Alkaline Phosphatase 100 U/L (38-126) 04/28/21 02:50 Total Protein 6.4 g/dL (6.3-8.2) 04/28/21 02:50 Albumin 4.0 g/dL (3.5-5.0) 04/28/21 02:50 Coagulation Labs PT 19.1 Secs (9.1-12.7) H 05/02/21 06:00 INR 1.69 (0.9-1.10) H 05/02/21 06:00 APTT 31.3 Secs (25.0-35.0) 05/02/21 06:00
CDC Split Type:

Write-up: 80 yo woman with hx of HTN, anxiety dneies any other conditions, presented to ER due to epigastric pain, vomiting x1. In Er presented with elevated heart rate, EKG with sinus tachycardia, regular rythm. CXR with COPD changes. There are bibasilar infiltrates suspicious for pneumonitis in the appropriate clinical setting. PAtient admitted to unit for further treatment and workup. WBC 16.91 4/27/2021


VAERS ID: 1290733 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-01-11
Onset:2021-01-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA DON?T KNOW / 1 UN / -

Administered by: Private       Purchased by: ?
Symptoms: Brain stem thrombosis, Imaging procedure abnormal, Pulmonary imaging procedure abnormal, Pulmonary thrombosis, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxin 50mcg, metoprolol tar 25mgdiltiazem 180mg, atorvastatin 20 mg,omeprazole 20 mg, pot cl micro tab 20meq,furosemide 20 mg, tramadol 50 mg, florastor 250,
Current Illness: COVID-19 on December 24th of 2020
Preexisting Conditions: Osteoporosis pain and scoliosis
Allergies:
Diagnostic Lab Data: Test found large blood clot at base of brain, blood clot in lung
CDC Split Type:

Write-up: Found unresponsive but still breathing at assisted living. Sent by ambulance to the hospital


VAERS ID: 1294370 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-04-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Hemiplegia, Magnetic resonance imaging head abnormal, Palpitations
SMQs:, Haemorrhage terms (excl laboratory terms) (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, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: AFIB, High Blood Pressure
Allergies:
Diagnostic Lab Data: Hospital performed MRI and CT scans of brain to determine cause of stroke.
CDC Split Type:

Write-up: Patient received the COVID-19 vaccine on Thursday, March 25, 2021. On Tuesday April 6, 2021 he had a massive stroke, blood clot to left side of his brain. On Friday morning April 9, 2021 doctor''s advised he had another stroke due to bleeding in the brain (paralysis on right side and racing heart beat). He died on Saturday, April 10, 2021 @ 5:45 AM.


VAERS ID: 1301096 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood lactic acid, Cardiac operation, Cerebral haemorrhage, Computerised tomogram abnormal, Coronary artery embolism, Hepatic vascular thrombosis, Intracardiac thrombus, Myocardial infarction, Pulmonary thrombosis, Renal vascular thrombosis, SARS-CoV-2 test negative, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Renovascular disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vancomycin
Current Illness: 3 weeks post op colostomy surgery
Preexisting Conditions: none
Allergies: no
Diagnostic Lab Data: Cat scan found embolisms on Friday 5/8/2021. Covid test was negative, lactic acid was 15.
CDC Split Type:

Write-up: 32 hours after the vaccine, he suffered a massive heart attack due to a blood clot and a massive clot in the right arm. He went to the hospital and under went surgery at 12 am on Saturday. The coronary surgeon mentioned that this was not from heart disease as all vessels were clear. Rather, this was due to an embolism due to an unknown origin. A further work up concluded that he also had blood clots throughout his body (both lungs, one kidney, heart, liver, legs, arms, and possibly brain). By 12 p.m. we were asked back to the hospital as he was worsening. Treatment options included a heparin drip, which caused a brain hemorrhage. He was just at the doctors two times this week, on Tuesday and Wednesday and was fine no issues found. They went through with the 2nd dose and came to our home on Thursday.


VAERS ID: 1313691 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-26
Onset:2021-05-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm, Brain death, Cerebral thrombosis, Cerebrovascular accident, Chills, Headache, Irritability, Malaise, Movement disorder, Nasopharyngitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: High blood pressure, hypothyroidism
Preexisting Conditions: High blood pressure, hypothyroid
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following the vaccination patient didn?t feel well. Fever, chills, cold symptoms, incredibly irritable. 5/1 she awake with a terrible headache which continued all day. Around 9:30 pm she laid down and shortly after was unable to move her body. 5/4/21 at 4:19pm her time of death was called. Cause; brain death due to aneurysm and stroke due to passing blood clot in brain.


VAERS ID: 1316583 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-01
Onset:2021-03-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Pulmonary embolism, Pulmonary thrombosis, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-28
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Couldn''t Breath, Died due to Blood Clots on Lungs, Bilateral Pulmonary Embolism, Bleeding on the Brain.
CDC Split Type:

Write-up: Couldn''t Breath, Died due to Blood Clots on Lungs, Bilateral Pulmonary Embolism, Bleeding on the Brain.


VAERS ID: 1317043 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-03-18
Onset:2021-05-03
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Cerebral venous thrombosis, Computerised tomogram head abnormal, Magnetic resonance imaging head abnormal, Spontaneous haemorrhage, Subarachnoid haemorrhage, Venogram, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Ventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-10
   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: None
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: 5/4/21 15:11 CT head 5/5/21 17:26 MRI MRV Brain 5/6/21 14:47 Cerebral Angiogram
CDC Split Type:

Write-up: Spontaneous Cortical Non aneurysmal subarachnoid hemorrhage with diagnostic suspicion but not confirmation of cortical venous thrombosis, and spontaneous ventricular tachycardia.


VAERS ID: 1318152 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Catheterisation cardiac normal, Death, Decreased activity, Decreased appetite, Dyspepsia, Dyspnoea, Ejection fraction decreased, Endotracheal intubation, Fatigue, Feeling abnormal, Fluid retention, Fungaemia, Generalised oedema, Headache, Left ventricular failure, Mesenteric vein thrombosis, Nausea, Peripheral swelling, Poor quality sleep, SARS-CoV-2 test negative, Sedative therapy, Septic shock, Supraventricular tachycardia, Urinary tract infection
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Toxic-septic shock conditions (narrow), Dementia (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Respiratory failure (broad), Sepsis (narrow), Opportunistic infections (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 83
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg daily Omeprazole 20mg daily
Current Illness: None reported
Preexisting Conditions: Osteoarthritis s/p bilateral knee replacements
Allergies: NKDA
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: (Information gained secondhand from patient''s close friend as patient was intubated and sedated at the time that potential relationship between events and vaccine administration recognized). 77 yo F with no known significant PMH (was independent in ADLs, active, line-danced twice/week) who developed nausea, headache, fatigue on first day after first dose of Moderna vaccine. Friend reports that patient complained of "just not feeling right" following vaccine administration. Complained of poor sleep, poor appetite, dyspepsia and began complaining of lower extremity swelling in the weeks following vaccine administration. Was no longer able to line-dance, etc. Was fatigued. Her friends became concerned and encouraged her to seek medical attention, patient reported that she had was prescribed "water pill" and told to "lay off salt,". Friends later found out that she had lied about doctor''s visit and was self-medicating with over the counter "water pills" for all of the water weight she was gaining. Eventually developed worsening shortness of breath. Admitted to hospital on 5/4 with shortness of breath and worsening abdominal pain. Found to have systolic heart failure (EF 20-30%) and was in SVT. Also diagnosed with UTI and SMV thrombus. Grossly anasarcic on exam. Treated for heart failure with diuretic and for her UTI with antibiotics, was started on Heparin drip for SMV thrombus. Underwent left heart catheterization at OSH that was negative for significant CAD. Developed worsening septic shock and was transferred to our hospital for higher level of care. Unfortunately had ongoing decline, found to be fungemic. Eventually succumbed to her septic shock, passed away on 5/14/21. Patient had second dose of vaccine on 3/18/21 according to vaccine card in her purse. Friend states that because of symptoms she developed after first dose of vaccine, she was fearful of getting second dose. Friends insist that she was well before the vaccine---knee pain was limiting factor for her activity level, never shortness of breath. Of note, several friends tested positive for COVID on 2/11/21, the week prior to patient receiving her vaccine. Patient tested negative and reportedly got tested at frequent intervals and was always negative.


VAERS ID: 1321140 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-04
Onset:2021-02-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cardiac monitoring, Cerebrovascular accident, Death, Fatigue, Feeling abnormal, Myocardial infarction, Peripheral swelling, Pyrexia, Thrombosis, Transient ischaemic attack
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-20
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: high cholesterol medication, low dose aspirin and some vitamins
Current Illness: double vision and some dizziness a few months prior
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Please contact medical facility
CDC Split Type:

Write-up: My mom, got her first Moderna shot on Feb. 4th, 2021 and developed trombosis in the legs about a week later. She went to the doctor, who at first didn''t want to see her and told her to elevate her leg. Pt. had a scheduled eye appointment on Feb. 12th with an other doctor and when she asked if she had any other issues, pt. showed her her leg. The eye doctor immediately told her to go to urgent care. When she did she received blood thinners and started injections in her stomach for 5 days. Feb. 18th pt. suffered a mini stroke and went to the hospital emergency room. She was transferred over to another facility in the afternoon and kept overnight. She had a phone appointment with the Dr. on Feb. 24th and on the 26th she received a heart monitor to wear for 2 weeks. She also had a check up about her leg, which was still swollen. On March 4, pt. received her second Moderna shot and she was feverish and very tired for days and weeks after. By March 18th her condition didn''t improve at all and in fact she was felling really bad over night, so on March 19th she was admitted again to the hospital. She was monitored and kept over night, but during the early morning she suffered a stroke and a heart attack and passed way the next day.


VAERS ID: 1334600 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-13
Onset:2021-04-30
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Concussion, Death, Fall, Resuscitation, Somnolence, Syncope, Thrombosis, Traumatic haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   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: Patient has passed away. Wife reports patient was on Plavix and medications for high cholesterol, high blood pressure, and Type II Diabetes. He also took immunotherapy every 6 months (an injection) for prostate cancer.
Current Illness: history of prostate cancer, high blood pressure, high cholesterol, Type II Diabetes, heart failure, past heart attack with stents
Preexisting Conditions: see item 11
Allergies: Bumex
Diagnostic Lab Data: Wife reports a head CT was performed on 4/29/21 in the emergency room. She is unsure if labs were drawn as she was not allowed to be in the room the entire time.
CDC Split Type:

Write-up: Patient passed away on 4/30/21. Wife reports that on 4/29/21, she found him in the garage in a "pool of blood, face down" after a fall. Upon finding him on 4/29/21, she took him to the emergency room where he had a CT scan. Patient was diagnosed with a "concussion" and sent back home, and was instructed to follow-up with his primary care provider on 4/30/21. On 4/30/21, patient was "sleepy all day." On his way out of the house around 3:30, he suddenly put his hand on his wife and proceeded to collapse. The wife also fell, and by the time she gathered herself and went to check on her husband, he had passed away. An ambulance came to the house; CPR was performed for 40 minutes but "they could not get him back." He was not transported to a medical center. An autopsy was not done, but the coroner informed patient''s wife that he likely died from a "clot, maybe a PE." Wife wonders how this could be, since he was on Plavix for 5 years. Wife does not feel that the COVID vaccine is to blame, but thought she should report the issue just in case. This writer is assisting wife of patient to fill out electronic report.


VAERS ID: 1347160 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-02
Onset:2021-05-19
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Angiogram cerebral abnormal, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure acute, Cardiac failure congestive, Cerebral haemorrhage, Cerebral mass effect, Cerebral thrombosis, Cerebrovascular accident, Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Depressed level of consciousness, Fall, Hemiplegia, Left ventricular failure, SARS-CoV-2 test positive, Troponin increased
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (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), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 5
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: Carvedidol 3.125 bid; lisinopril 5 mg; furosemide 20 mg daily; spironolactone 12.5 mg daily
Current Illness: DM - diet controlled; systolic heart failure; Rheumatoid arthritis; meth and alcohol abuse
Preexisting Conditions: DM - diet controlled; systolic heart failure; Rheumatoid arthritis; meth and alcohol abuse
Allergies: cephalexin
Diagnostic Lab Data: CT Imaging shows a very large right MCA stroke with small areas of hemorrhage. He does have 6 mm of shift and small petechiae. CT angiogram shows clot at the bifurcation with complete opacification. He is Covid positive, and chest x-ray shows significant Covid pneumonia. He has a history of CHF, and his BNP is 25,000, up from his baseline of 7000. His troponin is also positive at 0.18. I assume that this is from a type II NSTEMI.
CDC Split Type:

Write-up: fall on May 19 and admitted to ER May 22 with subacute R MCA stroke resulting in obtundation and left sided hemiparalysis. Complicating his presentation is acute COVID 19 infection with pneumonia along with acute on chronic systolic congestive heart failure.


VAERS ID: 1359313 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-14
Onset:2021-01-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Cerebral thrombosis, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Mechanical ventilation
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Myfortic, Prednisone, Bactrim, Omeprazole, Metoprolol, Tamsulosin, Vytorin, Amlodlpine, Calcitriol, Jadiance, Humalog, Lantas, Trulicity, Fish Oil, Aspirin, Multivitamin
Current Illness: none
Preexisting Conditions: diabetic high blood pressure Kidney Transplant
Allergies: none
Diagnostic Lab Data: Many CT scans and other test. I do not have the record to know exactly all the procedures that were done.
CDC Split Type:

Write-up: My husband had a stroke on 01/25/2021, with one large blood clot and many small blood clots. He was put on a ventilator until 02/06/2021 when I asked to have it removed. I died within 5 minutes after it being removed.


VAERS ID: 1362130 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-17
Onset:2021-04-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary, Aortic thrombosis, Brain herniation, Cerebrovascular accident, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Death, Ischaemic stroke, Laboratory test, Magnetic resonance imaging, Neurological symptom, Peripheral artery thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Abaloparatide 80mg sc daily Colestipol 1gm BID Famotidine 20mg daily Gabapentin HCTZ 25mg daily Metformin 500mg BID Venlafaxine 1 cap daily Hydromorphone 4mg prn pain
Current Illness:
Preexisting Conditions: T2DM HTN Obesity Esophageal stricture Depression Eczema He H pylori infection
Allergies: Benzoic acid
Diagnostic Lab Data: Multiple labs, head & chest CT scans, CTA chest, MRI?s.
CDC Split Type:

Write-up: Acute onset stroke symptoms the afternoon of 4/13/21 after returning home from room. EMS transported pt to local hospital. Dx with aortic arch/proximal subclavian artery thrombus, migration into axillary artery. Treated at local hospital with TNK for aortic arch clot & ischemic stroke. Transferred to tertiary medical center. Pt had massive stroke (left & right side) with brain stem herniation. Pt CMO after 16hrs and expired on 4/14, <32 hrs after symptom onset.


VAERS ID: 1378167 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2020-02-01
Onset:2020-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Bedridden, Blindness, Cough, Decreased appetite, General physical health deterioration, Mobility decreased, Pulmonary thrombosis, Pyrexia, Thrombosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-05-31
   Days after onset: 119
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 95 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Stage 4 lung cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The night after receiving the vaccine, the patient began having continuous fevers and coughs. It was later discovered that there were blood clots in the lung and legs. Patient health rapidly declined during hospitalization period. Mobility, apetite and overall strength and energy decreased. Patient was fully bedridden and soon lost eye sight.


VAERS ID: 1386054 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-14
Onset:2021-06-06
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VANAFLAXINE BUSPIRONE ABILIFY SPRINTEC
Current Illness: CHLAMYDIA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: AUTOPSY 6/8/21
CDC Split Type:

Write-up: DEATH FROM BLOOD CLOT


VAERS ID: 1391500 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-15
Onset:2021-05-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Dyspnoea, Laboratory test, Mechanical ventilation, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Seizure, Thrombosis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity
Allergies:
Diagnostic Lab Data: Yes, extensive. You will need medical records. He had 3 covid tests and 1 antibody test all negative for Covid.
CDC Split Type:

Write-up: Patient had his 2nd Moderna vaccine at pharmacy at 2:00 and was struggling to breathe a few hours later. We were at the emergency room around 6:00pm and he was placed on a ventilator between midnight and 1:00am. He died 10 days later after experiencing clots that led to seizures and congestive heart failure. I have a death certificate if needed.


VAERS ID: 1394058 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: This spontaneous case was reported by a patient family member or friend (subsequently medically confirmed) and describes the occurrence of DEATH (She passed away) and THROMBOSIS (Clots in her leg) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037A21B) for COVID-19 vaccination. No Medical History information was reported. On 17-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (She passed away) (seriousness criteria death, hospitalization and medically significant) and THROMBOSIS (Clots in her leg) (seriousness criteria hospitalization and medically significant). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, THROMBOSIS (Clots in her leg) outcome was unknown. No concomitant medications reported. Description: The patient had clots in her leg and was hospitalized. There was talk of amputation, but she passed away before that occurred. No treatment information provided. Company Comment: Very limited information regarding these events have been provided at this time. Further information cannot be requested.; Sender''s Comments: Very limited information regarding these events have been provided at this time. Further information cannot be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1399516 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-21
Onset:2021-05-12
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Hyperhidrosis, Pain, Thrombosis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin, otc allergy meds
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: No
Diagnostic Lab Data: 5/12/2021 blood clot
CDC Split Type:

Write-up: Sweating, soreness, vomiting


VAERS ID: 1401732 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-16
Onset:2021-05-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, Blood pressure measurement, Cardiac arrest, Cardiac failure acute, Dyspnoea, Gait disturbance, Glycosylated haemoglobin, Infection, Oxygen saturation, Pyrexia, SARS-CoV-2 antibody test, SARS-CoV-2 test, Seizure, Sepsis, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Interstitial lung disease (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), 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), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-25
   Days after onset: 24
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:
Current Illness: Obesity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210515; Test Name: Blood pressure; Result Unstructured Data: Twice normal; Test Date: 20210515; Test Name: HbA1c; Result Unstructured Data: High; Test Date: 20210515; Test Name: Oxygen saturation; Result Unstructured Data: Required intubation and was placed on ventilator.; Test Date: 20210515; Test Name: COVID Antibody test; Test Result: Negative ; Result Unstructured Data: 1 negative COVID antibody test; Test Date: 20210515; Test Name: COVID antigen test; Test Result: Negative ; Result Unstructured Data: 3 negative COVID antigen tests
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Seizures; Bood clots; Stuggling to breathe; Struggling to walk; ARDS; Acute hypoxic respiratory failure; Acute exacerbation of heart failure and sepsis; Acute exacerbation of heart failure and sepsis; Cardiac arrest; Blood infection; Fever; This spontaneous case was reported by a patient family member or friend (subsequently medically confirmed) and describes the occurrence of ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS), ACUTE RESPIRATORY FAILURE (Acute hypoxic respiratory failure), SEPSIS (Acute exacerbation of heart failure and sepsis), CARDIAC FAILURE ACUTE (Acute exacerbation of heart failure and sepsis), CARDIAC ARREST (Cardiac arrest), SEIZURE (Seizures), THROMBOSIS (Bood clots), DYSPNOEA (Stuggling to breathe) and GAIT DISTURBANCE (Struggling to walk) in a 53-year-old male patient 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 Obesity. On 16-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-May-2021 at 2:00 PM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-May-2021, the patient experienced ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) (seriousness criteria death and medically significant), ACUTE RESPIRATORY FAILURE (Acute hypoxic respiratory failure) (seriousness criteria death and medically significant), DYSPNOEA (Stuggling to breathe) (seriousness criterion hospitalization prolonged) and GAIT DISTURBANCE (Struggling to walk) (seriousness criterion hospitalization prolonged). In May 2021, the patient experienced SEPSIS (Acute exacerbation of heart failure and sepsis) (seriousness criteria death and medically significant), CARDIAC FAILURE ACUTE (Acute exacerbation of heart failure and sepsis) (seriousness criteria death and medically significant), CARDIAC ARREST (Cardiac arrest) (seriousness criteria death and medically significant), INFECTION (Blood infection) and PYREXIA (Fever). On 17-May-2021, the patient experienced SEIZURE (Seizures) (seriousness criteria hospitalization prolonged and medically significant) and THROMBOSIS (Bood clots) (seriousness criteria hospitalization prolonged and medically significant). The patient was hospitalized from 15-May-2021 to 25-May-2021 due to DYSPNOEA, GAIT DISTURBANCE, SEIZURE and THROMBOSIS. The patient died on 25-May-2021. The reported cause of death was Cardiac arrest, Acute hypoxic respiratory failure, ards and acute exacerbation of heart failure and sepsis. It is unknown if an autopsy was performed. At the time of death, SEIZURE (Seizures), THROMBOSIS (Bood clots), DYSPNOEA (Stuggling to breathe), GAIT DISTURBANCE (Struggling to walk), INFECTION (Blood infection) and PYREXIA (Fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 15-May-2021, Blood pressure measurement: elevated (High) Twice normal. On 15-May-2021, Glycosylated haemoglobin: elevated (High) High. On 15-May-2021, Oxygen saturation: low (Low) Required intubation and was placed on ventilator.. On 15-May-2021, SARS-CoV-2 antibody test: negative (Negative) 1 negative COVID antibody test. On 15-May-2021, SARS-CoV-2 test: negatie (Negative) 3 negative COVID antigen tests. No concomitant medications were provided. It was reported that within few hours after second dose of vaccine patient was struggling to walk and to breathe. The reporter and her husband went to see the patient and took him to an emergency room (ER). In the ER his blood pressure was markedly elevated (twice normal) and his oxygen level was low and by midnight he required intubation and was placed on a ventilator. His HbgA1c was noted to be elevated. Two days after admission (17-May-2021), he developed seizures which the medical team believed to be due to blood clots and he was anti-coagulated. It was determined that he did not have blood clots on his heart valves as the source of the clots. The source of the blood clots was never identified. He later developed fever and was diagnosed with a blood infection and treated with antibiotics. At one point his oxygen requirement on the ventilator went down to 65% but later returned and remained at 100%. He ultimately died on 25-May-2021 and as per copy of his death certificate he had 4 causes of death as cardiac arrest, acute hypoxic respiratory failure, acute respiratory distress syndrome (ARDS) and acute exacerbation of heart failure and sepsis. Treatment included, anticoagulants, antibiotics, intubation and ventilator. Very limited information regarding these events has been provided at this time. Further information has been requested. This case was linked to MOD-2021-219410 (Patient Link).; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Cardiac arrest; Acute hypoxic respiratory failure; ARDS; Acute exacerbation of heart failure and sepsis


VAERS ID: 1403750 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-02
Onset:2021-03-20
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J220A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiogram peripheral abnormal, Autopsy, Confusional state, Death, Embolism, Headache, Iliac artery stenosis, Malaise, Pain in extremity, Paranoia, Peripheral arterial occlusive disease, Peripheral artery occlusion, Peripheral artery stenosis, Peripheral coldness, Peripheral ischaemia, Pulmonary artery thrombosis, Pulmonary embolism, Pulse absent, Refusal of treatment by patient, Renal infarct, Skin discolouration, Urinary tract infection, Urine analysis abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Renovascular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-27
   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: None
Current Illness: None, only longstanding chronic conditions as stated in item 12
Preexisting Conditions: 1. Arteriosclerosis 2. Severe osteoarthritis (bilateral shoulders, bilateral hips and bilateral knees) 3. Chronic bilateral rotator cuff arthropathy 4. Chronic pain syndrome 5. History Atrial fibrillation with RVR on chronic anticoagulation 6. History of cardiac pause as long as 7 seconds worsened by metoprolol 7. Hypertension 8. Prediabetes 9. Vitamin B12 insufficiency 10. History of hyperuricemia 11. Malnutrition 12. History of hyponatremia 13. Dysphagia status post esophageal dilatation 14. GERD 15. Diverticulosis 16. Internal hemorrhoids 17. Constipation 18. BPH status post Urolift implants x 2 19. Urinary retention status post Foley catheter placement 20. Anemia 21. Dementia 22. Decubitus ulcer, stage 3, sacro-coccyx 23. Onychomycosis 24. Acute on chronic debility with impaired gait and functional mobility
Allergies: None
Diagnostic Lab Data: On 3/20/21, he had a CTA which showed as per radiology: "Occlusion of the right superficial femoral artery beginning just beyond the origin. Occluded right popliteal, anterior tibial, tibioperoneal, peroneal, and posterior tibial arteries without reconstitution on arterial and delayed phases. Patent right deep femoral artery with minimal luminal stenosis in the proximal segment. Patent mid and distal right external iliac artery with up to mild luminal stenosis."
CDC Split Type:

Write-up: Patient complained of feeling unwell and having headaches after his second dose of Moderna vaccine on 2/2/2021. He became increasingly confused, paranoid and started occasionally refusing medications. On early March 2021, he started refusing all medications. Around 3/17/21, his increasing confusion and paranoia prompted suspicion for UTI which was confirmed with a urinalsis. Unfortunately, he refused antibiotic treatment. On 3/20/2021, nursing staff noted that patients right lower extremity was purple from toes to mid-calf, cold to touch and pedal pulse were not present. He complained of right leg pain. He was evaluated and diagnosed with probable thromboembolic event, since patient refused his oral anticoagulant for weeks prior to these event. Patient was sent to the local Emergency Department (ED) and diagnosed with acute critical right limb ischemia. At the local ED, he had a CTA which showed as per radiology: "Occlusion of the right superficial femoral artery beginning just beyond the origin. Occluded right popliteal, anterior tibial, tibioperoneal, peroneal, and posterior tibial arteries without reconstitution on arterial and delayed phases. Patent right deep femoral artery with minimal luminal stenosis in the proximal segment. Patent mid and distal right external iliac artery with up to mild luminal stenosis." Per discharge summary, "vascular surgery evaluated patient in the ED and did not feel operative revascularization with fasciotomy would provide any benefit; recommended continued anticoagulation with amputation/palliative management." He was admitted to the general medicine service which consulted orthopedic, infectious diseases and palliative care. Medicine Service also contacted patient''s daughter who is his next of kin who opted for comfort care. He was discharged to facility on 3/25/2021 and started in the Comfort Care Program. He was pronounced dead on March 27, 2021 at 0807 hours. His autopsy showed that he also had thrombi on: 1. Pulmonary embolism, Left pulmonary artery 2. Left renal infarct


VAERS ID: 1407804 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-04-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Candida infection, Cardiac disorder, Condition aggravated, Death, Malaise, Mobility decreased, Myocardial infarction, Resuscitation, Seizure, Thrombosis
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: As per wife''s account, patient died approximately 9 days after receiving vaccine on 4/21 of massive, unknown (suspected cardiac) event. Wife explained that patient was diagnosed with Wolff-Parkinson-White (WPW) syndrome prior to being vaccinated. PCP unaware of diagnosis, and patient did not disclose that on vaccine consent form. Patient reported to his wife that he was feeling unwell after receiving vaccine including unable to move legs well. Patient later diagnosed with thrush and supposedly treated by physician. Patient did not discuss concerns regarding vaccine or WPW with physician. Patient called his wife the day of death and asked her to bring him to the doctor the following day. Wife reported that patient experienced seizures but not concerned as it was similar to childhood seizure. Wife was done at work and drove home after phone call, arriving at house approximately 10-15 minutes after call. Patient supposedly dead when wife arrived. Wife performed CPR for ~15 minutes until EMS arrived, and EMS attempted for another 40 minutes for any electrical activity. Wife declined full autopsy from ME, suspecting that it was massive MI or clot. Wife and patient unaware that WCW could place patient at risk of clots and wondering if the vaccine was partially responsible.


VAERS ID: 1414947 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-02
Onset:2021-06-05
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Back pain, Computerised tomogram abdomen, Computerised tomogram thorax, Death, Deep vein thrombosis, Dysphagia, Dysphonia, Dyspnoea, Electrocardiogram, Full blood count, Guillain-Barre syndrome, Metabolic function test, Muscular weakness, Peripheral swelling, Vena cava filter insertion
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 14
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: Norco 5/325mg 1 tab every 4 hours as needed, caltrate plus vitamin D-1 tablet daily, Fenofibric acid daily, Metformin 500 mg BID, Zyloprim 100 mg daily Synthroid 0.05mg daily, Vitamin D3 BID, Fish oil 1,200 mg daily, Claritin 10 mg QD, lipi
Current Illness: unknown was seen in the ER not a normal pt here at the Clinic
Preexisting Conditions: Acute Kidney injury, BPH, Type 2 diabetes, DVT, Gout, arthritis, HLD, Hypothyroidism ,renal rupture
Allergies: Warfarin, Lisinopril, Phenylbutazone
Diagnostic Lab Data: Consults-GI, Palliative care, rehab medicine, urology, IR and neuromuscular. Procedure: IVC filter placed on 6/11. CBC, CMP, CT chest,abd,pelvis, EKG all done on 6/5/2021
CDC Split Type:

Write-up: Pt showed up to the ER via EMS on 6/5/2021 with low back pain and weakness, bilateral leg swelling, shortness of breath. On 6/6/2021-developed bilateral upper and lower weakness that progressed to dysphagia and dysphonia. Transferred to ER on 6/8/2021 for Gillian Barre Syndrome On 6/11 had bilateral DVTS He was placed on palliative care and passed away on 6/19/2021


VAERS ID: 1415239 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-13
Onset:2021-05-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Anticoagulant therapy, Bilevel positive airway pressure, Blood cortisol, Blood creatinine increased, Blood lactic acid, C-reactive protein increased, Deep vein thrombosis, Fasciectomy, Fibrin D dimer, Intestinal ischaemia, Myocarditis, Myoglobin blood increased, N-terminal prohormone brain natriuretic peptide increased, Respiratory failure, SARS-CoV-2 test negative, Thrombosis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-19
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 34 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALPRAZOLAM (XANAX) 0.5 MG TABLET TAKE ONE-HALF TO ONE TABLET BY MOUTH THREE TIMES A DAY AS NEEDED FOR ANXIETY AMLODIPINE (NORVASC) 10 MG TABLET TAKE ONE TABLET BY MOUTH EVERY DAY ASPIRIN 81 MG CHEWABLE TABLET Take 1 tab
Current Illness: SOB after first covid shot.
Preexisting Conditions: ? Cholelithiases ? Clostridium difficile infection ? Diabetes mellitus (CMS/HCC) ? Enterocolitis ? Epistaxis ? Fracture of right hip (CMS/HCC) ? Hemoglobin A1c less than 7.0% 01/14/2018 6.2 ? History of bone density study unknown ? History of colonoscopy 04/03/2017 repeat 3 years ? Hypertension ? Myocardial infarction (CMS/HCC)
Allergies: Iodine Anaphylaxis Other reaction(s): see contrast passed out Severity: Unknown ? Sulfamethoxazole Hives Severity: Moderate ? Trimethoprim Hives Severity: Moderate ? Clopidogrel ? Codeine Nausea And Vomiting Severity: Severe ? Cyclobenzaprine Hcl ? Sulfamethoxazole-Trimethoprim ? Latex Rash
Diagnostic Lab Data: 6/18 - lactic acid 4.6 , CRP 13 6/16 -proBNP 19,000 6/15 - ddimer 5,513 6/10 - cortisol 145 5/18 Cr 2.58 5/17 myoglobin 1574 5/15 high sensitivity troponin 18,046, covid antigen rapid negative
CDC Split Type:

Write-up: Myocarditis in 2 days - diuretics, Respiratory Failure in 2 days Bipap and Airvo, Clotted off leg in a few weeks Angiogram and Fascitomy, Ischemic gut weeks - comfort care orders, DVT in arm in weeks could have been due to PICC also - Elquis


VAERS ID: 1417870 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-08
Onset:2021-03-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / UNK AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Colonoscopy, Intensive care, Magnetic resonance imaging, Rectal haemorrhage, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Thrombophlebitis (broad), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Coronary artery disease, arthritis, peripheral vascular disease, abdominal aortic aneurism
Allergies: None
Diagnostic Lab Data: Hospitalized in ICU, colonoscopy, MRI
CDC Split Type:

Write-up: Profuse rectal hemorrhaging and blood clots


VAERS ID: 1440737 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-04-04
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to the ED and was subsequently hospitalized for DVT within 6 weeks of receiving COVID vaccination. Patient died on 6/23/2021.


VAERS ID: 1441060 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-11
Onset:2021-04-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 1442 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, Dyspnoea, Hypotension, Thrombosis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-09
   Days after onset: 68
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODOPINE, ASPIRIN, ATORVASTATIN, BRIMINIDINE, DOROLAMIDE, FUROSEMIDE, LIQUID TEARS, LISINOPRIL MAG64, METOROLOL, MULTIVITAMIN, MYCOPHENOLIC, OMEPRAZOLE, PREDNISONE,PROGRAF, TIMOLOL, LATANAPROST, TYLENOL, LALMOTOL
Current Illness:
Preexisting Conditions: Legally blind due to diabetic complications.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots in heart with extremely low blood pressure and shortness of breath. Symptoms suddenly appeared on 04/02/21. Hospitalization and rehabilitation Until discharge of 05/03/2021. Extremely low blood pressure, weakness and shortness of breath continued until he was hospitalized again 06/02/2021 He passed away 06/09/2021. He was labeled as Covid 19


VAERS ID: 1446466 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-14
Onset:2021-05-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Electrocardiogram abnormal, Myocardial infarction, Resuscitation, Skin discolouration, Syncope, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (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), Thrombophlebitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   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: Unknown
Current Illness: Heart condition, diabetes (unsure of specifics, patient is now deceased and daughter is reporting)
Preexisting Conditions:
Allergies: Unknown
Diagnostic Lab Data: Waiting on medical records
CDC Split Type:

Write-up: Died of cardiac complications, heart attack, stroke or blood clot were all mentioned. Collapsed at work, grabbing his chest. Was revived 5 times before dying. Doctors mentioned his chest was oddly discolored so they thought blood clot but ekg was abnormal as well so heart attack was also mentioned.


VAERS ID: 1446639 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-29
Onset:2021-04-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, Biopsy bone marrow, Biopsy skin, Blood test, Cardio-respiratory arrest, Cerebrovascular accident, Chest X-ray, Chronic eosinophilic leukaemia, Colonoscopy, Computerised tomogram head abnormal, Death, Electrocardiogram, Endoscopy, Eosinophil count increased, Eosinophilia, Gastrointestinal tube insertion, Intensive care, Large intestinal ulcer, Magnetic resonance imaging head abnormal, Mechanical ventilation, Muscle spasms, Myalgia, Oesophageal ulcer, Pyrexia, Rash, Thrombosis, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Gastrointestinal ulceration (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-03
   Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 33 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: daily baby aspirin
Current Illness: tendonitis in elbow
Preexisting Conditions: occasional lower back pain
Allergies: bee stings
Diagnostic Lab Data: May1-June 2 2021 -daily routine blood work, EKGs, bone marrow biopsy, chest x-rays, skin biopsy, genetic testing, endoscopy, colonoscopy, CT scans, MRI; all is visible in 3200 page all medical testing viewable in patient''s 3200 page electronic Hospital medical record
CDC Split Type:

Write-up: My husband passed away June 3, 2021 resulting from complications which began a few hours after receiving his 2nd Moderna shot on April 29, 2021. He never tested positive for Covid19, however his first symptoms were the typical fever, muscle aches, rash. He declined daily from a host of mysterious symptoms including full body rash, blood clots, muscle spasms, atrial fibrillation, ulcers lining his esophagus and colon, and exorbitant WBC (157K) with extremely high eosinophils (90%). He was treated with a host of drugs including antibiotics, steroids, blood thinners, ivermectin and finally chemotherpay (Campath). His ICU team included hematology, pulmonology, ... oncology and infectious disease. After an incredible amount of diagnostic testing ( daily routine blood work, EKGs, chest x-rays, CT scans, MRI, bone marrow biopsy, endoscopy, colonoscopy, skin biopsy, genetic testing) no definitive diagnosis could be made, however, he was given the possible diagnosis of chronic eosinophilia leukemia in late May. The big question among the medical staff was, "Did the shot trigger something?" He was eventually treated with the chemotherapy drug Campath, which reduced the WBC and EOs some, but his organs, especially, lungs had been very compromised by the high WBC and eosinophils. Several days after being placed on a ventilator and given a feeding tube at the end of May, a CT scan and MRI confirmed patient had suffered multiple strokes. He passed away a half hour after being taken off the ventilator the morning of June 3, 2021. His death certificate read: A. cardiopulmonary arrest B. acute hypoxic respiratory failure C. hypereosinophila


VAERS ID: 1446954 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-09
Onset:2021-04-05
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: high blood pressure medication , anxiety meds
Current Illness: Prior to the first shot only high blood pressure
Preexisting Conditions: anxiety, HPB
Allergies: allergic to penicillin
Diagnostic Lab Data: body had so many clots the undertaker had to use 8 puncture sites instead of 4 in order to embalm
CDC Split Type:

Write-up: person was found dead 3 and a half weeks after last shot


VAERS ID: 1459429 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Michigan  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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.MOD20212

Write-up: Died with a blood clot in her brain; This spontaneous case was reported by a consumer and describes the occurrence of CEREBRAL THROMBOSIS (Died with a blood clot in her brain) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBRAL THROMBOSIS (Died with a blood clot in her brain) (seriousness criteria death and medically significant). The reported cause of death was died with a blood clot in her brain. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided. Company Comment: Very limited information on this fatal case. However, based on the current available information and assumed temporal association between the use of the unspecified Moderna Vaccine product and the start date of the event, a causal relationship cannot be excluded. Reporter did not allow further contact; Sender''s Comments: Very limited information on this fatal case. However, based on the current available information and assumed temporal association between the use of the unspecified Moderna Vaccine product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Died with a blood clot in her brain


VAERS ID: 1470120 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-10
Onset:2021-05-17
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Cardiac hypertrophy, Deep vein thrombosis, Electrocardiogram ST-T segment abnormal, Fatigue, Influenza virus test negative, Malaise, Myocardial strain, Nucleic acid test, Prostate cancer, Pulmonary embolism, SARS-CoV-2 test negative, Sudden death, Syncope, Toxicologic test normal
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (narrow), Other ischaemic heart disease (broad), Prostate malignant tumours (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Non-haematological malignant tumours (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None reported
Allergies: None known
Diagnostic Lab Data: Autopsy revealed: Noncontributory toxicologic testing. Negative COVID-19 and influenza NAA testing. Obstructive pulmonary thromboemboli, recent and organizing, with right lower extremity organizing DVT. Cardiac hypertrophy with slight left ventricular and right heart strain pattern (no evidence of myocarditis). Probable small focus of prostatic adenocarcinoma.
CDC Split Type:

Write-up: Patient had 1st dose of Moderna COVID-19 vaccine on 5/10/2021. Several days after he complained of "not feeling well" and fatigue, but did not give more specific symptomatology. On 5/17/2021 he had a sudden collapse at home and was transported to local hospital, where he was pronounced dead. Case accepted as medical examiner jurisdiction due to no apparent medical history and sudden death after vaccine administration. Full autopsy completed on 5/19/21 revealed obstructive pulmonary thromboemboli as cause of death, with lower extremity DVT. Both portions of the pulmonary thromboembolus and the DVT show organization, thus raising question of whether this process started before or after the vaccination. No known history of thrombophilic disorder, recent injury, or prolonged stasis/immobility. Not known to be current smoker. See below for additional autopsy information.


VAERS ID: 1478896 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-11
Onset:2021-05-13
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Military       Purchased by: ?
Symptoms: Abdominal X-ray, Aspiration pleural cavity, Cardiogenic shock, Cerebrovascular accident, Chest X-ray, Computerised tomogram, Deep vein thrombosis, Echocardiogram, Electrocardiogram, Electroencephalogram, Endotracheal intubation, Magnetic resonance imaging head, Respiratory failure, Seizure, Thrombocytopenia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Ventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-22
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Furosemide, Metoprolol, Tamsulosin, Atorvastatin,
Current Illness: None
Preexisting Conditions: High Blood Pressure, High Cholesterol, Heart Valve Replacement 2013
Allergies: None
Diagnostic Lab Data: EKG, CT Scan,Multiple Chest X-Rays, Heart Ultrasound, xray of Abdomen, Brain MRI, Chest fluid Removal, EEG, Insertion of Breathing tube,
CDC Split Type:

Write-up: Cardiogenic shock, Respiratory failure, Ventricular fibrillation, thrombocytopenia, Acute Stroke, seizure, acute deep venous thrombosis


VAERS ID: 1481806 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arkansas  
Vaccinated:2021-01-01
Onset:2021-01-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood disorder, Blood test, Body temperature, Cough, Fatigue, Impaired work ability, Myocardial infarction, Pyrexia, Sinusitis, Thrombosis, Vaccination site pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   Days after onset: 51
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: Blood disorder; Dialysis; Renal failure
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: normal; Test Date: 202102; Test Name: Temperature; Result Unstructured Data: started running a temperature
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Thick blood; Missed a whole week of work; second shot:-heart attack; second shot: tired; second shot- started running a temperature; second dose- throwing up; Sinus infection; second dose-coughing; second dose- blood clots; left arm was hurting; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (second shot:-heart attack) and THROMBOSIS (second dose- blood clots) 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. The patient''s past medical history included Renal failure. Concurrent medical conditions included Dialysis and Blood disorder. In January 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In January 2021, the patient experienced VACCINATION SITE PAIN (left arm was hurting). On 14-Feb-2021, the patient experienced SINUSITIS (Sinus infection), COUGH (second dose-coughing) and VOMITING (second dose- throwing up). On 15-Feb-2021, the patient experienced FATIGUE (second shot: tired) and PYREXIA (second shot- started running a temperature). In February 2021, the patient experienced THROMBOSIS (second dose- blood clots) (seriousness criteria death and medically significant). On 21-Feb-2021, the patient experienced MYOCARDIAL INFARCTION (second shot:-heart attack) (seriousness criteria death and medically significant). On an unknown date, the patient experienced BLOOD DISORDER (Thick blood) and IMPAIRED WORK ABILITY (Missed a whole week of work). The patient was treated with IBUPROFEN for Fever, at an unspecified dose and frequency and ONDANSETRON (ZOFRAN MELT) for Stomach pain, at an unspecified dose and frequency. On 21-Feb-2021, SINUSITIS (Sinus infection), COUGH (second dose-coughing), VOMITING (second dose- throwing up) and FATIGUE (second shot: tired) outcome was unknown and PYREXIA (second shot- started running a temperature) had resolved with sequelae. The patient died on 21-Feb-2021. The reported cause of death was blood clots leading to heart attack. An autopsy was not performed. At the time of death, BLOOD DISORDER (Thick blood), IMPAIRED WORK ABILITY (Missed a whole week of work) and VACCINATION SITE PAIN (left arm was hurting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In February 2021, Body temperature: abnormal (abnormal) started running a temperature. On an unknown date, Blood test: normal (normal) normal. Patient took first dose of moderna vaccine in JAN 2021 and second dose in FEB 2021. Patients body temperature was 98-104 after taking ibuprofen for few days. Patient''s blood was thick as pancake syrup. Patient was on dialysis for 5 years before the shot. On 16 FEB 2021 Dialysis and blood work was done. Patient went to doctor on 19 FEB 2021. Patient missed her work a week from 15 FEB 2021 to 21 FEB 2021. Very limited information regarding this event/s has been provided at this time. Further information has been requested. This case was linked to MOD-2021-256627 (Patient Link).; Sender''s Comments: Very limited information regarding this event/s has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Blood clots leading to heart attack


VAERS ID: 1507866 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-22
Onset:2021-06-22
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic shock, Aortic dissection, Blood pressure measurement, Burning sensation, Dyspnoea, Haemorrhage, Heart rate, Paralysis, Thrombosis
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Open heart surgery
Allergies:
Diagnostic Lab Data: Test Date: 20210622; Test Name: Blood pressure; Result Unstructured Data: Systolic blood pressure <90 mmHg; Test Date: 20210622; Test Name: Heart Rate; Result Unstructured Data: Heart rate $g100 beats per min
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Aortic Dissection hemostatic shock; Anaphylactic shock; Paralyze in the lower half of her body; Clotting; Excessive bleeding; Burning sensation going down to her spine; Difficulty breathing; This spontaneous case was reported by a patient family member or friend and describes the occurrence of ANAPHYLACTIC SHOCK (Anaphylactic shock), PARALYSIS (Paralyze in the lower half of her body), THROMBOSIS (Clotting), HAEMORRHAGE (Excessive bleeding), BURNING SENSATION (Burning sensation going down to her spine), DYSPNOEA (Difficulty breathing) and AORTIC DISSECTION (Aortic Dissection hemostatic shock) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 054c21a and 009c21a) for COVID-19 vaccination. The patient''s past medical history included Open heart surgery on 18-May-2021. On 22-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 22-Jun-2021, the patient experienced ANAPHYLACTIC SHOCK (Anaphylactic shock) (seriousness criteria death, hospitalization and medically significant), PARALYSIS (Paralyze in the lower half of her body) (seriousness criteria death, hospitalization and medically significant), THROMBOSIS (Clotting) (seriousness criteria death, hospitalization and medically significant), HAEMORRHAGE (Excessive bleeding) (seriousness criteria death, hospitalization and medically significant), BURNING SENSATION (Burning sensation going down to her spine) (seriousness criteria death and hospitalization) and DYSPNOEA (Difficulty breathing) (seriousness criteria death and hospitalization). On an unknown date, the patient experienced AORTIC DISSECTION (Aortic Dissection hemostatic shock) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized from 22-Jun-2021 to 04-Jul-2021 due to ANAPHYLACTIC SHOCK, BURNING SENSATION, DYSPNOEA, HAEMORRHAGE, PARALYSIS and THROMBOSIS. The patient died on 04-Jul-2021. The reported cause of death was aortic dissection hemostatic shock. An autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 22-Jun-2021, Blood pressure measurement: decreased (abnormal) Systolic blood pressure <90 mmHg. On 22-Jun-2021, Heart rate: increased (abnormal) Heart rate $g100 beats per min. No relevant concomitant medications were reported. Oxygen was given as treatment. She had the second dose on 22JUN2021. 5 hours after the vaccine, she had a burning sensation going down to her spine. Then she was paralyzed in the lower half of her body. She was rush to the local hospital. She was medevac to another hospital. She had clotting and excessive bleeding. She was in the hospital for 13 days. She passed on 04JUL2021 Company comment: This is a case of sudden death in a 75-year-old male subject with hx of open heart surgery, who died 12 days after receiving second dose of vaccine. Very limited information has been provided at this time. However, recent open heart surgery might have at least partially contributed to the events occurrence. Most recent FOLLOW-UP information incorporated above includes: On 26-Jul-2021: Follow-up received- Patient demographics, cause of death, lab data, causality and vaccination details updated.; Sender''s Comments: This is a case of sudden death in a 75-year-old male subject with hx of open heart surgery, who died 12 days after receiving second dose of vaccine. Very limited information has been provided at this time. However, recent open heart surgery might have at least partially contributed to the events occurrence.; Reported Cause(s) of Death: Aortic Dissection hemostatic shock


VAERS ID: 1521946 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-01
Onset:2021-05-13
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Thrombosis
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), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aneurysm
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Strokes; Blood clots; Died; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died), CEREBROVASCULAR ACCIDENT (Strokes) and THROMBOSIS (Blood clots) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Aneurysm. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CEREBROVASCULAR ACCIDENT (Strokes) (seriousness criteria death and medically significant) and THROMBOSIS (Blood clots) (seriousness criteria death and medically significant). The patient died on 13-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medication use information was not provided by reporter. Treatment medication use information was not provided by reporter Patient had multiple medical issues , got vaccine after and aneurysm. Very limited information regarding this events has been provided at this time. Further information can''t be requested. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information can''t be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1523152 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-06
Onset:2021-07-21
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sudden death, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Girlfriend came in for her 2nd dose and reported that her boyfriend "died in my arms from a blood clot after his first covid vaccine." Patient, died suddenly at home on 7/21/2021 in the presence of Girlfriend. She called 911 and the fire department responded. He was dead when they arrived. They did not transport him to the hospital but directly to the morgue. No autopsy was performed. The coroner did not speak with Girlfriend. She got the information about the blood clot from the EMTs who said "I could tell by looking at his neck that he had a clot". Not sure why she attributed it to the Moderna vaccine? He was vaccinated in our pharmacy on 7/6/2021. I told Girlfriend I would report this to the Pharmacy system and to VAERS. She said no one else had reported it to her knowledge.


VAERS ID: 1528612 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-15
Onset:2021-06-12
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Cerebral haemorrhage, Cerebrovascular accident, Death, Deep vein thrombosis, Renal infarct
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, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Renovascular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-29
   Days after onset: 47
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 40 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, metoprolol
Current Illness: none
Preexisting Conditions: distant history of breast cancer and hypertension
Allergies: sulfa antibiotics
Diagnostic Lab Data: 6/24 initiation of apixaban 7/13 apixaban + aspirin 7/18 off apixaban and started on warfarin
CDC Split Type:

Write-up: Moderna Vaccine given 3/15/21 and 4/12/21. Developed spontaneous renal infarct 6/12/21., placed on apixaban. Had acute CVA 6/24/21, unknown cause with no arrhythmia, negative hyper coagulable work up, and no evidence of recurrence of malignancy. 7/13/21 with new DVT was started on aspirin in addition to apixaban and 7/18/21 another CVA occurred. Was started on warfarin. 7/29/21 develop cerebral hemorrhage and passed.


VAERS ID: 1529725 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Agonal respiration, Arteriosclerosis coronary artery, Autopsy, Coronary artery thrombosis, Malaise, Myocardial rupture, Pericardial haemorrhage, Resuscitation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Accidents and injuries (narrow), Other ischaemic heart disease (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sent home from work early complaining of feeling unwell one day after receiving vaccine. Witnessed agonal breathing while sitting in chair that same afternoon. Resuscitation unsuccessful. Autopsy showed hemopericardium due to ruptured myocardial infarct due to coronary artery thrombosis due to coronary artery atherosclerosis. No evidence of anaphylaxis or myocarditis.


VAERS ID: 1535468 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-15
Onset:2021-07-23
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral venous sinus thrombosis, Coagulation factor V level abnormal, Endotracheal intubation, Epilepsy, Factor V Leiden mutation, Magnetic resonance imaging head, Palliative care, Seizure, Superior sagittal sinus thrombosis
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 9
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levetiracetam 1000mg BID, levothyroxine 137 mcg
Current Illness: None
Preexisting Conditions: Obesity, hypothyroidism
Allergies: Flonase (dizziness), prednisone (confusion)
Diagnostic Lab Data: Single R506Q Factor V Leiden mutation on hypercoagulable panel, which I don''t think is significant. Otherwise, the pt did not have another reason (recent cranial surgery, dehydration, etc) to have this.
CDC Split Type:

Write-up: Patient developed cerebral venous sinus thrombosis (superior sagittal vein) and a large right occipito-parietal intracerebral hemorrhage. He developed epilepsy ~ a month prior to his presentation and there was a possible meningioma seen on a prior MRI - he was started on levetiracetam and had a follow-up appt but had his hemorrhage first. The patient had a seizure upon arrival and was intubated. Ultimately, we have pursued palliative care this afternoon.


VAERS ID: 1536899 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-19
Onset:2021-03-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebrovascular accident, Coma, Confusional state, Death, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-24
   Days after onset: 4
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: I am not sure of what types but he was on blood thinners, type 2 diabetic and other health issues
Current Illness:
Preexisting Conditions: Type 2 diabetic several stints and pacemaker
Allergies: unknown
Diagnostic Lab Data: None as I know of . To be honest any healthcare person we talked to or dealt with played off the fact he was just given the vaccine before death. Which I am also frustrated with the fact no autopsy performed which given the information we gave the nurses etc doesn''t make sense to me
CDC Split Type:

Write-up: 1 -2 days after the first dose he started getting confused . 3rd day we admitted him to the hospital . At one point they thought or were testing about his brain bleeding . Roughly after 4 days in the hopsital his body crashed he was in a coma and then died roughly 14 days after the injection on March 24, 2021. He died of an acute intracerebral hemorrhage which we were told he had a blood clot then stroke


VAERS ID: 1549114 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-09
Onset:2021-02-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA/039K20A / UNK RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral thrombosis, Cerebrovascular accident, Dizziness, Fatigue, Illness, Ischaemic stroke, Pain, Vision blurred
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-06-02
   Days after onset: 107
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 101 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NA
Preexisting Conditions: None
Allergies: Penicillin Aspirin Tylenol
Diagnostic Lab Data: Hospital has this information
CDC Split Type:

Write-up: After the shot, sick, tired, aches and pains for two - three days. Day 3 - 5 Dizziness, blurred vision. Day 5 went to the hospital, ER found sign of stroke. Day 7 saw a neurologist, was told that a stroke occurred, but was not sure if it was new or old. Day 12, massive Ischemic Stroke followed by multiple hemorrhages. The Clot left a 10mm hole in the left side of the brain.


VAERS ID: 1554249 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-28
Onset:2021-08-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Syncope, Thrombosis
SMQs:, Torsade de pointes/QT prolongation (broad), 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, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: moderna vaccine
Current Illness: no known illnesses
Preexisting Conditions: no known medical conditions
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Clot resulted in a stroke; was leaving a checkup with the doctor when she collapsed. August 3rd 4:30pm; passed away 7 hours later at 11:30pm.


VAERS ID: 1574074 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-10
Onset:2021-05-26
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A-1 / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Anticoagulant therapy, Aspartate aminotransferase increased, Blood bicarbonate decreased, Blood bilirubin increased, Blood creatinine increased, Blood lactic acid, Computerised tomogram abdomen, Computerised tomogram liver, Computerised tomogram pelvis, Death, General physical health deterioration, Hepatic ischaemia, Intestinal ischaemia, Mesenteric vein thrombosis, Multiple organ dysfunction syndrome, Platelet count decreased, Portal vein thrombosis, Scan with contrast, Septic shock, Thrombectomy, Venogram, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   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: None
Current Illness: None
Preexisting Conditions: Hypertension, Hyperlipidemia
Allergies: None
Diagnostic Lab Data: 5/26: CT abdomen and pelvis with contrast 5/27: CT 3 phase liver with and without contrast 5/28: IR venogram and thrombectomy lactate 10.1 ALT 3378 AST 3700 Bilirubin 4.0 Creatinine 3.03 WBC 25,000 Platelets 60 Bicarbonate 19
CDC Split Type:

Write-up: 69 year old male who presented with abdominal pain due to mesenteric venous thrombosis of the portal vein / superior mesenteric vein confluence. He was managed medically with therapeutic heparin anticoagulation, however he rapidly progressed in less than 24 hours despite medical therapy to having extensive superior mesenteric vein thrombosis and portal vein thrombosis causing bowel and liver ischemia with septic shock. He went to Interventional Radiology and underwent extensive thrombectomy, however he was too unstable to undergo surgery for resection of dead bowel and died secondary to septic shock and multi organ failure.


VAERS ID: 1582680 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-14
Onset:2021-02-17
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Dyspnoea, Incomplete course of vaccination, Lymphadenopathy, Productive cough, Pulmonary thrombosis, Swelling
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 117
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Staton
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt.''s Wife states that after receiving the 1st dose of Moderna 02/14/2021, started experiencing symptoms 02/17/2021 of head swelling, swelling in the Lymphoids lasting 3 weeks, shortness of breath, coughing up mucus, passed away from from Blood Clots in the lungs 06/15/2021. Primary visit (no tests) treated with Antibiotics for 2 months, noted as Congestive Heart Failure. Primary recommendation to not receive the 2nd dose of Moderna.


VAERS ID: 1623388 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-04
Onset:2021-03-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Death, Headache, Internal haemorrhage, Nausea, Organ failure, Thrombosis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (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), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisentapril
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: Blood Work 03/07/2021
CDC Split Type:

Write-up: Pt.''s daughter states that after her Mother received the 2nd dose of Moderna 03/04/2021, started experiencing symptoms 03/05/2021 with nausea, vomiting, and severe headache. ER visit 03/07/2021 noted internal bleeding (treated with coils) 03/15/2021 discharged. Blood clot located *heparin treated. No resolve, made comfortable and passed away 03/18/2021 03:00pm. Blood Clot blocking blood flow to bowels. No noted Autopsy, Cause of Death listed (Organ Failure)


VAERS ID: 1623471 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-24
Onset:2021-08-04
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Arteriosclerosis coronary artery, Atelectasis, Atypical pneumonia, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Chest tube insertion, Echocardiogram abnormal, Endotracheal intubation, Fluid overload, Goitre, Interstitial lung disease, Lung consolidation, Lung infiltration, Lung opacity, Pericardial effusion, Pleural effusion, Pneumomediastinum, Pneumonia, Pneumothorax, Pulmonary congestion, Pulmonary oedema, Scan with contrast abnormal, Subcutaneous emphysema, Thrombophlebitis superficial, Thrombosis, Thyroid calcification, Ultrasound Doppler abnormal, Vascular calcification
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), 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), 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 (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-19
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD B-12 drops Gabapentin 300 mg BID Gabapentin 900 mg QHS Imdur 30 mg 24H tabpet QD Hyzaar 100/12.5 mg QD Lovastatin 40 mg QD Omega 3 fish oil 100/160/1000 mg QD Potassium chloride 20 MEQ QD Trazodone 160 mg QHS Effexor-XR 150
Current Illness:
Preexisting Conditions: DMII without insulin Vascular disease High blood pressure
Allergies: Sulfa drugs
Diagnostic Lab Data: 8/9/2021 Echo 2D: 1: Extensive interstitial and alveolar infiltrates throughout both lungs. This may represent pneumonic infiltrate and/or pulmonary edema. 2: Trace pleural fluid 3: Cardiomegaly with coronary artery and other vascular calcifications and trace pericardial effusion. 4: No evidence of pneumothorax or pneumomediastinum. 8/4/2021 Portable CXR: Hazy opacity in the left lung baser possibly due to a small pleural effusion associated with atelectasis or pneumonia. Patchy opacities in the midlung fields bilaterally possibly related to atelectasis or pneumonia. Cardiac silhouette is enlarged. 8/6/2021 Portable CXR: 1: Cardiomegaly 2: Marked worsening of bilateral upper lobe perihilar interstitial patchy opacities. Worsening of bibasilar infrahilar interstitial patchy opacities. This would be suspicious for worsening multifocal pneumonia including atypical viral etiology and/or pulmonary edema. 8/7/2021 Portable CXR: There is stable and significant bilateral vascular congestion, suspicious for underlying changes of volume overload. Superimposed infiltrates in the right upper, mid, and lower lung zone and in the left perihilar region are noted. 8/8/2021 Portable CXR: Congestive heart failure. No significant change. 8/9/2021 Portable CXR: Extensive interstitial and bilateral airspace disease is similar though has mildly improved relative to 8/8/2021. This again likely reflects at least a component of infection, though edema could also be contributing to this appearance. 8/10/2021 Portable CXR: Interval worsening in the diffuse groundglass infiltrates throughout the lungs is present. Findings suggest worsening infectious and/or edematous process. 8/10/2021 Portable CXR: 1: Endotracheal tube in place. 2: Extensive bilateral airspace disease, stable since earlier today and again infectious in appearance. 3: Pneumomediastinum, also present previously. 8/11/2021 Portable CXR: There has been interval development of a moderate to large pneumothorax. 8/12/2021 Portable CXR: 1: No pneumothorax. 2: Persistent diffuse interstitial infiltrates with superimposed left lower lobe atelectasis/consolidation. 8/13/2021 Portable CXR: 1: There is minimal right apical pneumothorax which is probably better delineated on today''s exam and is likely unchanged. 2: There is relative stability of the bilateral interstitial and alveolar infiltrates. 8/15/2021 Portable CXR: No significant change. 8/16/2021 Portable CXR: 1: Endotracheal tube in place as above. 2: Extensive opacity throughout both lungs appearing increased. 8/17/2021 Portable CXR: No significant interval change 8/18/2021 Portable CXR: No significant interval change 8/19/2021 Portable CXR: 1: Worsening pneumomediastinum with development of subcutaneous emphysema in the soft tissue of the neck. 2: Right-sided chest tube in place without pneumothorax. 3: Persistent extensive interstitial infiltrates with left lower lobe atelectasis. 8/9/2021 CTA chest with contrast: No evidence of central pulmonary embolism. Assessment of branches of pulmonary artery distal to the segmental branches are limited due to suboptimal contrast. Bilateral diffuse groundglass opacities in the lung parenchyma, with consolidation in the mid to lower lung on both sides, due to COVID-19 pneumonia. Mild to moderate pneumomediastinum extending to the base of the neck. Cardiomegaly with trace amount of pericardial effusion. Goitrous change of bilateral thyroid glands with calcification on the left measuring 4.4 mm. 8/10/2021 VL lower extremity venous imaging bilateral: 1: Thrombus within right gastrocnemius vein with is a branch vessel of the right popliteal vein. 2: Thrombus proximal left greater saphenous vein at a level estimated to be within approximately 5 cm. of the junction with the left common femoral vein. 3: Thrombus within a superficial vein at the level of the distal left calf likely in the distal left grater saphenous vein. 4: Portions of the mid to distal left femoral vein could bot be adequately imaged for assessment as detailed above.
CDC Split Type:

Write-up: Acute respiratory failure secondary to COVID-19 infection


VAERS ID: 1623782 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-08-07
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Angiogram pulmonary normal, Atelectasis, COVID-19, Cardiac failure congestive, Deep vein thrombosis, Hyponatraemia, Lung opacity, Pleural effusion, Pneumonia viral, Scan with contrast normal, Septic shock, Ultrasound Doppler abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), 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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Hyponatraemia/SIADH (narrow), 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 (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD Atorvastatin 20 mg QD Donepezil 5 mg QHS Metoprolol 25 mg 24H tablet QD Valsartan-HCTZ 160/12.5 mg QD
Current Illness: Unknown
Preexisting Conditions: Vascular disease Alzheimers High blood pressure
Allergies: Unknown
Diagnostic Lab Data: 8/6/2021: CTA chest pulmonary embolism with contrast: No evidence of pulmonary embolism. There are small bilateral pleural effusions and bibasilar atelectasis. Geographic areas of groundglass attenuation are noted throughout both lungs suspicious for pneumonia, congestive heart failure, or other inflammatory process. 8/10/2021 VL lower extremity bilateral venous imaging: 1: Popliteal vein DVT. 2: No sonographic evidence of left lower extremity DVT.
CDC Split Type:

Write-up: Discharge diagnosis: Acute hypoxic respiratory failure secondary to viral pneumonia in the setting of COVID-19 Acute kidney injury Septic shock Right popliteal DVT Hyponatremia


VAERS ID: 1624286 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-04-07
Onset:2021-04-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-17
   Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood clots in both lungs.


VAERS ID: 1625270 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-08
Onset:2021-08-10
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute hepatic failure, Anticoagulant therapy, Cerebral venous thrombosis, Death, Infusion, Mesenteric venous occlusion, Superior mesenteric artery syndrome, Thrombectomy
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal obstruction (narrow), Thrombophlebitis (broad), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 13
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: HRT
Current Illness:
Preexisting Conditions: Breast Ca s/p resection on HRT (2016)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4 month after completing immunization series patient noted with SMA, SMV, and cerebral venous thrombus. Report from outside hospital show that the SMA had collateralization in August suggestive of a chronic occlusion s/p thrombectomy with TPA infusion the patient develped ALF and died on 8/23


VAERS ID: 1644373 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hepatic failure, Portal vein thrombosis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: liver failure; developed a clot in her portal vein; This spontaneous case was reported by a consumer and describes the occurrence of PORTAL VEIN THROMBOSIS (developed a clot in her portal vein) and HEPATIC FAILURE (liver failure) in an 85-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002A21A and 041L20A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Diabetes. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PORTAL VEIN THROMBOSIS (developed a clot in her portal vein) (seriousness criteria death, hospitalization and medically significant) and HEPATIC FAILURE (liver failure) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was Liver failure. It is unknown if an autopsy was performed. It was reported that the reporter believed that her mother passed away as a result of a complication with the vaccine. Patient''s mother received first dose on 28-JAN-2021. Patient received second dose one 26-FEB-2021. The patient was 85-year-old with hypertension and diabetes and developed a clot in her portal vein. Patient was hospitalized. The clot made her go into liver failure which was the cause of death. The date of the reported events remained unknown at the time of the report. Treatment information were not provided by the reporter. Concomitant medications were not reported by reporter. Company Comment: This is the case of an 85-year-old female subject with a history of hypetension and diabetes who died due to hepatic falure. Reportedly, the patient initially developed thrombosis in portal vein (a clot in her portal vein), however a temporal association between the use of the product and the start date of the event was not reported. The patient subsequently developed liver failure and died due to liver failure, as reported, however, the date of death was not provided. It is unknown if an autopsy was performed. Very limited information regarding these events has been provided at this time. Causality is confounded with the patient''s advanced age, hypertension and diabetes.; Sender''s Comments: This is the case of an 85-year-old female subject with a history of hypetension and diabetes who died due to hepatic falure. Reportedly, the patient initially developed thrombosis in portal vein (a clot in her portal vein), however a temporal association between the use of the product and the start date of the event was not reported. The patient subsequently developed liver failure and died due to liver failure, as reported, however, the date of death was not provided. It is unknown if an autopsy was performed. Very limited information regarding these events has been provided at this time. Causality is confounded with the patient''s advanced age, hypertension and diabetes.; Reported Cause(s) of Death: Liver failure


VAERS ID: 1644390 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Blood clots; This spontaneous case was reported by a consumer and describes the occurrence of THROMBOSIS (Blood clots) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced THROMBOSIS (Blood clots) (seriousness criteria death, hospitalization and medically significant). The reported cause of death was blood clots. It is unknown if an autopsy was performed. The concomitant medication was not reported. A consumer called and stated that his uncle passed away 2 days after receiving Moderna Covis-19 Vaccine. Reporter stated that his uncle had to go to ICU due to blood clots and died from it. No treatment medication information was provided. This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Sender''s Comments: This is a case of death of a Male subject who passed away two days after receiving the vaccine. Very limited information regarding the event has been provided at this time. No further information is expected.; Reported Cause(s) of Death: blood clots


VAERS ID: 1644561 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-03-01
Onset:2021-04-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, Back pain, Burning sensation, Cerebral thrombosis, Cerebrovascular accident, Chills, Diarrhoea, Fall, Gastrointestinal pain, Haemorrhage, Headache, Lid sulcus deepened, Muscle spasms, Pain in extremity, Pyrexia, Swelling face, Thrombosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (Codeine allergy); Penicillin allergy (penicillin allergy).
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Hysterectomy.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: she ends up bleeding; Swollen face; Sunken eyes; Couldn''t speak; legs were cramping; burning legs; Blood clots on brain; Stroke; Blood clots on legs (left and right); stinging in leg; Fever; Diarrhea; Chills; Lower gut pain; Headache; back pain; Fall; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Stroke), THROMBOSIS (Blood clots on legs (left and right)), HAEMORRHAGE (she ends up bleeding), PYREXIA (Fever), DIARRHEA (Diarrhea), CHILLS (Chills), GASTROINTESTINAL PAIN (Lower gut pain), HEADACHE (Headache), PAIN IN EXTREMITY (stinging in leg), FALL (Fall), SWELLING FACE (Swollen face), LID SULCUS DEEPENED (Sunken eyes), APHASIA (Couldn''t speak), BACK PAIN (back pain), MUSCLE SPASMS (legs were cramping), BURNING SENSATION (burning legs) and CEREBRAL THROMBOSIS (Blood clots on brain) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Blood pressure high and Hysterectomy in 1981. Concurrent medical conditions included Penicillin allergy (penicillin allergy) and Drug allergy (Codeine allergy). In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Apr-2021, the patient experienced PYREXIA (Fever) (seriousness criterion hospitalization), DIARRHOEA (Diarrhea) (seriousness criterion hospitalization), CHILLS (Chills) (seriousness criterion hospitalization), GASTROINTESTINAL PAIN (Lower gut pain) (seriousness criterion hospitalization), HEADACHE (Headache) (seriousness criterion hospitalization) and BACK PAIN (back pain) (seriousness criterion hospitalization). On 11-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Stroke) (seriousness criteria death, hospitalization and medically significant), THROMBOSIS (Blood clots on legs (left and right)) (seriousness criteria hospitalization and medically significant), PAIN IN EXTREMITY (stinging in leg) (seriousness criterion hospitalization), MUSCLE SPASMS (legs were cramping) (seriousness criterion hospitalization), BURNING SENSATION (burning legs) (seriousness criterion hospitalization) and CEREBRAL THROMBOSIS (Blood clots on brain) (seriousness criteria hospitalization and medically significant). In 2021, the patient experienced FALL (Fall) (seriousness criterion hospitalization). In July 2021, the patient experienced SWELLING FACE (Swollen face) (seriousness criterion hospitalization), LID SULCUS DEEPENED (Sunken eyes) (seriousness criterion hospitalization) and APHASIA (Couldn''t speak) (seriousness criterion hospitalization). On an unknown date, the patient experienced HAEMORRHAGE (she ends up bleeding) (seriousness criteria hospitalization and medically significant). The patient was treated with Surgery (blood transfusion) for Thrombosis. The patient died on an unknown date. The reported cause of death was Stroke. It is unknown if an autopsy was performed. At the time of death, THROMBOSIS (Blood clots on legs (left and right)), HAEMORRHAGE (she ends up bleeding), PYREXIA (Fever), DIARRHOEA (Diarrhea), CHILLS (Chills), GASTROINTESTINAL PAIN (Lower gut pain), HEADACHE (Headache), PAIN IN EXTREMITY (stinging in leg), FALL (Fall), SWELLING FACE (Swollen face), LID SULCUS DEEPENED (Sunken eyes), APHASIA (Couldn''t speak), BACK PAIN (back pain), MUSCLE SPASMS (legs were cramping), BURNING SENSATION (burning legs) and CEREBRAL THROMBOSIS (Blood clots on brain) outcome was unknown. Patient was sent to the hospital that day and several tests were conducted like urine and Pet scan. No pulse on her legs as per husband and it also revealed that she had blood clots on both her left and right leg. She had 3 surgeries to take out the blood clot, however, she ended up bleeding. It got worse and hit her brain but fortunately, she did some therapy and after about 6 weeks, she was progressing well. Added that she fell three times in 2 days as per husband. Three weeks ago, he could not remember the exact date at around 7:15PM, he found his wife with swollen face, sunken eyes and couldn''t speak. That day, he called 911 and was sent at the medical facility and was referred to a neurologist. They found out that she had massive blood clot on her brain that keeps on leaking and major stroke. She laid there for 3 days and the doctor told the husband that brain scan showed worst results and so they decided to remove her breathing tool and or extubated. She lasted for about 12 hours and died. No concomitant drugs were provided. Company comment Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Reported Cause(s) of Death: Stroke


VAERS ID: 1651218 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-10
Onset:2021-08-03
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 07B21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac, Cerebrovascular accident, Computerised tomogram head abnormal, Death, Infarction, Intensive care, Neurological symptom, Thrombosis, Vascular operation
SMQs:, Myocardial infarction (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), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-27
   Days after onset: 24
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:
Current Illness: Diabetes and CHF.
Preexisting Conditions: Diabetes and CHF.
Allergies:
Diagnostic Lab Data: Left Heart Cath likely 8/4 or 8/5/21, CT of brain 8/8/21, Vascular surgery 8/25 or 8/26/21
CDC Split Type:

Write-up: Patient with history of diabetes and CHF came in for non-ST elevated myocardial infarction on 8/3/21 for Left Heart Cath. Another admission on 8/8/21 for stroke-like symptoms, CT scan of head revealed acute-subacute infarction. Patient had extended stay in hospital, suffering a second stroke. Then underwent vascular surgery on either 8/25/21 or 8/26/21 to remove thrombus (blood clot) in one leg. After surgery went to ICU for recovery, and was transferred to floor bed after one day. He expired (passed away) on 8/27/21.


VAERS ID: 1202944 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, Cerebral thrombosis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 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: Medical History/Concurrent Conditions: Diabetes; Ehlers-Danlos syndrome; Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type: SEMODERNATX, INC.MOD20210

Write-up: This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 02-Apr-2021 and was forwarded to Moderna on 02-Apr-2021. This regulatory authority case was reported by an other and describes the occurrence of BLOOD GLUCOSE INCREASED and CEREBRAL THROMBOSIS in a 76-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included Diabetes, Ehlers-Danlos syndrome and Hypertension. In February 2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. In February 2021, the patient experienced BLOOD GLUCOSE INCREASED (seriousness criterion death) and CEREBRAL THROMBOSIS (seriousness criterion death). The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (COVID 19 Vaccine Moderna) (Unknown Route) was unknown. Treatment information was not provided. Concomitant medications were not reported. Very limited information regarding these events has been provided at this time. The events are probably related to the patient''s comorbidities. Reporter did not allow further contact; Sender''s Comments: Very limited information regarding these events has been provided at this time. The events are probably related to the patient''s comorbidities; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1257553 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-09
Onset:2021-03-18
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000489 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, Blood pressure measurement, Blood test, Chest pain, Colonoscopy, Death, Endoscopy upper gastrointestinal tract, Haemoglobin, Haemorrhage, Infarction, Pulmonary oedema, Thrombosis
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 3
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: Aortic stenosis (Moderate); Chronic disease (Severe); Hypercholesteraemia; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210318; Test Name: Blood pressure; Result Unstructured Data: Hypovolemic shock; Test Name: Blood test; Test Result: Inconclusive ; Result Unstructured Data: Broad arrange of blood tests; Test Date: 20210318; Test Name: Colonoscopy; Result Unstructured Data: left colon filled with clots.; Test Date: 20210318; Test Name: Gastroscopy; Result Unstructured Data: left colon filled with clots.; Test Date: 20210318; Test Name: Hemoglobin; Test Result: Inconclusive ; Result Unstructured Data: 2.8 Not specified
CDC Split Type: DKMODERNATX, INC.MOD20210

Write-up: Altered state of consciousness; During wake up at the hospital the PT develops high pressure lung oedema; Type II infarction; Acute gastro- and colonoscopy finds the left colon filled with clots.; Chest pain; death; Bleeding; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 20-Apr-2021 and was forwarded to Moderna on 20-Apr-2021. This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (death), HAEMORRHAGE (Bleeding), ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness), PULMONARY OEDEMA (During wake up at the hospital the PT develops high pressure lung oedema), INFARCTION (Type II infarction), THROMBOSIS (Acute gastro- and colonoscopy finds the left colon filled with clots.) and CHEST PAIN (Chest pain) in an 85-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3000489) for COVID-19 vaccination. Concurrent medical conditions included Hypertension, Aortic stenosis (Moderate), Hypercholesteraemia and Chronic disease (Severe). On 09-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 18-Mar-2021, the patient experienced HAEMORRHAGE (Bleeding) (seriousness criterion death), ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness) (seriousness criterion hospitalization), PULMONARY OEDEMA (During wake up at the hospital the PT develops high pressure lung oedema) (seriousness criterion hospitalization), INFARCTION (Type II infarction) (seriousness criterion hospitalization), THROMBOSIS (Acute gastro- and colonoscopy finds the left colon filled with clots.) (seriousness criterion hospitalization) and CHEST PAIN (Chest pain) (seriousness criterion hospitalization). The patient died on 21-Mar-2021. The reported cause of death was Circulatory failure, Bleeding and Chronic disease. An autopsy was not performed. At the time of death, ALTERED STATE OF CONSCIOUSNESS (Altered state of consciousness), PULMONARY OEDEMA (During wake up at the hospital the PT develops high pressure lung oedema), INFARCTION (Type II infarction), THROMBOSIS (Acute gastro- and colonoscopy finds the left colon filled with clots.) and CHEST PAIN (Chest pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Mar-2021, Blood pressure measurement: 80/40 mmhg (Low) Hypovolemic shock. On 18-Mar-2021, Colonoscopy: abnormal (abnormal) left colon filled with clots.. On 18-Mar-2021, Endoscopy upper gastrointestinal tract: abnormal (abnormal) left colon filled with clots.. On 18-Mar-2021, Haemoglobin: incocnclusive (Inconclusive) 2.8 Not specified. On an unknown date, Blood test: incocnclusive (Inconclusive) Broad arrange of blood tests. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Company Comment: This is a case of death in a 85-year-old male subject with a medical history of Hypertension, Aortic stenosis (Moderate), Hypercholesterolemia and unspecified chronic disease, who died 12 days after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible. Reporter did not allow further contact; Sender''s Comments: This is a case of death in a 85-year-old male subject with a medical history of Hypertension, Aortic stenosis (Moderate), Hypercholesterolemia and unspecified chronic disease, who died 12 days after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: Circulatory failure; Bleeding; Chronic disease


VAERS ID: 1260491 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000494 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Cyanosis, Death, Deep vein thrombosis, Oedema, Pain in extremity, Pyrexia, Ultrasound Doppler, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: FUROSEMIDE; RAMIPRIL; GLYCERYL TRINITRATE; POTASSIUM CANRENOATE; IVABRADINE; LOPRESOR [METOPROLOL FUMARATE]
Current Illness: Angina pectoris; Cardiac failure; Hyperaldosteronism; Hypertension arterial
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210405; Test Name: body temperature; Result Unstructured Data: 37.2 degree celsius; Test Name: Ultrasound Doppler; Test Result: Inconclusive ; Result Unstructured Data: not provided
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death), DEEP VEIN THROMBOSIS, PAIN IN EXTREMITY, OEDEMA , PYREXIA , CYANOSIS and VOMITING in a 93-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3000494) for COVID-19 vaccination. Concurrent medical conditions included Cardiac failure, Hypertension arterial, Angina pectoris and Hyperaldosteronism. Concomitant products included GLYCERYL TRINITRATE and IVABRADINE for Angina pectoris, FUROSEMIDE for Cardiac failure, POTASSIUM CANRENOATE for Hyperaldosteronism, RAMIPRIL and METOPROLOL FUMARATE (LOPRESOR [METOPROLOL FUMARATE]) for Hypertension arterial. On 01-Apr-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form in total. On 05-Apr-2021, the patient experienced DEEP VEIN THROMBOSIS (seriousness criterion medically significant), PAIN IN EXTREMITY (seriousness criterion medically significant), OEDEMA (seriousness criterion medically significant), PYREXIA (seriousness criterion medically significant), CYANOSIS (seriousness criterion medically significant) and VOMITING (seriousness criterion medically significant). The patient died on 06-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DEEP VEIN THROMBOSIS, PAIN IN EXTREMITY, OEDEMA, PYREXIA , CYANOSIS and VOMITING outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 05-Apr-2021, Body temperature: 37.2 degree celcius (abnormal) 37.2 degree celsius. On an unknown date, Ultrasound Doppler: not provided (Inconclusive) not provided. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. The action taken with mRNA-1273 in response to the event was not applicable. No treatment information was provided. Company comment: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Event of death added as none of the reported events are likely to directly result in death but could have contributed to the fatal outcome. Reporter did not allow further contact; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Event of death added as none of the reported events are likely to directly result in death but could have contributed to the fatal outcome.; Reported Cause(s) of Death: Death


VAERS ID: 1309030 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20211

Write-up: pulmonary embolism; The day of the vaccine, the ankle was very swollen (photo material as evidence); leg / ankle thrombosis; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 29-Apr-2021 and was forwarded to Moderna on 29-Apr-2021. This regulatory authority case was reported by a consumer and describes the occurrence of THROMBOSIS (The day of the vaccine, the ankle was very swollen (photo material as evidence); leg / ankle thrombosis) and PULMONARY EMBOLISM (pulmonary embolism) in a 70-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 31-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 31-Mar-2021, the patient experienced THROMBOSIS (The day of the vaccine, the ankle was very swollen (photo material as evidence); leg / ankle thrombosis) (seriousness criterion death). On 07-Apr-2021, the patient experienced PULMONARY EMBOLISM (pulmonary embolism) (seriousness criteria death and medically significant). The patient died on 07-Apr-2021. The reported cause of death was pulmonary embolism presumably from thrombotic. It is unknown if an autopsy was performed. No concomitant medication reported. No treatment information was provided. Very limited information regarding these events has been provided at this time. The events are probably related to the patient''s comorbidities, further information required. Most recent FOLLOW-UP information incorporated above includes: On 29-Apr-2021: Translation received; The event verbatim changed for both the events and the stop date for the event thrombosis leg updated; Sender''s Comments: Very limited information regarding these events has been provided at this time. The events are probably related to the patient''s comorbidities, further information required.; Reported Cause(s) of Death: Pulmonary embolism presumably from thrombotic


VAERS ID: 1380474 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-09
Onset:2021-04-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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: 2021-04-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Heart disease, unspecified (The patient was taking heart medications); Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PLMODERNATX, INC.MOD20211

Write-up: Possibly thrombosis; This regulatory authority case was reported by a consumer and describes the occurrence of THROMBOSIS (Possibly thrombosis) in a 63-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Hypertension and Heart disease, unspecified (The patient was taking heart medications). On 09-Apr-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, after starting mRNA-1273 (Moderna CoviD-19 Vaccine), the patient experienced THROMBOSIS (Possibly thrombosis) (seriousness criteria death and medically significant). The patient died on 20-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant product use was reported as heart medications (not otherwise specified). Treatment information was not provided. Very limited information regarding this event has been provided at this time. Further information cannot be requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information cannot be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1418591 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-17
Onset:2021-04-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042722 / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 41
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CACIT VITAMINE D3 1000 mg/880 MONOPROST 50 microgrammes/ml, ; LACTULOSE; HYDROCHLOROTHIAZIDE; KARDEGIC 75 mg, ; CARDENSIEL 1,25 mg, ; IRBESARTAN; STAGID 700 mg,
Current Illness: Hypertension arterial; Type 2 diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210401; Test Name: CT angiography; Test Result: Inconclusive ; Result Unstructured Data
CDC Split Type: FRMODERNATX, INC.MOD20212

Write-up: Double thrombose pulmonaire; This regulatory authority case was reported by a consumer and describes the occurrence of PULMONARY THROMBOSIS (Double thrombose pulmonaire) in a 91-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 300042722) for COVID-19 vaccination. Concurrent medical conditions included Type 2 diabetes mellitus and Hypertension arterial. Concomitant products included CACIT VITAMINE D3 1000 mg/880 UI, LATANOPROST (MONOPROST 50 microgrammes/ml), LACTULOSE, HYDROCHLOROTHIAZIDE, KARDEGIC 75 mg, , CARDENSIEL 1,25 mg, comprim? pellicul?, IRBESARTAN and STAGID 700 mg, comprim? s?cable for an unknown indication. On 17-Mar-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 01-Apr-2021, the patient experienced PULMONARY THROMBOSIS (Double thrombose pulmonaire) (seriousness criteria death and medically significant). The patient died on 12-May-2021. The reported cause of death was Pulmonary thrombosis. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 01-Apr-2021, Angiogram: embolie pulmonaire (Inconclusive) embolie pulmonaire proximale bilat?rale avec signes de gravit?. Treatment information was not provided. On an unknown date, the patient had a COVID-19 PCR test that was negative. Very limited information regarding the event has been provided at this time. Further information is not expected. Sender''s Case Number: FR-AFSSAPS-2021065147. Most recent FOLLOW-UP information incorporated above includes: On 15-Jun-2021: Follow up was received on 15 Jun 2021. Updated the date of death, added medical history, concomitant medications, batch number, the start and end date of event.; Sender''s Comments: Very limited information regarding the event has been provided at this time. Further information is not expected.; Reported Cause(s) of Death: Pulmonary thrombosis


VAERS ID: 1421010 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Arterial hypertension; Cardiac arrhythmia; Diabetes mellitus, antepartum
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a consumer and describes the occurrence of PULMONARY EMBOLISM and THROMBOSIS in an 80-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included COVID-19 in January 2021. Concurrent medical conditions included Arterial hypertension, Diabetes mellitus, antepartum and Cardiac arrhythmia. On 17-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PULMONARY EMBOLISM (seriousness criteria death and medically significant) and THROMBOSIS (seriousness criterion medically significant). The patient died on 12-May-2021. The reported cause of death was Lung embolism. An autopsy was performed, but no results were provided. At the time of death, THROMBOSIS had not resolved. No concomitant medications were provided. No treatment was reported for the events. Action taken with the suspect product was not applicable. This is a case of an 80-year-old female patient with a history of arterial hypertension, diabetes mellitus, and cardiac arrhythmia who experienced thrombosis and lung embolism which resulted in fatal outcome three weeks following second dose of the vaccine. An autopsy was performed, but no results were provided. Very limited information has been provided at this time. Causality is confounded with patient''s advanced age and reported medical history.; Sender''s Comments: This is a case of an 80-year-old female patient with a history of arterial hypertension, diabetes melitus, and cardiac arrhytmia who experienced thrombosis and lung embolism which resulted in fatal outcome three weeks following second dose of the vaccine. An autopsy was performed, but no results were provided. Very limited information has been provided at this time. Causality is confouded with patient''s advanced age and reported medical history.; Reported Cause(s) of Death: Lung embolism


VAERS ID: 1431597 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-28
Onset:2021-05-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002186 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Cerebral artery thrombosis, Cerebral infarction
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   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: GALANTAMINE; LOSATRIX; PLAVIX; NITROSID; PIOGLITAZONE; PARACETAMOL; SIMVASTATIN; ATENBLOCK; TRAJENTA
Current Illness:
Preexisting Conditions: Comments: No medical history was provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: FIMODERNATX, INC.MOD20212

Write-up: Atrial fibrillation; Cerebral infarction; Middle cerebral artery thrombosis; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 18-Jun-2021 and was forwarded to Moderna on 18-Jun-2021. This regulatory authority case was reported by a physician and describes the occurrence of ATRIAL FIBRILLATION (Atrial fibrillation), CEREBRAL INFARCTION (Cerebral infarction) and CEREBRAL ARTERY THROMBOSIS (Middle cerebral artery thrombosis) in an 86-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002186) for COVID-19 vaccination. No medical history was provided. Concomitant products included GALANTAMINE, LOSARTAN POTASSIUM (LOSATRIX), CLOPIDOGREL BISULFATE (PLAVIX), ISOSORBIDE DINITRATE (NITROSID), PIOGLITAZONE, PARACETAMOL, SIMVASTATIN, ATENOLOL (ATENBLOCK) and LINAGLIPTIN (TRAJENTA) for an unknown indication. On 28-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 29-May-2021, the patient experienced ATRIAL FIBRILLATION (Atrial fibrillation) (seriousness criteria death and medically significant), CEREBRAL INFARCTION (Cerebral infarction) (seriousness criteria death and medically significant) and CEREBRAL ARTERY THROMBOSIS (Middle cerebral artery thrombosis) (seriousness criteria death and medically significant). The patient died on 01-Jun-2021. The reported cause of death was Cerebral infarction. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. The action taken with mRNA-1273 in response to the events was not applicable since the patient died. This fatal case concerns an 86-year-old female with serious unexpected events of atrial fibrillation, cerebral infarction, and cerebral artery thrombosis. Event latency 2 days after first dose mRNA-1273. Event outcome death. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: This fatal case concerns an 86-year-old female with serious unexpected events of atrial fibrillation, cerebral infarction, and cerebral artery thrombosis. Event latency 2 days after first dose mRNA-1273. Event outcome death. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Cerebral infarction


VAERS ID: 1452864 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-25
Onset:2021-06-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Coronary artery thrombosis, Death, Ischaemic cardiomyopathy
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: GRMODERNATX, INC.MOD20212

Write-up: thrombosis in anterior descending branch of the left coronary artery; Death; Ischemic cardiomyopathy; This regulatory authority case was reported by a consumer and describes the occurrence of CORONARY ARTERY THROMBOSIS (thrombosis in anterior descending branch of the left coronary artery), DEATH (Death) and ISCHAEMIC CARDIOMYOPATHY (Ischemic cardiomyopathy) in a 57-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included ATORVASTATIN CALCIUM (LIPITOR) for an unknown indication. On 25-May-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. On 05-Jun-2021, the patient experienced CORONARY ARTERY THROMBOSIS (thrombosis in anterior descending branch of the left coronary artery) (seriousness criteria death and medically significant), DEATH (Death) (seriousness criteria death and medically significant) and ISCHAEMIC CARDIOMYOPATHY (Ischemic cardiomyopathy) (seriousness criteria death and medically significant). The patient died on 05-Jun-2021. The reported cause of death was atherosclerotic coronary lesions. An autopsy was performed, but no results were provided. Treatment information was not provided. Action taken with mRNA-1273 (Moderna COVID-19 Vaccine) in response to the event was not applicable. Very limited information regarding this events has been provided at this time. Further information is not expected.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information is not expected.; Reported Cause(s) of Death: atherosclerotic coronary lesions


VAERS ID: 1455223 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-30
Onset:2021-05-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001532 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hepatic vein thrombosis, Platelet count, Pulmonary embolism, Pyrexia, Raynaud's phenomenon, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Rectal cancer metastatic
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Platelet count; Test Result: Inconclusive ; Result Unstructured Data: 52000; Test Date: 20210613; Test Name: Platelet count; Test Result: Inconclusive ; Result Unstructured Data: 370000
CDC Split Type: ESMODERNATX, INC.MOD20212

Write-up: Tromboembolia pulmonar; Thrombopenia; Trombosis de vena hep?tica; Raynaud; Fiebre; This regulatory authority case was reported by a physician and describes the occurrence of HEPATIC VEIN THROMBOSIS (Trombosis de vena hep?tica), PULMONARY EMBOLISM (Tromboembolia pulmonar), THROMBOCYTOPENIA (Thrombopenia), RAYNAUD''S PHENOMENON (Raynaud) and PYREXIA (Fiebre) in a 64-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch nos. 3002183 and 3001532) for COVID-19 vaccination. The patient''s past medical history included Rectal cancer metastatic and COVID-19 (Covid-19) in September 2020. On 30-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 28-May-2021, received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 28-May-2021, the patient experienced RAYNAUD''S PHENOMENON (Raynaud) (seriousness criterion hospitalization) and PYREXIA (Fiebre) (seriousness criterion hospitalization). On 03-Jun-2021, the patient experienced HEPATIC VEIN THROMBOSIS (seriousness criteria death, hospitalization and medically significant) and THROMBOCYTOPENIA (Thrombopenia) (seriousness criteria hospitalization and medically significant). On 17-Jun-2021, the patient experienced PULMONARY EMBOLISM (Tromboembolia pulmonar) (seriousness criteria death, hospitalization and medically significant). On 13-Jun-2021, THROMBOCYTOPENIA (Thrombopenia) had resolved. In June 2021, RAYNAUD''S PHENOMENON (Raynaud) and PYREXIA (Fiebre) had resolved. The patient died on an unknown date. The reported cause of death was thrombosis and tromboembolia pulmonar. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Jun-2021, Platelet count: 52000 cells per microlitre (Inconclusive) 52000. On 13-Jun-2021, Platelet count: 370000 cells per microlitre (Inconclusive) 370000. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company comment Very limited information regarding events (hepatic vein thrombosis and pulmonary embolism) has been provided at this time. Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Sender''s Comments: Very limited information regarding events (hepatic vein thrombosis and pulmonary embolism) has been provided at this time. Based on the current available information and temporal association between the use of the product and the start date of the rest of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death; Tromboembolia pulmonar


VAERS ID: 1467705 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-10
Onset:2021-06-23
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Circulatory collapse
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-25
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a consumer and describes the occurrence of CIRCULATORY COLLAPSE and CEREBRAL VENOUS SINUS THROMBOSIS in a 68-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 10-Jun-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 23-Jun-2021, the patient experienced CIRCULATORY COLLAPSE (seriousness criteria death and medically significant) and CEREBRAL VENOUS SINUS THROMBOSIS (seriousness criteria death and medically significant). The patient died on 25-Jun-2021. The reported cause of death was Thrombosis of venous sinuses. An autopsy was not performed. The concomitant medications were not reported. The treatment information was not provided. Action taken with mRNA-1273 in response to the event was not applicable. This is a case of sudden death in a 68-year-old male subject, who died 15 days after receiving second dose of vaccine. Very limited information has been provided at this time. Very limited information has been provided at this time. Reported Cause(s) of Death: Thrombosis of venous sinuses


VAERS ID: 1548821 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-29
Onset:2021-06-12
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001530 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arterial thrombosis, Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-14
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acid reflux (esophageal) (segnalato reflusso, data diagnosi esatta non nota, trattato dal 10.12.2013,); Hip replacement (protesi anca destra)
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20212

Write-up: Thrombose der Arteria Basilaris; Thrombose der Arteria Basilaris; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of ISCHAEMIC STROKE (Thrombose der Arteria Basilaris) and ARTERIAL THROMBOSIS (Thrombose der Arteria Basilaris) in a 72-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch nos. 3001941 and 3001530) for COVID-19 vaccination. The patient''s past medical history included Acid reflux (esophageal) (segnalato reflusso, data diagnosi esatta non nota, trattato dal 10.12.2013,) and Hip replacement (protesi anca destra) in March 2021. Concomitant products included PANTOPRAZOLE from 10-Dec-2013 to 14-Jun-2021 for an unknown indication. On 29-Mar-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 26-Apr-2021, received second dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 12-Jun-2021, the patient experienced ISCHAEMIC STROKE (Thrombose der Arteria Basilaris) (seriousness criteria death, hospitalization and medically significant) and ARTERIAL THROMBOSIS (Thrombose der Arteria Basilaris) (seriousness criteria death and hospitalization). The patient died on 14-Jun-2021. The reported cause of death was Arterial thrombosis and Ischaemic stroke. An autopsy was not performed. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No treatment medication details was reported. Company comments: This is a case of ischaemic stroke and arterial thrombosis which caused the death of a 72-year-old male with history of acid reflux.. Very limited information has been provided at this time. No further information is expected. Reviewed pending translation.; Sender''s Comments: This is a case of ischaemic stroke and arterial thrombosis which caused the death of a 72-year-old male with history of acid reflux.. Very limited information has been provided at this time. No further information is expected. Reviewed pending translation.; Reported Cause(s) of Death: Arterial thrombosis; Ischaemic stroke


VAERS ID: 1574673 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-10
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? Yes
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: DEMODERNATX, INC.MOD20212

Write-up: Lung embolism; Thrombosis; This case was received via Regulatory Authority (Reference number: 202100135167) on 03-Aug-2021 and was forwarded to Moderna on 03-Aug-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of PULMONARY EMBOLISM (Lung embolism) and THROMBOSIS (Thrombosis) in a 68-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 10-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. On 17-Jun-2021, received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PULMONARY EMBOLISM (Lung embolism) (seriousness criteria death, medically significant and life threatening) and THROMBOSIS (Thrombosis) (seriousness criteria death, medically significant and life threatening). The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided. Company Comment: Very limited information regarding this events has been provided at this time. Further information will not be requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information will not be requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1574958 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-16
Onset:2021-04-16
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-12
   Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEMODERNATX, INC.MOD20212

Write-up: This case was received via Regulatory Authority (Reference number: 202100134331) on 04-Aug-2021 and was forwarded to Moderna on 04-Aug-2021. This regulatory authority case was reported by a consumer and describes the occurrence of THROMBOSIS in a 45-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 16-Apr-2021, the patient received dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 16-Apr-2021, the patient experienced THROMBOSIS (seriousness criteria death and medically significant). The patient died on 12-Jul-2021. The reported cause of death was Clot blood. An autopsy was not performed. Concomitant medication was not provided. Treatment information was not provided. Company comment: This case concerns a 45 year-old male patient who experienced the fatal unexpected event of thrombosis on the vaccination day. The patient died 2 months and 27 days after receiving the dose of the mRNA-1273 vaccine. Very limited information regarding this event has been provided at this time. Translation has been requested.; Sender''s Comments: This case concerns a 45 year-old male patient who experienced the fatal unexpected event of thrombosis on the vaccination day. The patient died 2 months and 27 days after receiving the dose of the mRNA-1273 vaccine. Very limited information regarding this event has been provided at this time. Translation has been requested.; Reported Cause(s) of Death: Clot blood


VAERS ID: 1586225 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Basilar artery thrombosis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-01
   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: DEMODERNATX, INC.MOD20212

Write-up: Gestorben 10 Stunden nach der Impfung basilaris Thrombose; This case was received via Regulatory Authority Agency (Reference number: 202100153191) on 10-Aug-2021 and was forwarded to Moderna on 10-Aug-2021. This Regulatory Authority case was reported by a consumer and describes the occurrence of BASILAR ARTERY THROMBOSIS (Gestorben 10 Stunden nach der Impfung basilaris Thrombose) in a 90-year-old male patient who received mRNA-1273 (Spikevax) for Prophylactic vaccination. No Medical History information was reported. On 01-Apr-2021, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 01-Apr-2021, the patient experienced BASILAR ARTERY THROMBOSIS (Gestorben 10 Stunden nach der Impfung basilaris Thrombose) (seriousness criteria death and medically significant). The patient died on 01-Apr-2021. The reported cause of death was Basilar artery thrombosis. It is unknown if an autopsy was performed. Concomitant medications were not reported . Treatment information was not provided. Company comment This fatal case concerns a 90-year-old male with a serious unexpected event of basilar artery thrombosis. Event latency within 10 hours after first dose mRNA-1273. Cause of death reported as basilar artery thrombosis. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded. Very limited information regarding this event has been provided at this time. Further information has been requested; Sender''s Comments: This fatal case concerns a 90-year-old male with a serious unexpected event of basilar artery thrombosis. Event latency within 10 hours after first dose mRNA-1273. Cause of death reported as basilar artery thrombosis. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded. Very limited information regarding this event has been provided at this time. Further information has been requested; Reported Cause(s) of Death: Basilar artery thrombosis


VAERS ID: 1590098 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-08-03
Onset:2021-08-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Brain herniation, Cerebral haemorrhage, Chills, Meningitis, Physical deconditioning, Restlessness, Thrombocytopenic purpura, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPTAKEDA2021TJP072379

Write-up: Meningitis (decerebrate rigidity); Thrombosis with thrombocytopenia; Brain herniation; Cerebral hemorrhage; Thrombocytopenic purpura; Restlessness; Physical deconditioning; Chills; This case was received via Regulatory Authority (Reference number: 2021TJP072379) on 11-Aug-2021 and was forwarded to Moderna on 15-Aug-2021. This case, initially reported to the Regulatory Authority by a (physician), was received via the RA (Ref, v21122858). On an unknown date, the patient received the 1st dose of this vaccine. On an unknown date, body temperature before the vaccination: Unknown. On 03-Aug-2021, the patient received the 2nd dose of this vaccine. On 04-Aug-2021, in the morning, the patient had physical deconditioning and rested at home. At 18:00, chills developed. At 20:00, the patient had restlessness and was taken to a hospital by ambulance. On arrival, JCS/100, BT: 38.3 degrees Celsius, and SPO2: 97% (10 L of O2 mask). Decerebrate rigidity was noted, and meningitis was suspected. Cerebrospinal fluid test showed no increase in cell count. Thereafter, bleeding tendency became significant. Platelets decreased. thrombosis with thrombocytopenia (TTS) after the vaccination was suspected. It was considered to be thrombocytopenic purpura. Steroid pulse IVIG and plasma exchange were performed, but no improvement was noted. Brain herniation due to cerebral hemorrhage was suspected. On 09-Aug-2021, the patient died. The outcome of physical deconditioning, chills, restlessness, meningitis (decerebrate rigidity), thrombosis with thrombocytopenia, thrombocytopenic purpura, brain herniation, and cerebral hemorrhage was reported as fatal. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: The causal relationship with the vaccine is questionable.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Additional information required.; Reported Cause(s) of Death: Physical deconditioning; Chills; Unrest; Meningitis; Thrombosis; Thrombocytopenic purpura; Brain herniation; Cerebral hemorrhage


VAERS ID: 1590108 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-07-26
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Thrombosis
SMQs:, Anaphylactic reaction (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: 2021-08-07
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KRMODERNATX, INC.MOD20212

Write-up: breathing difficulty; thrombosis; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (breathing difficulty) and THROMBOSIS (thrombosis) in a 20-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 26-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In July 2021, the patient experienced THROMBOSIS (thrombosis) (seriousness criteria death, hospitalization and medically significant). On 31-Jul-2021, the patient experienced DYSPNOEA (breathing difficulty) (seriousness criteria death and hospitalization). The patient was hospitalized on 31-Jul-2021 due to DYSPNOEA and THROMBOSIS. The patient died on 07-Aug-2021. The reported cause of death was breathing difficulty and Thrombosis. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: breathing difficulty; thrombosis


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?TABLE=ON&GROUP1=AGE&EVENTS=ON&PERPAGE=200&SYMPTOMS[]=Aortic+thrombosis+%2810002910%29&SYMPTOMS[]=Arterial+thrombosis+%2810003178%29&SYMPTOMS[]=Arterial+thrombosis+limb+%2810003180%29&SYMPTOMS[]=Atrial+thrombosis+%2810048632%29&SYMPTOMS[]=Axillary+vein+thrombosis+%2810003880%29&SYMPTOMS[]=Basilar+artery+thrombosis+%2810063093%29&SYMPTOMS[]=Brachiocephalic+vein+thrombosis+%2810063363%29&SYMPTOMS[]=Carotid+artery+thrombosis+%2810007688%29&SYMPTOMS[]=Cavernous+sinus+thrombosis+%2810007830%29&SYMPTOMS[]=Cerebral+artery+thrombosis+%2810008092%29&SYMPTOMS[]=Cerebral+thrombosis+%2810008132%29&SYMPTOMS[]=Cerebral+venous+sinus+thrombosis+%2810083037%29&SYMPTOMS[]=Cerebral+venous+thrombosis+%2810008138%29&SYMPTOMS[]=Coronary+artery+thrombosis+%2810011091%29&SYMPTOMS[]=Deep+vein+thrombosis+%2810051055%29&SYMPTOMS[]=Hepatic+vein+thrombosis+%2810019713%29&SYMPTOMS[]=Iliac+artery+thrombosis+%2810021340%29&SYMPTOMS[]=Injection+site+thrombosis+%2810022104%29&SYMPTOMS[]=Intracranial+venous+sinus+thrombosis+%2810061251%29&SYMPTOMS[]=Jugular+vein+thrombosis+%2810023237%29&SYMPTOMS[]=Mesenteric+vein+thrombosis+%2810027402%29&SYMPTOMS[]=Ophthalmic+artery+thrombosis+%2810081144%29&SYMPTOMS[]=Ophthalmic+vein+thrombosis+%2810074349%29&SYMPTOMS[]=Pelvic+venous+thrombosis+%2810034272%29&SYMPTOMS[]=Peripheral+artery+thrombosis+%2810072564%29&SYMPTOMS[]=Portal+vein+thrombosis+%2810036206%29&SYMPTOMS[]=Postpartum+venous+thrombosis+%2810036300%29&SYMPTOMS[]=Pulmonary+artery+thrombosis+%2810037340%29&SYMPTOMS[]=Pulmonary+thrombosis+%2810037437%29&SYMPTOMS[]=Retinal+artery+thrombosis+%2810038831%29&SYMPTOMS[]=Retinal+vascular+thrombosis+%2810062108%29&SYMPTOMS[]=Retinal+vein+thrombosis+%2810038908%29&SYMPTOMS[]=Spinal+artery+thrombosis+%2810071316%29&SYMPTOMS[]=Splenic+vein+thrombosis+%2810041659%29&SYMPTOMS[]=Subclavian+vein+thrombosis+%2810049446%29&SYMPTOMS[]=Superior+sagittal+sinus+thrombosis+%2810042567%29&SYMPTOMS[]=Thrombosis+%2810043607%29&SYMPTOMS[]=Thrombosis+in+device+%2810062546%29&SYMPTOMS[]=Transverse+sinus+thrombosis+%2810044457%29&SYMPTOMS[]=Truncus+coeliacus+thrombosis+%2810062363%29&SYMPTOMS[]=Umbilical+cord+thrombosis+%2810071652%29&SYMPTOMS[]=Vena+cava+thrombosis+%2810047195%29&SYMPTOMS[]=Venous+thrombosis+%2810047249%29&SYMPTOMS[]=Venous+thrombosis+limb+%2810061408%29&VAX=COVID19&VAXMAN=MODERNA&DIED=Yes


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166