|
| VAERS ID: |
1093939 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Male |
| Location: |
Mississippi |
| Vaccinated: | 2021-03-05 |
| Onset: | 2021-03-11 |
| Days after vaccination: | 6 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805020 / 1 |
RA / IM |
Administered by: Public Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-11
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Blood Thinner Current Illness: Unknown Preexisting Conditions: Unknown Allergies: Unknown Diagnostic Lab Data: None CDC Split Type:
Write-up: No report of negative event after 15 min wait past receipt of vaccine. Notified by Coronor, on 3/11/2021 that this patient expired on 3/11/2021 at home. Not sent to hospital. Pronounced at home. Sent to Funeral Home |
|
| VAERS ID: |
1098028 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Male |
| Location: |
New York |
| Vaccinated: | 2021-03-13 |
| Onset: | 2021-03-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Cardiac arrest,
Death SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-14
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: levothyroxine Current Illness: Preexisting Conditions: Hypothyroidism, MVP, valve repair Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Cardiac arrest, death approx 12 hours later |
|
| VAERS ID: |
1100865 (history) |
| Form: |
Version 2.0 |
| Age: |
77.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2021-03-13 |
| Onset: | 2021-03-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1802068 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-14
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Cefuroxime, Lansoprazole, Sulfasalazine, Azulfidine, Amoxicillin, Lisinopril, Fluticasone Nasal Spray, Tenormin, Atenolol, Current Illness: Hospitalized for Pneumonia 2-8-2021 Preexisting Conditions: Hypertension, obesity Allergies: Unknown Diagnostic Lab Data: Decedent is currently at facility awaiting further examination/investigation. CDC Split Type:
Write-up: Patient died within 24 hours of vaccine. Unknown at this time if related. |
|
| VAERS ID: |
1102572 (history) |
| Form: |
Version 2.0 |
| Age: |
87.0 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 2021-03-12 |
| Onset: | 2021-03-15 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805029 / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-12
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: Clobetasol 0.05% topical ointment, fluocinonide 0.05% topical cream, atorvastatin, daily multi-vitamin, glimepiride, metformin, clonidine transdermal, coumadin, folic acid, furosemide, hydralazine Current Illness: arthritis, atrial fibrillation, congestive heart failure, diabetes mellitus, high cholesterol levels, hypertension Preexisting Conditions: aortic valve replacement Allergies: no known drug allergies Diagnostic Lab Data: unknown CDC Split Type:
Write-up: Was notified by a third party that patient died on morning of 3/15/2021. No other information available. |
|
| VAERS ID: |
1102815 (history) |
| Form: |
Version 2.0 |
| Age: |
87.0 |
| Sex: |
Female |
| Location: |
Missouri |
| Vaccinated: | 2021-03-05 |
| Onset: | 2021-03-09 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805018 / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Bilevel positive airway pressure,
Blood lactic acid increased,
Dyspnoea,
Endotracheal intubation,
General physical health deterioration,
Human rhinovirus test positive,
Lung infiltration,
Oxygen saturation decreased,
Procalcitonin increased,
Pyrexia,
Refusal of treatment by patient,
Rhinovirus infection,
Septic shock,
Vasopressive therapy SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-12
Days after onset: 3
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Advair, Alprozolam, Amlodipine, Aspirin, Atorvastatin, Azithromycin, Biotin, Cefuroxime, Dexilant, Dymista, Fenofibrate, Fluticasone, Hydrochlorothiazide, Incruse Ellipta, Isosorbide Monoitrate, Levothyroxine, Lipitor, Loratadine, Magnesium Current Illness: 2-3 weeks prior to vaccine was croupy and saw a pulmonologist and lungs were clear, on and off antibiotics from 2/12 to 3/5, failed stress test (occlusion of left anterior descending artery) and recommended cardiac cath and had a cardiac implant, possibly defibrillator. Preexisting Conditions: COPD and Diastolic CHF, Pre-Diabetic, Hypertension Allergies: Penicillin Diagnostic Lab Data: 3/11/21 Positive for Rhinovirus 3/11/21 Procalcitonin 54.97 and lactic acid 33.5 3/12/21 Procalcitonin 98.61 and lactic acid 72.4 CDC Split Type:
Write-up: Patient presented to hospital on 3/11 with shortness of breath. History of chronic oxygen dependency at night. Became more sob over last several days and was not able to make it to md appointment. Had a recent abnormal stress test. Family states she was febrile at home. Was low on oxygen level on 2LNC, placed on non-rebreather and then BIPAP. Positive for Rhinovirus. Chest xray showed bilateral lower infiltrates. Patient detiorated through the night and was intubated and placed on vasopressors for septic shock. Patient was made DNR and family refused hemodialysis. Family then made decision to withdraw care. |
|
| VAERS ID: |
1103106 (history) |
| Form: |
Version 2.0 |
| Age: |
80.0 |
| Sex: |
Male |
| Location: |
Mississippi |
| Vaccinated: | 2021-01-15 |
| Onset: | 2021-01-16 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
UN / SYR |
Administered by: Unknown Purchased by: ? Symptoms: Death,
Malaise SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-24
Days after onset: 8
Permanent Disability? No
Recovered? No Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: UNK Current Illness: NA Preexisting Conditions: NA Allergies: NA Diagnostic Lab Data: UNK CDC Split Type:
Write-up: Patient died on 01/24/2021. Began exhibiting symptoms similar to Covid 1 day after vaccination. |
|
| VAERS ID: |
1103748 (history) |
| Form: |
Version 2.0 |
| Age: |
76.0 |
| Sex: |
Female |
| Location: |
Alabama |
| Vaccinated: | 2021-03-13 |
| Onset: | 2021-03-16 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 1 |
- / IM |
Administered by: Pharmacy Purchased by: ? Symptoms: Cardiac arrest,
Death SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-16
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: unknown Current Illness: unknown Preexisting Conditions: unknown Allergies: unknown Diagnostic Lab Data: CDC Split Type:
Write-up: Cardiac Arrest/Death |
|
| VAERS ID: |
1104430 (history) |
| Form: |
Version 2.0 |
| Age: |
98.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2021-03-12 |
| Onset: | 2021-03-13 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1802070 / UNK |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-13
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 has been admitted to a home hospice program since approximately 11/12/20 with an initial terminal diagnosis of dysphagia which was later changed in February 2021 to vascular dementia. Patient with significant past medical history of several CVA''s which led to aphasia and vascular dementia. |
|
| VAERS ID: |
1104671 (history) |
| Form: |
Version 2.0 |
| Age: |
39.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2021-03-12 |
| Onset: | 2021-03-13 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1802068 / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Condition aggravated,
Death,
Malaise,
Respiratory arrest,
Seizure SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), 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), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-13
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: CoQ-10 200 mg twice a day, diazepam 10mg one as needed for seizures, Dilantin Infatabs 50mg 1 tab every morning. lamictal 150mg 2 tabs twice a day, midodrine 2.5mg 1 tab twice a day, vitamin D3 400IU daily. Current Illness: Seizure disorder, severe mitochondrial myopathy, gastroesophageal reflux disease Preexisting Conditions: Seizure disorder, severe mitochondrial myopathy Allergies: IV lactated ringers, midazolam, morphine, vancomycin Diagnostic Lab Data: None CDC Split Type:
Write-up: Patient has a long history of seizures. He has seizures on a daily basis. He lives with his family, who are his primary caregivers, they family provides all of his activities of daily living. Patient received vaccine on Friday morning, feeling well throughout the day according to the father. Went to bed, during the night in bed he had seizures which is typical for him, and during the episode the father noticed that he had stopped breathing. called 911 who came to the house and the patient died in the house. I do not believe he went to the hospital. |
|
| VAERS ID: |
1106737 (history) |
| Form: |
Version 2.0 |
| Age: |
82.0 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 2021-03-11 |
| Onset: | 2021-03-14 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-03-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1805031 / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Asthenia,
Death,
Malaise SMQs:, Guillain-Barre syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-14
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: melatonin, calcium, vitamin D, famotidine, quetiapine 50 mg QHS Current Illness: Normal pressure hydrocephalus -- s/p VP shunt with dementia Preexisting Conditions: BPH, C-spine fracture with myelopathy, GERD Allergies: opiates, pencillins (hives) Diagnostic Lab Data: none CDC Split Type:
Write-up: weakness/malaise per daughter, death on 3/14 (did have underlying medical conditions) |
|