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From the 10/8/2021 release of VAERS data:

Found 36 cases where Age is 18-or-more-and-under-30 and Number of Vaccines Administered is '1' and Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Symptom is Death and Patient Died and Date of Death from '2019-01-01' to '2021-12-31'

Table

   
VAERS FormYear,Month,Day of VaccinationManufacturersAgeYear,Month,Day of DeathCountPercent
22020-12-22MODERNA17-44 Years2021-01-1112.78%
2020-12-22MODERNA17-44 Yearstotal12.78%
2020-12-22MODERNAtotal12.78%
2020-12-22total12.78%
2021-01-19MODERNA17-44 Years2021-01-2125.56%
2021-01-19MODERNA17-44 Yearstotal25.56%
2021-01-19MODERNAtotal25.56%
2021-01-19total25.56%
2021-01-30MODERNA17-44 Years2021-02-0212.78%
2021-01-30MODERNA17-44 Yearstotal12.78%
2021-01-30MODERNAtotal12.78%
2021-01-30total12.78%
2021-02-14MODERNA17-44 Years2021-02-2812.78%
2021-02-14MODERNA17-44 Yearstotal12.78%
2021-02-14MODERNAtotal12.78%
2021-02-14total12.78%
2021-02-18MODERNA17-44 Years2021-02-1912.78%
2021-02-18MODERNA17-44 Yearstotal12.78%
2021-02-18MODERNAtotal12.78%
2021-02-18total12.78%
2021-03-02MODERNA17-44 Years2021-03-0512.78%
2021-03-02MODERNA17-44 Yearstotal12.78%
2021-03-02MODERNAtotal12.78%
2021-03-02total12.78%
2021-03-08MODERNA17-44 Years2021-03-2312.78%
2021-03-08MODERNA17-44 Yearstotal12.78%
2021-03-08MODERNAtotal12.78%
2021-03-08total12.78%
2021-03-19MODERNA17-44 Years2021-04-0412.78%
2021-03-19MODERNA17-44 Yearstotal12.78%
2021-03-19MODERNAtotal12.78%
2021-03-19total12.78%
2021-03-24MODERNA17-44 Years2021-03-2612.78%
2021-03-24MODERNA17-44 Yearstotal12.78%
2021-03-24MODERNAtotal12.78%
2021-03-24total12.78%
2021-04-10MODERNA17-44 Years2021-04-1212.78%
2021-04-10MODERNA17-44 Yearstotal12.78%
2021-04-10MODERNAtotal12.78%
2021-04-10total12.78%
2021-04-11MODERNA17-44 Years2021-04-1212.78%
2021-04-11MODERNA17-44 Yearstotal12.78%
2021-04-11MODERNAtotal12.78%
2021-04-11total12.78%
2021-04-16MODERNA17-44 Years2021-06-1212.78%
2021-04-16MODERNA17-44 Yearstotal12.78%
2021-04-16MODERNAtotal12.78%
2021-04-16total12.78%
2021-04-20MODERNA17-44 Years2021-05-0112.78%
2021-04-20MODERNA17-44 Yearstotal12.78%
2021-04-20MODERNAtotal12.78%
2021-04-20total12.78%
2021-04-28MODERNA17-44 Years2021-04-2912.78%
2021-04-28MODERNA17-44 Yearstotal12.78%
2021-04-28MODERNAtotal12.78%
2021-04-28total12.78%
2021-05-06MODERNA17-44 Years2021-05-0912.78%
2021-05-06MODERNA17-44 Yearstotal12.78%
2021-05-06MODERNAtotal12.78%
2021-05-06total12.78%
2021-05-11MODERNA17-44 Years2021-05-1512.78%
2021-05-11MODERNA17-44 Yearstotal12.78%
2021-05-11MODERNAtotal12.78%
2021-05-11total12.78%
2021-05-14MODERNA17-44 Years2021-06-0612.78%
2021-05-14MODERNA17-44 Yearstotal12.78%
2021-05-14MODERNAtotal12.78%
2021-05-14total12.78%
2021-05-21MODERNA17-44 Years2021-05-2412.78%
2021-05-21MODERNA17-44 Years2021-05-2912.78%
2021-05-21MODERNA17-44 Yearstotal25.56%
2021-05-21MODERNAtotal25.56%
2021-05-21total25.56%
2021-05-25MODERNA17-44 Years2021-06-2912.78%
2021-05-25MODERNA17-44 Yearstotal12.78%
2021-05-25MODERNAtotal12.78%
2021-05-25total12.78%
2021-05-27MODERNA17-44 Years2021-06-2212.78%
2021-05-27MODERNA17-44 Yearstotal12.78%
2021-05-27MODERNAtotal12.78%
2021-05-27total12.78%
2021-06-10MODERNA17-44 Years2021-06-1312.78%
2021-06-10MODERNA17-44 Yearstotal12.78%
2021-06-10MODERNAtotal12.78%
2021-06-10total12.78%
2021-06-12MODERNA17-44 Years2021-07-2412.78%
2021-06-12MODERNA17-44 Yearstotal12.78%
2021-06-12MODERNAtotal12.78%
2021-06-12total12.78%
2021-06-13MODERNA17-44 Years2021-06-1825.56%
2021-06-13MODERNA17-44 Yearstotal25.56%
2021-06-13MODERNAtotal25.56%
2021-06-13total25.56%
2021-07-07MODERNA17-44 Years2021-07-1012.78%
2021-07-07MODERNA17-44 Yearstotal12.78%
2021-07-07MODERNAtotal12.78%
2021-07-07total12.78%
2021-07-12MODERNA17-44 Years2021-07-1412.78%
2021-07-12MODERNA17-44 Yearstotal12.78%
2021-07-12MODERNAtotal12.78%
2021-07-12total12.78%
2021-07-21MODERNA17-44 Years2021-08-0312.78%
2021-07-21MODERNA17-44 Yearstotal12.78%
2021-07-21MODERNAtotal12.78%
2021-07-21total12.78%
2021-07-23MODERNA17-44 Years2021-09-1512.78%
2021-07-23MODERNA17-44 Yearstotal12.78%
2021-07-23MODERNAtotal12.78%
2021-07-23total12.78%
2021-07-24MODERNA17-44 Years2021-08-1412.78%
2021-07-24MODERNA17-44 Yearstotal12.78%
2021-07-24MODERNAtotal12.78%
2021-07-24total12.78%
2021-07-31MODERNA17-44 Years2021-08-0112.78%
2021-07-31MODERNA17-44 Yearstotal12.78%
2021-07-31MODERNAtotal12.78%
2021-07-31total12.78%
2021-08-18MODERNA17-44 Years2021-08-1812.78%
2021-08-18MODERNA17-44 Yearstotal12.78%
2021-08-18MODERNAtotal12.78%
2021-08-18total12.78%
2021-09-01MODERNA17-44 Years2021-09-0212.78%
2021-09-01MODERNA17-44 Yearstotal12.78%
2021-09-01MODERNAtotal12.78%
2021-09-01total12.78%
2021-09-13MODERNA17-44 Years2021-09-1512.78%
2021-09-13MODERNA17-44 Yearstotal12.78%
2021-09-13MODERNAtotal12.78%
2021-09-13total12.78%
UnknownMODERNA17-44 Years2021-06-2412.78%
UnknownMODERNA17-44 Yearstotal12.78%
UnknownMODERNAtotal12.78%
Unknowntotal12.78%
total36100%
TOTAL36100%



Case Details

VAERS ID: 936805 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2020-12-22
Onset:2021-01-11
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-11
   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: See Continuation Field
Current Illness: Whiplash injury to neck. Sprain of ligaments of cervical spine
Preexisting Conditions: Septal defect (heart), chronic sinusitis
Allergies: Ceftriaxone
Diagnostic Lab Data: None associated.
CDC Split Type:

Write-up: Patient received the vaccine on 12/22/20 without complication. It was reported today that the patient was found unresponsive and subsequently expired at home on 1/11/21.


VAERS ID: 1078352 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-02
Onset:2021-03-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, Fatigue, Headache, Pain, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   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: Medical examiner report is pending.
CDC Split Type:

Write-up: Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home.


VAERS ID: 1105115 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-02-14
Onset:2021-02-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Abscess limb, Death, Decreased activity, Groin abscess, Increased upper airway secretion
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra 1000 mg, Lamictal , Vimpat, Quetiapina, Lorazepam, Zyprexa, Motrin, Vitamina K, Acido Folico, Sultato Ferroso, Multivitam?nico 365
Current Illness: None
Preexisting Conditions: Portal hypertension (secondary to portal vein thrombosis), Leukopenia, Thrombocytopenia, Epilepsy, Splenomegaly, Esophageal Varices, Asthma, Pancytopenia and Severe mental retardation.
Allergies: Dilantin and aspirin
Diagnostic Lab Data: None
CDC Split Type: PR-55-21

Write-up: Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)


VAERS ID: 1105146 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-01-30
Onset:2021-01-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Death, Decreased appetite, Productive cough, Resuscitation, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   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: Keppra 1000 mg, Flexeril, Vitamins
Current Illness: None
Preexisting Conditions: Epilepsy, Hydrocephalus, and Multiple Sclerosis
Allergies: Not reported
Diagnostic Lab Data: None
CDC Split Type: PR-56-21

Write-up: 1/19 began vomiting and was hospitalized. On 1/30 he was discharged and later received the vaccine. It begins with weakness and a lack of appetite. He started coughing up foul-smelling secretions. He makes the arrangements to take him to the emergency room again, he called 911 to be transported, when they are taking the information from the POC, he is under oxygenation to 44. They take him in the ambulance, he receives CPR, they transport him to the facility where he arrives lifeless.


VAERS ID: 1129860 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-01-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   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: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died January 21 after she received an mRNA shot; A spontaneous report was received from a consumer via social media concerning a 28-year-old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and died two days later (death). The patient''s medical history was not provided. No relevant concomitant medications were reported. On 19 Jan 2021, per social media post, the patient received one of their two planned doses of mRNA-1273 (Batch number not provided) intramuscularly for prophylaxis of COVID-19 infection. The reporter stated that the patient was dead on 21 Jan 2021. Treatment information was not provided. Action taken with mRNA-1273 in response to the event was not applicable. The patient died on 21 Jan 2021. The cause of death was reported as unknown. An autopsy was done. The reporter stated that the autopsy showed no other red flags, otherwise, no additional autopsy results were reported.; Reporter''s Comments: Very limited information regarding this event has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1145918 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-21
   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: Diabetes Mellitus Type I
Allergies: No reported allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: As reported by the patient''s mother, the patient received the vaccine on 1/19/21, "got sick" on 1/20/21, and died in the early morning hours of 1/21/21. No further information was offered.


VAERS ID: 1206330 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-11
Onset:2021-04-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: Cardiomegaly
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Death


VAERS ID: 1243791 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-10
Onset:2021-04-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   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: Per family, Xarelto
Current Illness: None communicated at this time to this office
Preexisting Conditions: History of clotting disorder at age 16 with Xarelto treatment and hospitalization
Allergies: None communicated to this office
Diagnostic Lab Data: None known at this time.
CDC Split Type:

Write-up: Per the father, the deceased received his first shot of Moderna vaccine on Saturday, 4/10/2021 at a local church. He did not work on 4/11/2021. Worked on 4/12/2021. The deceased was found dead at 6:43 p.m. at his home.


VAERS ID: 1243832 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-08
Onset:2021-03-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Atrioventricular block, Body temperature increased, Cardiac arrest, Chills, Condition aggravated, Death, Electrolyte imbalance, Fall, Fatigue, Feeling abnormal, Loss of consciousness, Pain in extremity, Pyrexia, Respiratory arrest, Rhinorrhoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-23
   Days after onset: 14
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: None reported
Preexisting Conditions: Anorexia, 2nd Degree Type II heart block, pacemaker
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4.21.2021- I spoke with (patient''s husband) related to spouse. Husband stated the patient has a history of 2nd Degree Type 2 heart block, pacemaker placed at the age of 14, and she currently has issues with an eating disorder dx with anorexia. Patient is reported to be approximately 68-70 pounds at the time of vaccination. March 8.2021- Husband states he and his wife came to receive the vaccine around 1630. After, receiving the vaccine the patient stated to her Husband "my arm really hurts." She begin experiencing s/s at approximately 1900 including: fever, chills, runny nose, fatigued and tired - reportedly temperature was 100.0 and the patient began to drink Gatorade and take Tylenol. Monday, 3.15.2021 patient continued to have symptoms therefore, (husband) contacted Moderna Representatives from the safety team, to determine if it would be safe for the patient to get the 2nd vaccine dose - advised everyone that does not have contraindications should be vaccinated-advised to reach out to PCP. Husband stated that the patient did not want to go to her PCP because of her eating disorder. The patient worked from bed during the week per the husband and spent 90-95% of her time in the bed after receiving the vaccine. Husband states on Saturday 3.20.2021 the patients fever had subsided however, she continued to feel poorly and remained bedbound most of the time. Husband is an Pilot 3.23.2021 stated once, he had landed he began trying to contact wife but she was not answering the phone, after several attempts to contact wife - Husband called a neighbor to check on wife. Upon, entering the residence the neighbor found wife lying on the floor unconscious and not breathing. The neighbor notified Husband and called 911. EMS arrived at the scene and pronounced the patient as a DOA. Husband states that the death certification list cardiac arrest, electrolyte imbalance, and heart block, as causes for death. Husband is concerned that the vaccine may have contributed in some way demise of his wife as he stated "she was never the same after the vaccination."


VAERS ID: 1273475 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-04-28
Onset:2021-04-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apnoea, Death, Pulse absent, Resuscitation
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Isosource Continuous feeding, Tylenol 650mg PRN; Ibuprofen 400mg PRN; Metoprolol 50mg BID
Current Illness: Anoxic Brain Injury, History of MI, Uterine rupture, dysphagia, PEG TUBE, Tracheostomy
Preexisting Conditions: Anoxic Brain Injury
Allergies: NKA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: on 04/29/2021 Resident was checked at 1830 and found to be at baseline status. At approximately 1855, resident was found pulses and apneic. CPR initiated and resident transferred to medical center. Resident expired 1939.


VAERS ID: 1302844 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-06
Onset:2021-05-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Autopsy, Chest pain, Death, Dyspnoea, Lethargy
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-09
   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: Hydroxyzine pamoate
Current Illness:
Preexisting Conditions: Hypertension, non-insulin dependent diabetes
Allergies: None
Diagnostic Lab Data: Autopsy on May 10, 2021. Results pending.
CDC Split Type:

Write-up: Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day. Decedent was found deceased the next evening.


VAERS ID: 1346657 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, Blood immunoglobulin E increased, Death, Histology, SARS-CoV-2 test negative, Seizure, Toxicologic test, Tryptase
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidine, Vyvanse, Vraylor
Current Illness: none
Preexisting Conditions: Autism and ADHD
Allergies:
Diagnostic Lab Data: Autopsy with histology, toxicology, postmortem Covid-19 PCR test negative, post mortem Tryptase normal and elevated elevated IgE, cause and manner of death undetermined, Covid-19 not suspected cause, suspected cause heart arrhythmia (family history, history of chest pain, and medications) or seizure.
CDC Split Type:

Write-up: Found deceased in bed, no known symptoms, undetermined cause and manner of death


VAERS ID: 1347105 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-20
Onset:2021-05-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-01
   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: Lamictal, zestoretic
Current Illness: Had seizure 3.5 years prior, had "night time seizure in mid march.
Preexisting Conditions: elevated BP, seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead on May 3, 2021. Question day of death 05/01/2021. Medical examiners case. Cause pending, possible SUDEP.


VAERS ID: 1349127 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-04-04
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 - / OT

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

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: CLONAZEPAM; TRILEPTAL; GABAPENTIN
Current Illness: Movement disorder; Seizures (since she was a baby at 11 months old); Speech loss; Traumatic brain injury
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: found dead; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (found dead) in a 22-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032m20a) for COVID-19 vaccination. Concurrent medical conditions included Traumatic brain injury, Movement disorder, Seizures (since she was a baby at 11 months old) and Speech loss. Concomitant products included CLONAZEPAM, OXCARBAZEPINE (TRILEPTAL) and GABAPENTIN for an unknown indication. On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. Death occurred on 04-Apr-2021 The patient died on 04-Apr-2021. The cause of death was not reported. An autopsy was not performed. Reporter stated that death certificate said the cause of death was natural causes. She did have her yearly physical exam after her first dose with her physician prior to her death and no other health issues were noted at the time of the exam. 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: Natural causes


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: 1390027 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-21
Onset:2021-05-24
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Histology, Muscle rigidity, Pain, Snoring, Toxicologic test normal
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Up until the vaccination has been on Augmentin Oral Tablet for an ear infection that was changed on the day of vaccination to Cefurozime Axetil 500MG
Current Illness: Ear infection
Preexisting Conditions: High function autism
Allergies: No known
Diagnostic Lab Data: Autopsy conducted by the local Medical Examiner, as of the date of this report cause of death is still undetermined pending results of tissue samples taken during the autopsy. Tox screens were negative.
CDC Split Type:

Write-up: The day after the vaccine, reported typical reactions including aches and pains, which improved the following day. The Monday after noted snoring, which was atypical but consistent with the ear infection and seasonal allergies. Sometime on midday Monday 5/24 Pt died. Was found in his bed at approximately 6pm with rigor already set.


VAERS ID: 1407929 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-21
Onset:2021-05-29
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C1A / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Death, Toxicologic test
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes mellitus type I, inactive TB
Allergies: unknown
Diagnostic Lab Data: Blood and vitreous toxicology
CDC Split Type:

Write-up: Decedent passed away from causes not yet determined


VAERS ID: 1443187 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-24
Onset:2021-03-26
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiomegaly, Death, Hepatomegaly
SMQs:, Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Below are the medications he was on but he was not always consistent about taking them, so I can''t be sure what all he took in the days and weeks leading up to his death. clonazepam amitriptyline buspirone hydrochlorothiazide metoprolol pr
Current Illness:
Preexisting Conditions: Hypertension Hypercholesterolemia Depression Anxiety Alcohol abuse
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexpected death. Coroner reported enlarged heart, enlarged liver.


VAERS ID: 1458126 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-13
Onset:2021-06-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pulmonary haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications taken at the time and no medication profile given by patient.
Current Illness: Patient recorded no illnesses or chronic conditions at the time of receiving his vaccination.
Preexisting Conditions: No chronic history or medical condition was documented on his paperwork.
Allergies: No allergies to medication, food or other products.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Father of patient came to store pharmacy to inform us of his son''s passing. He stated patient died 5 days after receiving his Moderna vaccine on 6/13/2021 due to blood in the lungs. He stated the autopsy has not been done yet to confirm his death, however he was curious of the possibility. I contacted Moderna on July 8th at 4:30pm and spoke to a pharmaceutical representative of Moderna regarding possible side effects of the vaccine.


VAERS ID: 1481758 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-13
Onset:2021-06-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pulmonary haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: passed away; blood in lungs; This spontaneous case was reported by a pharmacist and describes the occurrence of DEATH (passed away) and PULMONARY HAEMORRHAGE (blood in lungs) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Jun-2021, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and PULMONARY HAEMORRHAGE (blood in lungs) (seriousness criteria death and medically significant). The patient died on 18-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. No treatment information was provided. Company Comment: Very limited information regarding the events has been provided at this time. Further information is expected.; Sender''s Comments: Very limited information regarding the events has been provided at this time. Further information is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1500834 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-11
Onset:2021-05-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: She got very sick, was already not feeling well before vaccine. She died may 15, 2021.


VAERS ID: 1502047 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-16
Onset:2021-06-12
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03EB21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-12
   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: Vyvanse 40 mg
Current Illness: no
Preexisting Conditions: sports ashthma
Allergies: allergic to bee stings and mosquito bites. She got bit up by mosquito''s on Sunday June 6, 2021 the bites swelled up but she wouldn''t put any antiseptic cream on them
Diagnostic Lab Data: Autopsy report still pending for 4-5 months.
CDC Split Type:

Write-up: Patient found deceased in her bed on june 12, 2021, reported to Strongsville Police Department at 10:15am., taken to Cuyahoga Medical Examiner''s Office the same day. Autopsy done. Results still pending for 4-5 months.


VAERS ID: 1535195 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-10
Onset:2021-06-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Death, Influenza like illness
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-13
   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: Unknown
Current Illness:
Preexisting Conditions: diabetes insipidus
Allergies: Tree nuts
Diagnostic Lab Data: Examined by the Office of the Chief Medical Examiner on June 15, 2021.
CDC Split Type:

Write-up: Patient experienced flu-like symptoms and an upset stomach and died 60-72 hours later. Immediate cause of death is still pending further study.


VAERS ID: 1574026 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-24
Onset:2021-07-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Platelet count decreased, Thrombotic thrombocytopenic purpura
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 21
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: Albuterol, apixiban, furosemids, gabapentin, leuprolide, pantoprazole, ondansetron, prednisone, spironalactone, tadalafil, treprostinil.
Current Illness: Pulmonary hypertension, scleroderma, myopathy, nicm, fsgs.
Preexisting Conditions: Pulmonary hypertension, scleroderma, myopathy, nicm, fsgs.
Allergies: Latex
Diagnostic Lab Data: Platelet count went from 277 to 16K/ul
CDC Split Type:

Write-up: Pt developed acute TTP ~3 weeks post dose and subsequently passed away.


VAERS ID: 1582987 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-21
Onset:2021-08-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriovenous malformation, Cardioversion, Cerebral haemorrhage, Computerised tomogram head abnormal, Cyanosis, Death, Headache, Mechanical ventilation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-03
   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: No
Current Illness: Common cold, recovered.
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: CT Scan showing brain hemorrhage
CDC Split Type:

Write-up: Young, healthy 25 year old male. Very physically active, no health issues. Suddenly had horrible headache at 2am. Threw up, went to take a shower, girlfriend found him 10-20 min later purple in the shower. Called EMS. Heart & lungs brought back with defibrillator & ventilator. CT scan showed massive brain hemorrhage. No brain activity. Pronounced dead Tuesday Aug 3rd. Doctors concluded ruptured AVM due to amount of blood in brain. Does vaccine cause inflammation that could have caused early rupture?


VAERS ID: 1586936 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-18
Onset:2021-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aphasia, Blood pressure immeasurable, Death, Hypopnoea, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant 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), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   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: ASA BUMETANIDE CARVEDILOL ENTRESTO FERROUS SULFATE LEVSIN SPIRONOLACTONE
Current Illness: ENCOUNTER FOR AUTISM SCREENING ACUTE EMBOLISM & THROMBOSIS OF OTHER SPECIFIED VEINS OBESITY IRON DEFICIENT ANEMIA ACUTE ON CHRONIC COMBINED SYSTOLIC & DIASTOLIC CONGESTIVE HEART FAILURE HEART FAILURE DUCHENNE OR BECKER MUSCULAR DYSTROPHY PULMONARY HTN MILD PROTEIN-CALORIE MALNUTRITION
Preexisting Conditions: SEE ABOVE
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: RESIDENT REC''D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334. PROGRESS NOTE FROM FACILITY READS: 8/18/21 @ 15:11- "RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST." 8/18/21 @ 20:50- "RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO ER, RESIDENT FAMILY NOTIFIED, RN NOTIFIED." RN STATES THEY REC''D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.


VAERS ID: 1700329 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-23
Onset:2021-08-30
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNAVAILABLE / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time prolonged, Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Alanine aminotransferase increased, Anisocytosis, Aspartate aminotransferase normal, Base excess abnormal, Basophil count, Basophil percentage decreased, Blood albumin decreased, Blood bicarbonate decreased, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood fibrinogen decreased, Blood glucose increased, Blood magnesium normal, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Bronchoscopy abnormal, Calcium ionised decreased, Carbon dioxide abnormal, Carbon dioxide decreased, Cardiac arrest, Catheterisation cardiac abnormal, Chest X-ray abnormal, Coronary artery occlusion, Culture, Death, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, Eosinophil count decreased, Eosinophil percentage decreased, Fatigue, Fibrin D dimer, Full blood count, Haematocrit decreased, Haemofiltration, Haemoglobin decreased, Haemorrhage, Hypoxia, Immature granulocyte count increased, Intensive care, International normalised ratio increased, Lung assist device therapy, Lung opacity, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Mechanical ventilation, Metabolic function test, Monocyte count, Monocyte percentage decreased, Myocardial infarction, Neutrophil count increased, Oxygen saturation decreased, PCO2 decreased, PO2 decreased, Platelet count decreased, Prothrombin time prolonged, Pulmonary alveolar haemorrhage, Pulmonary haemorrhage, Pyrexia, Red blood cell count decreased, Red blood cell nucleated morphology present, Red cell distribution width increased, Right ventricular failure, SARS-CoV-2 test negative, Sepsis, Septic shock, Sinus tachycardia, Tachycardia, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), 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), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ergocalciferol, vitamin D2, 50,000 Units capsule pimecrolimus cream (ELIDEL) 1 % cream triamcinolone ointment (KENALOG) 0.1 % ointment
Current Illness: Lupus
Preexisting Conditions: Lupus diagnosis on 7/21/21
Allergies: Bactrim
Diagnostic Lab Data: Results for patient 9/1/2021 04:10 Arterial pH: 7.35 Arterial pCO2: 31.5 (L) Arterial pO2: 71.6 Arterial HCO3: 16.8 (L) Arterial Total CO2: 17.8 (L) Arterial Base Excess/Deficit: -7.6 Arterial Measured O2 Saturation: 90.0 Sodium Blood: 136 Potassium Blood: 4.4 Chloride Blood: 114 (H) Carbon Dioxide: 17.8 (L) Glucose Blood: 241 (H) BUN: 27 (H) Creatinine Blood: 0.82 Calcium Blood: 6.8 (L) WBC: 11.3 (H) RBC: 2.33 (L) Hemoglobin: 7.2 (L) Hematocrit: 22.8 (L) MCV: 97.9 MCH: 30.9 MCHC: 31.6 (L) Platelet Count: 184 MPV: 11.4 (H) RDW: 17.9 (H) Nucleated RBC Automated: 0.2 (H) Differential Type: MANUAL DIFF % Seg: 97.5 (H) % Lymphocytes: 1.0 (L) % Monocytes: 1.0 % Meta: 0.5 (H) Absolute Neutrophils: 11.018 (H) Abs Seg: 11.02 (H) Absolute Lymphocytes: 0.11 (L) Absolute Monocytes: 0.11 Abs Meta: 0.06 (H) Total Cells Counted: 198 Anisocytosis: SLIGHT Results for patient 9/1/2021 13:38 Arterial pH: 7.11 (LL) Arterial pCO2: 62.6 (HH) Arterial pO2: 70.3 Arterial HCO3: 18.8 (L) Arterial Total CO2: 20.7 Arterial Base Excess/Deficit: -12.7 Arterial Measured O2 Saturation: 85.2 (L) Sodium Blood: 137 Potassium Blood: 4.7 Chloride Blood: 119 (H) Carbon Dioxide: 20.7 (L) Glucose Blood: 226 (H) BUN: 31 (H) Creatinine Blood: 0.89 Calcium Blood: 6.6 (L) WBC: 17.0 (H) RBC: 2.90 (L) Hemoglobin: 8.9 (L) Hematocrit: 28.7 (L) MCV: 99.0 MCH: 30.7 MCHC: 31.0 (L) Platelet Count: 187 MPV: 11.0 (H) RDW: 16.9 (H) Nucleated RBC Automated: 0.1 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 94.1 (H) % Imm Gran: 1.2 (H) % Lymphocytes: 1.1 (L) % Monocytes: 3.2 % Eosinophils: 0.0 % Basophils: 0.4 Absolute Neutrophils: 15.930 (H) Abs Imm Gran: 0.21 (H) Absolute Lymphocytes: 0.19 (L) Absolute Monocytes: 0.55 (H) Absolute Eosinophils: 0.00 Absolute Basophils: 0.07 Results for patient 9/4/2021 16:04 Arterial pH: 7.40 Arterial pCO2: 47.4 (H) Arterial pO2: 60.2 (L) Arterial HCO3: 28.5 (H) Arterial Total CO2: 29.9 (H) Arterial Base Excess/Deficit: 3.7 Arterial Measured O2 Saturation: 89.7 (L) Sodium Blood: 146 (H) Potassium Blood: 3.0 (L) Chloride Blood: 106 Carbon Dioxide: 29.9 Glucose Blood: 176 (H) BUN: 67 (HH) Creatinine Blood: 2.53 (H) Calcium Blood: 8.3 (L) Ionized Calcium: 4.66 Magnesium Blood: 1.9 WBC: 8.7 RBC: 2.47 (L) Hemoglobin: 7.2 (L) Hematocrit: 21.9 (L) MCV: 88.7 MCH: 29.1 MCHC: 32.9 Platelet Count: 96 (L) MPV: 11.2 (H) RDW: 16.1 (H) Nucleated RBC Automated: 0.6 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 93.0 (H) % Imm Gran: 1.6 (H) % Lymphocytes: 1.5 (L) % Monocytes: 3.7 % Eosinophils: 0.0 % Basophils: 0.2 Absolute Neutrophils: 8.120 (H) Abs Imm Gran: 0.14 (H) Absolute Lymphocytes: 0.13 (L) Absolute Monocytes: 0.32 Absolute Eosinophils: 0.00 Absolute Basophils: 0.02 PT Result: 16.1 (H) INR Result: 1.25 PTT Result: 94.3 (H) TT Result: $g100.0 (H) D Dimer: 2.56 (H) Fibrinogen: 192 (L) Heparin Level.: 0.36 PREOPERATIVE DIAGNOSIS: STEMI POSTOPERATIVE DIAGNOSIS: stemi Procedure(s): Left heart catheterization with coronary angiography JL3 and SCR ANESTHESIA: General ESTIMATED BLOOD LOSS: Minimal COMPLICATIONS: None CONDITION: Critical ACCESS: 5 Fr left FA FINDINGS: Totally occluded left anterior descending & circumflex coronary arteries. Right coronary artery patent
CDC Split Type:

Write-up: Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine. At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6$g8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO. On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl. Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID Parents spanish speaking. Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation. Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am


VAERS ID: 1700774 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-13
Onset:2021-09-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Anion gap increased, Ascites, Blood bicarbonate decreased, Blood chloride decreased, Blood creatinine increased, Blood glucose normal, Blood lactic acid increased, Blood pH decreased, Blood potassium normal, Blood sodium decreased, Blood urea increased, COVID-19, Cardiac arrest, Cardiac failure, Cardiogenic shock, Cardiomegaly, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Congestive hepatopathy, Death, Electrocardiogram ST segment elevation, Fibrin D dimer increased, Glomerular filtration rate decreased, Hepatic failure, Hepatomegaly, Hyperventilation, Inflammation, Metabolic acidosis, Myocarditis, PCO2 decreased, Pericardial effusion, Pneumonia, Renal disorder, Renal failure, SARS-CoV-2 test positive, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), 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: 2021-09-15
   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: Unknown
Current Illness: Active COVID-19 infection suspected based on symptom onset 9/10/2021. Tested positive yesterday, 9/14 and confirmed today in our ED, 9/15.
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: EKG showing diffuse ST elevations concerning for myocarditis. Cardiologist did not feel that transfer to a higher level care center immediately for cardiac catheterization indicated. Troponin 113.793. Lactate 14.0. Creatinine 2.97. pH 7.124. Bicarb 9. Anion gap 30. Glucose 144. Sodium 135 potassium 4 chloride 96. BUN 22. SARS-CoV-2 detected. Per radiology: CTA chest: Small to moderate relatively hyperdense pericardial effusion, nonspecific. Mild cardiomegaly. Evidence of heart failure. These findings collectively would be compatible with inflammatory disease. Consider myocarditis or pericarditis. No evidence of pulmonary thromboembolism. Bilateral pneumonia. CTA abdomen and pelvis: No evidence of bowel ischemia. The enlargement of the liver and of mild ascites suggest hepatic congestion. This could reflect either heart failure or liver failure. Heterogeneous appearance of the kidneys, suggesting possible pyelonephritis, but this appearance could also be the result of some other inflammatory process.
CDC Split Type:

Write-up: Death. Presented to the emergency department with diffuse ST elevations concerning for myocarditis. His troponin was elevated at 113. His lactate was 14. He was in renal failure with a creatinine of 2.97, GFR 26. D-dimer was elevated at 1.25 without any obvious pulmonary embolism according to the CT. Upon presentation he was hyperventilating, not complaining of chest pain. Labs demonstrate a significant metabolic acidosis with a pH of 7.124, PCO2 of 15.4. O2 sat 96.8% on room air. Patient unfortunately went into cardiac arrest and was unable to be revived. Cause of death suspected to be myocarditis and cardiogenic shock In the setting of active COVID-19 infection.


VAERS ID: 1732186 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-01
Onset:2021-09-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Cardioversion, Death, Malaise, Myocardial infarction, Nausea, Respiratory arrest, Resuscitation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   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: xyzal
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Paramedics stated he died of heart attack.
CDC Split Type:

Write-up: Patient began complaining about not feeling well. He was nauseated and began throwing up and going to the bathroom. That continued off and on all night. Around 6:30 - 6am the next morning he said he was feeling somewhat better but was very weak. H e went back to bed. We checked on him around lunch time lying on his bed with his phone in his hand. He appeared to be trying to text. I checked on him a few minutes later and he had not moved. I checked and saw he wasn''t breathing. At that time he had a heart beat. We called 911 and I started CPR and continued for approx 25 until paramedics arrived. They bagged him and used defibrillator but could not bring him back.


VAERS ID: 1463936 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-25
Onset:2021-06-29
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Death, Embolism, Loss of consciousness, Malaise, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Past medical history included "homocysteinurie."
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20212

Write-up: beeld van asystolie; beeld van embool; tijdens hulpverlening convulsieve bewegingen en bewustzijnsverlies; op 29/06 plots onwel; tijdens hulpverlening convulsieve bewegingen en bewustzijnsverlies; overlijden; This regulatory authority case was reported by a physician and describes the occurrence of DEATH (overlijden), CARDIAC ARREST (beeld van asystolie), LOSS OF CONSCIOUSNESS (tijdens hulpverlening convulsieve bewegingen en bewustzijnsverlies), EMBOLISM (beeld van embool), SEIZURE (tijdens hulpverlening convulsieve bewegingen en bewustzijnsverlies) and MALAISE (op 29/06 plots onwel) in a 27-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Past medical history included "homocysteinurie.". On 25-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 23-Jun-2021, received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 29-Jun-2021, the patient experienced DEATH (overlijden) (seriousness criteria death and medically significant), LOSS OF CONSCIOUSNESS (tijdens hulpverlening convulsieve bewegingen en bewustzijnsverlies) (seriousness criteria death and medically significant), SEIZURE (tijdens hulpverlening convulsieve bewegingen en bewustzijnsverlies) (seriousness criteria death and medically significant) and MALAISE (op 29/06 plots onwel) (seriousness criterion death). On an unknown date, the patient experienced CARDIAC ARREST (beeld van asystolie) (seriousness criteria death and medically significant) and EMBOLISM (beeld van embool) (seriousness criteria death and medically significant). The patient died on 29-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment was reported for the events. Translation is pending. Very limited information regarding this events has been provided at this time. Further information has been requested. Further information is not expected.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested. Further information is not expected.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1480185 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-27
Onset:2021-06-19
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiocardiogram, Blood bicarbonate, Blood creatine phosphokinase, Blood creatinine, Blood fibrinogen, Blood gases, Blood lactic acid, Blood test, Chest X-ray, Computerised tomogram head, Death, Glomerular filtration rate, Haemoglobin, International normalised ratio, Neck pain, PCO2, PO2, Platelet count, Prothrombin time, Troponin I, White blood cell count, pH body fluid
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210619; Test Name: aPTT; Result Unstructured Data: 60 sec; Test Date: 20210619; Test Name: CAG; Test Result: Inconclusive ; Result Unstructured Data: date was estimated most likely date, between start of events 19/6 and death 22/6; Test Date: 20210619; Test Name: bicarbonaat; Test Result: Inconclusive ; Result Unstructured Data: 19 mmol/L; Test Date: 20210619; Test Name: CK; Result Unstructured Data: 902 = high (<200= normal); Test Date: 20210619; Test Name: kreatinine; Result Unstructured Data: 97= normal for male; Test Date: 20210619; Test Name: fibrinogeen; Result Unstructured Data: 2.6 g/L = normal; Test Date: 20210619; Test Name: bloedgassen; Test Result: Inconclusive ; Result Unstructured Data: pH 7.28, pCO2 5.5 kPa, bicarbonaat 19 mmol/L. paO2 19.0 kPa.; Test Date: 20210619; Test Name: lactaat; Result Unstructured Data: 3.1 mmol/l; Test Date: 20210619; Test Name: Electrolyten; Result Unstructured Data: electrolytes normal; Test Date: 20210619; Test Name: Thorax X; Test Result: Inconclusive ; Result Unstructured Data: unknown; Test Date: 20210619; Test Name: CT Cerebrum; Test Result: Inconclusive ; Result Unstructured Data: unknown; Test Date: 20210619; Test Name: eGFR; Result Unstructured Data: $g90= normal; Test Date: 20210619; Test Name: hemoglobine; Result Unstructured Data: 11.3 mmlo/l = increased; Test Date: 20210619; Test Name: INR; Test Result: Inconclusive ; Result Unstructured Data: 1.2= normal; Test Date: 20210619; Test Name: pco2; Test Result: Inconclusive ; Result Unstructured Data: 5.5 kPa; Test Date: 20210619; Test Name: PH; Test Result: Inconclusive ; Result Unstructured Data: 7.28; Test Date: 20210619; Test Name: trombocyten; Result Unstructured Data: 454 = increased; Test Date: 20210619; Test Name: pao2; Test Result: Inconclusive ; Result Unstructured Data: 19 kPa; Test Date: 20210619; Test Name: PT; Result Unstructured Data: 16 sec = high; Test Date: 20210619; Test Name: Troponine I; Result Unstructured Data: 4319; Test Date: 20210619; Test Name: leukocyten; Result Unstructured Data: 19.6 = increased
CDC Split Type: NLMODERNATX, INC.MOD20212

Write-up: ; This regulatory authority case was reported by a physician and describes the occurrence of DEATH in a 29-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 27-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 19-Jun-2021, the patient experienced NECK PAIN (nekpijn). On 22-Jun-2021, NECK PAIN outcome was unknown. The patient died on 22-Jun-2021. The cause of death was not reported. An autopsy was performed, but no results were provided. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Jun-2021, Activated partial thromboplastin time (30-40): 60 (High) 60 sec. On 19-Jun-2021, Angiocardiogram: inconclusive (Inconclusive) date was estimated most likely date, between start of events 19/6 and death 22/6. On 19-Jun-2021, Blood bicarbonate: 19 mmol/l (Inconclusive) 19 mmol/L. On 19-Jun-2021, Blood creatine phosphokinase: 902 (High) 902 = high (<200= normal). On 19-Jun-2021, Blood creatinine: normal (normal) 97= normal for male. On 19-Jun-2021, Blood fibrinogen: 2.6 (normal) 2.6 g/L = normal. On 19-Jun-2021, Blood gases: ph 7.28, pco2 5.5 kpa, bicarbonaat 19 mmol/l. (Inconclusive) pH 7.28, pCO2 5.5 kPa, bicarbonaat 19 mmol/L. paO2 19.0 kPa.. On 19-Jun-2021, Blood lactic acid: 3.1 (High) 3.1 mmol/l. On 19-Jun-2021, Blood test: normal (normal) electrolytes normal. On 19-Jun-2021, Chest X-ray: unknown (Inconclusive) unknown. On 19-Jun-2021, Computerised tomogram head: unknown (Inconclusive) unknown. On 19-Jun-2021, Glomerular filtration rate: normal (normal) $g90= normal. On 19-Jun-2021, Haemoglobin: 11.3 (High) 11.3 mmlo/l = increased. On 19-Jun-2021, International normalised ratio: 1.2 (Inconclusive) 1.2= normal. On 19-Jun-2021, PCO2: 5.5 kpa (Inconclusive) 5.5 kPa. On 19-Jun-2021, PO2: 19 kpa (Inconclusive) 19 kPa. On 19-Jun-2021, Platelet count: 454 (High) 454 = increased. On 19-Jun-2021, Prothrombin time (11-14): 16 sec (High) 16 sec = high. On 19-Jun-2021, Troponin I: 4319 (High) 4319. On 19-Jun-2021, White blood cell count: 19.6 (High) 19.6 = increased. On 19-Jun-2021, pH body fluid: 7.28 (Inconclusive) 7.28. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. Treatment drug information was not given. Company Comment : This is a case of sudden death in 29-year-old male with no hx provided and associated of AE of neck pain, who died 1 month after receiving the first dose of vaccine. Very limited information has been provided at this time; Sender''s Comments: This is a case of sudden death in 29-year-old male with no hx provided and associated of AE of neck pain, who died 1 month after receiving the first dose of vaccine. Very limited information has been provided at this time; Reported Cause(s) of Death


VAERS ID: 1504349 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No medical history was provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20212

Write-up: Morte; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (Morte) in a 23-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No medical history was provided. On an unknown date, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. Death occurred on 24-Jun-2021 The patient died on 24-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. No treatment information was provided. Very limited information regarding this event has been provided at this time. Further information has been requested. Further information is not expected; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested. Further information is not expected; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1504956 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002916 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Death
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a physician and describes the occurrence of DEATH and CHEST PAIN in an 18-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002916) for COVID-19 vaccination. No Medical History information was reported. On 12-Jul-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) (unknown route) 1 dosage form. On 14-Jul-2021, the patient experienced DEATH and CHEST PAIN (seriousness criterion death). The patient died on 14-Jul-2021. 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 provided. No treatment information was provided. Company Comment: This is a case of death in a 18-year-old male subject, who died after receiving second dose of vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 18-year-old male subject, who died after receiving second dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: UNKNOWN


VAERS ID: 1576955 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003604 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? 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.MOD20212

Write-up: This case was received via Regulatory Authority (Reference number: 00646946) on 06-Aug-2021 and was forwarded to Moderna on 06-Aug-2021. This regulatory authority case was reported by a consumer and describes the occurrence of DEATH in a 29-year-old male patient who received mRNA-1273 (Spikevax) (batch no. 3003604) for COVID-19 vaccination. No Medical History information was reported. On 07-Jul-2021, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. Death occurred on 10-Jul-2021 The patient died on 10-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Company comment: This case refers to a 29-year-old male patient who died 4 days after receiving the dose 1 of mRNA-1273. Cause of death was not reported. Very limited information regarding the event has been provided at this time insufficient for causality assessment.; Sender''s Comments: This case refers to a 29-year-old male patient who died 4 days after receiving the dose 1 of mRNA-1273. Cause of death was not reported. Very limited information regarding the event has been provided at this time insufficient for causality assessment.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1592685 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-31
Onset:2021-08-01
   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: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   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: FRMODERNATX, INC.MOD20212

Write-up: This case was received via Regulatory Authority (Reference number: MP20215979) on 12-Aug-2021 and was forwarded to Moderna on 12-Aug-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DEATH in a 28-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 31-Jul-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. Death occurred on August 2021 The patient died in August 2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. No treatment drug information provided. No concomitant drug information provided. Company comment: This is a case of Death Not Otherwise Specified in a 28-year-old male patient, that occurred at an unspecified number of days after receiving first dose of vaccine (Lot number unknown). Very limited information regarding the date of death and the clinical details pertaining to death, medical history, and concomitant medication was provided at this time. No further information is expected.; Sender''s Comments: This is a case of Death Not Otherwise Specified in a 28-year-old male patient, that occurred at an unspecified number of days after receiving first dose of vaccine (Lot number unknown). Very limited information regarding the date of death and the clinical details pertaining to death, medical history, and concomitant medication was provided at this time. No further information is expected.; Reported Cause(s) of Death: Unknown cause of Death


VAERS ID: 1632184 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-06-12
Onset:2021-07-19
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002912 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Encephalitis
SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-24
   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: Medical History/Concurrent Conditions: Migraine
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20212

Write-up: Death; This regulatory authority case was reported by a pharmacist and describes the occurrence of ENCEPHALITIS and DEATH (Death) in a 21-year-old female patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch nos. 3003606 and 3002912) for COVID-19 vaccination. The patient''s past medical history included Migraine in 2019. On 12-Jun-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 10-Jul-2021, received second dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 19-Jul-2021, after starting mRNA-1273 (COVID-19 Vaccine Moderna), the patient experienced ENCEPHALITIS (seriousness criteria death and medically significant). The patient died on 24-Jul-2021. The reported cause of death was Meningoencephalitis. It is unknown if an autopsy was performed. 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. On an unknown date, laboratory test performed (result not reported). Regarding the event of Encephalitis, based on the 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. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested. No treatment information was provided. Company Comment: Regarding the event of Encephalitis, based on the 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. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Regarding the event of Encephalitis, based on the 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. However regarding the event of death, Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Meningoencephalitis; Death


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