|
| VAERS ID: |
2001207 (history) |
| Form: |
Version 2.0 |
| Age: |
70.0 |
| Sex: |
Female |
| Location: |
Indiana |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2022-01-02
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: chronic RA and PMR, on chronic low dose prednisone and upadacitinib, HL and PVD Preexisting Conditions: Allergies: epinephrine, toradol Diagnostic Lab Data: CDC Split Type:
Write-up: None stated. |
|
| VAERS ID: |
2001229 (history) |
| Form: |
Version 2.0 |
| Age: |
72.0 |
| Sex: |
Male |
| Location: |
Kentucky |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
Administered by: Unknown Purchased by: ? Symptoms: Death,
Respiratory failure SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2022-01-04
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: HTN, kidney transplant Allergies: NKA Diagnostic Lab Data: CDC Split Type:
Write-up: Wife states that pt is vaccinated for COVID-19. Unknown dates or manufacturer. Pt hospitalized 1/2/2022 for respiratory failure. Expired 1/4/2022. |
|
| VAERS ID: |
2005517 (history) |
| Form: |
Version 2.0 |
| Age: |
0.17 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2021-08-06 |
| Onset: | 2021-08-07 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Private Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-08-07
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient died one day after receiving vaccine series. |
|
| VAERS ID: |
2005688 (history) |
| Form: |
Version 2.0 |
| Age: |
32.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2021-10-05 |
| Onset: | 2021-10-06 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / - |
Administered by: Private Purchased by: ? Symptoms: Autopsy,
Death,
Malaise,
Myocarditis SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-10-06
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: Current Illness: 2 days postpartum Preexisting Conditions: Allergies: Diagnostic Lab Data: Autopsy examination performed on October 7th, 2021. CDC Split Type:
Write-up: This is a 32-year-old woman who was found deceased 2 days after giving birth and 1 day after receiving an unknown type of Influenza vaccine. She complained of generally not feeling well the day of her death. Autopsy revealed lymphocytic myocarditis, which was the cause of death. |
|
| VAERS ID: |
2005710 (history) |
| Form: |
Version 2.0 |
| Age: |
75.0 |
| Sex: |
Male |
| Location: |
Minnesota |
| Vaccinated: | 2021-09-16 |
| Onset: | 2021-09-23 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UJ709AA / 1 |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Angiogram cerebral normal,
Antibody test positive,
Death,
Dysphagia,
Dysphonia,
Endotracheal intubation,
Magnetic resonance imaging head normal,
Myasthenia gravis SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Vasculitis (broad), Hypersensitivity (broad), Respiratory failure (broad), Immune-mediated/autoimmune disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-10-02
Days after onset: 9
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: tylenol prn, aspirin 81, atenolol 100, atorvastatin 40, benazipril 10, oral cranberry, aricept 10, fish oil, lasix 20, multivitamin, namenda 10, Current Illness: Two days later presented to our ER with dysphonia and dysphagia. MRI/MRA showed no sign of acute stroke. Consult with Dr. suggested possible variant of Guillan Barre Syndrome. Transferred to Facility. He was intubated initially to protect his airway. Subsequently extubated and died. Diagnosis of Myasthenia Gravis was also considered and test has subsequently come back positive for this antibody. Preexisting Conditions: hypertension, afib, dilated aortic root, hyperlipid, obesity, sessile serated adenoma of colon, osteoarthritis, depression, memory loss, obstructive sleep apnea, hypertestosternia, elevated psa, Allergies: oxycodone- confusion Diagnostic Lab Data: CDC Split Type:
Write-up: Received Influenza Vaccine 9/16/21. Two days later presented to our ER with dysphonia and dysphagia. MRI/MRA showed no sign of acute stroke. Consult with Dr. suggested possible variant of Guillan Barre Syndrome. Transferred to Facility. He was intubated initially to protect his airway. Subsequently extubated and died. Diagnosis of Myasthenia Gravis was also considered and test has subsequently come back positive for this antibody. |
|
| VAERS ID: |
2010400 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2021-03-02 |
| Onset: | 2021-12-22 |
| Days after vaccination: | 295 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / IM |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / IM |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR |
UJ742AC / UNK |
LA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Abdominal distension,
COVID-19,
Confusional state,
Death,
Gastrointestinal sounds abnormal,
Nausea,
SARS-CoV-2 test positive,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2022-01-03
Days after onset: 12
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: Preexisting Conditions: HTN, Dementia, Encephalopathy,,Hypoglycemia, Polyneuropathy Allergies: Penicillin Diagnostic Lab Data: SARS test 12/23/2021 CDC Split Type:
Write-up: 12/22/2021Per nurses note this resident had nausea and dark brown emesis. Zofran 4mg administered. Then on 12/23/2021 Resident had increased dark brown emesis, zofran was not effective. Abdomen was distended, RUQ hyperactive and there was increased confusion. Resident was sent to Hospital ER. She was tested there for COVID and had positive results. She was admitted to Hospital and per information from the hospital she expired on 01/03/2022. |
|
| VAERS ID: |
2012990 (history) |
| Form: |
Version 2.0 |
| Age: |
89.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2021-02-11 |
| Onset: | 2021-02-12 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / SYR |
Administered by: Unknown Purchased by: ? Symptoms: Death,
General physical health deterioration,
Pain SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-14
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: N/A Diagnostic Lab Data: CDC Split Type:
Write-up: Pain began hours after vaccination; physical health declined rapidly and led to death within 48 hours. |
|
| VAERS ID: |
2014023 (history) |
| Form: |
Version 2.0 |
| Age: |
79.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2021-12-19 |
| Onset: | 2022-01-06 |
| Days after vaccination: | 18 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
1855835 / 1 |
LA / IM |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
LUT732MA / 1 |
RA / IM |
Administered by: Private 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), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2022-01-06
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient was admitted on 12/17/2021 with bilateral pulmonary emboli and DVT. She received J&J COVID Vaccine and the seasonal flu vaccine on 12/19/2021 and was discharged to a skilled nursing facility on 12/23/2021. She had a cardiac arrest on 01/06/2022 and was brought to the emergency department via EMS. Patient had an active code status of DNA A2 and subsequently expired. |
|
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN |
- / 2 |
- / OT |
| FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Comments: Unknown Allergies: Diagnostic Lab Data: CDC Split Type: USJNJFOC20211263885
Write-up: DIED; This spontaneous report received from a patient via social media through company representative concerned a male of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient previously received influenza vaccine. The patient previously received covid-19 vaccine ad26. cov2. s from an unspecified manufacturer (suspension for injection, route of admin, and batch number: Unknown, Expiry: Unknown) dose not reported, frequency 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series 1). It was unknown if the patient had any adverse events with covid-19 vaccine ad26. cov2. s dose number series 1. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number: Unknown, Expiry: Unknown) dose not reported, frequency 1 total, start therapy date were not reported for prophylactic vaccination (Dose number in series 2). The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. As per report "I was on a job working for people I''ve worked for before the man though not not young but in good health and spirt went to get a flue shot and the covid booster then died in 2 days after" (Dose number in series 2). On an unspecified date, the patient died from unknown cause of death. It was unspecified if an autopsy was performed. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of event died was fatal. This report was serious (Death).; Sender''s Comments: V0: 20211263885-covid-19 vaccine ad26.cov2.s-Died. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).; Reported Cause(s) of Death: UNKNOWN CAUSE OF DEATH |
|
| VAERS ID: |
2018725 (history) |
| Form: |
Version 2.0 |
| Age: |
68.0 |
| Sex: |
Male |
| Location: |
Illinois |
| Vaccinated: | 2021-12-27 |
| Onset: | 2021-12-27 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-01-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FL3197 / 3 |
RA / OT |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
5397F / 2 |
- / - |
Administered by: Pharmacy Purchased by: ? Symptoms: Death,
Immunisation,
Off label use,
Product use issue SMQs:, Medication errors (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-12-28
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: USPFIZER INC202101870746
Write-up: off label use; Other vaccine same date vaccine date 27Dec2021; Patient died within 24 hrs of vaccination; booster; This is a spontaneous report received from contactable reporter(s) (Other HCP). A 68 year-old male patient received bnt162b2 (BNT162B2), intramuscular, administered in arm right, administration date 27Dec2021 (Lot number: FL3197) at the age of 68 years as dose 3 (booster), single for covid-19 immunisation; hepatitis b vaccine rhbsag (yeast) (ENGERIX-B), administration date 27Dec2021 (Lot number: 5397F) as unk, single. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Covid (Dose Number: 2, Batch/Lot No: EN6204, Location of injection: Arm Right, Route of Administration: Intramuscular), administration date: 19Mar2021, when the patient was 67 years old, for Covid-19 immunization; Covid (Dose Number: 1, Batch/Lot No: EN6203, Location of injection: Arm Right, Route of Administration: Intramuscular), administration date: 26Feb2021, when the patient was 67 years old, for Covid-19 immunization. The following information was reported: IMMUNISATION (death, medically significant) with onset 27Dec2021, outcome fatal; OFF LABEL USE (death, medically significant) with onset 28Dec2021, outcome fatal; PRODUCT USE ISSUE (death, medically significant) with onset 28Dec2021, outcome fatal; DEATH (death, medically significant) with onset 28Dec2021, outcome fatal. It was unknown if therapeutic measures were taken as a result of immunisation, off label use, product use issue, death. The patient date of death was 28Dec2021. The reported cause of death was Unknown cause of death. It was not reported if an autopsy was performed. Additional Information: Patient died within 24 hrs of vaccination.; Sender''s Comments: Based on the available information in the case, the causal association between the events immunization, off label use, product use issue, death and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Unknown cause of death |
|