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

Found 343 cases where Age is 30-or-more-and-under-40 or 40-or-more-and-under-50 or 50-or-more-and-under-60 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
22020-12-23MODERNA17-44 Years2021-01-1910.29%
2020-12-23MODERNA17-44 Yearstotal10.29%
2020-12-23MODERNA44-65 Years2021-01-0810.29%
2020-12-23MODERNA44-65 Yearstotal10.29%
2020-12-23MODERNAtotal20.58%
2020-12-23total20.58%
2020-12-28MODERNA17-44 Years2021-01-0410.29%
2020-12-28MODERNA17-44 Yearstotal10.29%
2020-12-28MODERNA44-65 Years2020-12-2910.29%
2020-12-28MODERNA44-65 Yearstotal10.29%
2020-12-28MODERNAtotal20.58%
2020-12-28total20.58%
2020-12-29MODERNA44-65 Years2021-01-2510.29%
2020-12-29MODERNA44-65 Yearstotal10.29%
2020-12-29MODERNAtotal10.29%
2020-12-29total10.29%
2020-12-30MODERNA44-65 Years2021-01-0410.29%
2020-12-30MODERNA44-65 Years2021-01-3110.29%
2020-12-30MODERNA44-65 Yearstotal20.58%
2020-12-30MODERNAtotal20.58%
2020-12-30total20.58%
2020-12-31MODERNA44-65 Years2020-12-3110.29%
2020-12-31MODERNA44-65 Yearstotal10.29%
2020-12-31MODERNAtotal10.29%
2020-12-31total10.29%
2021-01-05MODERNA44-65 Years2021-01-1510.29%
2021-01-05MODERNA44-65 Yearstotal10.29%
2021-01-05MODERNAtotal10.29%
2021-01-05total10.29%
2021-01-06MODERNA17-44 Years2021-06-0110.29%
2021-01-06MODERNA17-44 Yearstotal10.29%
2021-01-06MODERNAtotal10.29%
2021-01-06total10.29%
2021-01-07MODERNA44-65 Years2021-01-1210.29%
2021-01-07MODERNA44-65 Yearstotal10.29%
2021-01-07MODERNAtotal10.29%
2021-01-07total10.29%
2021-01-08MODERNA44-65 Years2021-01-0810.29%
2021-01-08MODERNA44-65 Years2021-01-0910.29%
2021-01-08MODERNA44-65 Years2021-01-1510.29%
2021-01-08MODERNA44-65 Years2021-01-2710.29%
2021-01-08MODERNA44-65 Yearstotal41.17%
2021-01-08MODERNAtotal41.17%
2021-01-08total41.17%
2021-01-11MODERNA44-65 Years2021-01-2710.29%
2021-01-11MODERNA44-65 Yearstotal10.29%
2021-01-11MODERNAtotal10.29%
2021-01-11total10.29%
2021-01-12MODERNA44-65 Years2021-01-1610.29%
2021-01-12MODERNA44-65 Years2021-09-2510.29%
2021-01-12MODERNA44-65 Yearstotal20.58%
2021-01-12MODERNAtotal20.58%
2021-01-12total20.58%
2021-01-13MODERNA44-65 Years2021-01-3110.29%
2021-01-13MODERNA44-65 Yearstotal10.29%
2021-01-13MODERNAtotal10.29%
2021-01-13total10.29%
2021-01-14MODERNA44-65 Years2021-02-0210.29%
2021-01-14MODERNA44-65 Yearstotal10.29%
2021-01-14MODERNAtotal10.29%
2021-01-14total10.29%
2021-01-18MODERNA44-65 Years2021-01-1910.29%
2021-01-18MODERNA44-65 Years2021-02-1710.29%
2021-01-18MODERNA44-65 Yearstotal20.58%
2021-01-18MODERNAtotal20.58%
2021-01-18total20.58%
2021-01-19MODERNA44-65 Years2021-01-2110.29%
2021-01-19MODERNA44-65 Yearstotal10.29%
2021-01-19MODERNAtotal10.29%
2021-01-19total10.29%
2021-01-20MODERNA44-65 Years2021-01-2410.29%
2021-01-20MODERNA44-65 Years2021-02-0910.29%
2021-01-20MODERNA44-65 Yearstotal20.58%
2021-01-20MODERNAtotal20.58%
2021-01-20total20.58%
2021-01-21MODERNA44-65 Years2021-01-2210.29%
2021-01-21MODERNA44-65 Years2021-03-1810.29%
2021-01-21MODERNA44-65 Yearstotal20.58%
2021-01-21MODERNAtotal20.58%
2021-01-21total20.58%
2021-01-22MODERNA44-65 Years2021-01-2210.29%
2021-01-22MODERNA44-65 Years2021-02-0110.29%
2021-01-22MODERNA44-65 Yearstotal20.58%
2021-01-22MODERNAtotal20.58%
2021-01-22total20.58%
2021-01-23MODERNA44-65 Years2021-02-2010.29%
2021-01-23MODERNA44-65 Yearstotal10.29%
2021-01-23MODERNAtotal10.29%
2021-01-23total10.29%
2021-01-25MODERNA44-65 Years2021-01-0110.29%
2021-01-25MODERNA44-65 Yearstotal10.29%
2021-01-25MODERNAtotal10.29%
2021-01-25total10.29%
2021-01-27MODERNA44-65 Years2021-02-1410.29%
2021-01-27MODERNA44-65 Yearstotal10.29%
2021-01-27MODERNAtotal10.29%
2021-01-27total10.29%
2021-01-28MODERNA44-65 Years2021-02-0310.29%
2021-01-28MODERNA44-65 Years2021-02-1310.29%
2021-01-28MODERNA44-65 Yearstotal20.58%
2021-01-28MODERNAtotal20.58%
2021-01-28total20.58%
2021-01-29MODERNA17-44 Years2021-04-1310.29%
2021-01-29MODERNA17-44 Yearstotal10.29%
2021-01-29MODERNAtotal10.29%
2021-01-29total10.29%
2021-01-30MODERNA44-65 Years2021-02-0110.29%
2021-01-30MODERNA44-65 Years2021-02-0610.29%
2021-01-30MODERNA44-65 Yearstotal20.58%
2021-01-30MODERNAtotal20.58%
2021-01-30total20.58%
2021-02-01MODERNA17-44 Years2021-02-0510.29%
2021-02-01MODERNA17-44 Yearstotal10.29%
2021-02-01MODERNA44-65 Years2021-02-0210.29%
2021-02-01MODERNA44-65 Yearstotal10.29%
2021-02-01MODERNAtotal20.58%
2021-02-01total20.58%
2021-02-02MODERNA44-65 Years2021-02-2110.29%
2021-02-02MODERNA44-65 Yearstotal10.29%
2021-02-02MODERNAtotal10.29%
2021-02-02total10.29%
2021-02-03MODERNA44-65 Years2021-04-2710.29%
2021-02-03MODERNA44-65 Yearstotal10.29%
2021-02-03MODERNAtotal10.29%
2021-02-03total10.29%
2021-02-04MODERNA44-65 Years2021-02-1610.29%
2021-02-04MODERNA44-65 Years2021-03-2510.29%
2021-02-04MODERNA44-65 Yearstotal20.58%
2021-02-04MODERNAtotal20.58%
2021-02-04total20.58%
2021-02-05MODERNA17-44 Years2021-03-0510.29%
2021-02-05MODERNA17-44 Years2021-04-2010.29%
2021-02-05MODERNA17-44 Yearstotal20.58%
2021-02-05MODERNA44-65 Years2021-07-1610.29%
2021-02-05MODERNA44-65 Yearstotal10.29%
2021-02-05MODERNAtotal30.87%
2021-02-05total30.87%
2021-02-09MODERNA44-65 Years2021-02-0910.29%
2021-02-09MODERNA44-65 Yearstotal10.29%
2021-02-09MODERNAtotal10.29%
2021-02-09total10.29%
2021-02-10MODERNA17-44 Years2021-02-1110.29%
2021-02-10MODERNA17-44 Yearstotal10.29%
2021-02-10MODERNAtotal10.29%
2021-02-10total10.29%
2021-02-11MODERNA17-44 Years2021-02-1510.29%
2021-02-11MODERNA17-44 Yearstotal10.29%
2021-02-11MODERNA44-65 Years2021-02-1710.29%
2021-02-11MODERNA44-65 Yearstotal10.29%
2021-02-11MODERNAtotal20.58%
2021-02-11total20.58%
2021-02-12MODERNA17-44 Years2021-02-1410.29%
2021-02-12MODERNA17-44 Yearstotal10.29%
2021-02-12MODERNA44-65 Years2021-02-1310.29%
2021-02-12MODERNA44-65 Years2021-02-2110.29%
2021-02-12MODERNA44-65 Yearstotal20.58%
2021-02-12MODERNAtotal30.87%
2021-02-12total30.87%
2021-02-17MODERNA44-65 Years2021-02-2010.29%
2021-02-17MODERNA44-65 Yearstotal10.29%
2021-02-17MODERNAtotal10.29%
2021-02-17total10.29%
2021-02-18MODERNA44-65 Years2021-02-1810.29%
2021-02-18MODERNA44-65 Years2021-02-1910.29%
2021-02-18MODERNA44-65 Years2021-03-3010.29%
2021-02-18MODERNA44-65 Yearstotal30.87%
2021-02-18MODERNAtotal30.87%
2021-02-18total30.87%
2021-02-19MODERNA17-44 Years2021-02-2110.29%
2021-02-19MODERNA17-44 Yearstotal10.29%
2021-02-19MODERNA44-65 Years2021-02-2010.29%
2021-02-19MODERNA44-65 Years2021-03-1910.29%
2021-02-19MODERNA44-65 Yearstotal20.58%
2021-02-19MODERNAtotal30.87%
2021-02-19total30.87%
2021-02-22MODERNA44-65 Years2021-03-2610.29%
2021-02-22MODERNA44-65 Yearstotal10.29%
2021-02-22MODERNAtotal10.29%
2021-02-22total10.29%
2021-02-23MODERNA17-44 Years2021-03-0410.29%
2021-02-23MODERNA17-44 Yearstotal10.29%
2021-02-23MODERNA44-65 Years2021-02-2410.29%
2021-02-23MODERNA44-65 Yearstotal10.29%
2021-02-23MODERNAtotal20.58%
2021-02-23total20.58%
2021-02-24MODERNA44-65 Years2021-02-2410.29%
2021-02-24MODERNA44-65 Years2021-03-1210.29%
2021-02-24MODERNA44-65 Years2021-03-1710.29%
2021-02-24MODERNA44-65 Years2021-04-0810.29%
2021-02-24MODERNA44-65 Yearstotal41.17%
2021-02-24MODERNAtotal41.17%
2021-02-24total41.17%
2021-02-25MODERNA44-65 Years2021-02-2610.29%
2021-02-25MODERNA44-65 Years2021-03-0110.29%
2021-02-25MODERNA44-65 Yearstotal20.58%
2021-02-25MODERNAtotal20.58%
2021-02-25total20.58%
2021-02-26MODERNA44-65 Years2021-03-1310.29%
2021-02-26MODERNA44-65 Years2021-03-1810.29%
2021-02-26MODERNA44-65 Yearstotal20.58%
2021-02-26MODERNAtotal20.58%
2021-02-26total20.58%
2021-02-27MODERNA17-44 Years2021-04-0710.29%
2021-02-27MODERNA17-44 Yearstotal10.29%
2021-02-27MODERNA44-65 Years2021-02-2810.29%
2021-02-27MODERNA44-65 Years2021-03-1710.29%
2021-02-27MODERNA44-65 Yearstotal20.58%
2021-02-27MODERNAtotal30.87%
2021-02-27total30.87%
2021-02-28MODERNA44-65 Years2021-03-1510.29%
2021-02-28MODERNA44-65 Yearstotal10.29%
2021-02-28MODERNAtotal10.29%
2021-02-28total10.29%
2021-03-01MODERNA44-65 Years2021-03-1010.29%
2021-03-01MODERNA44-65 Years2021-08-0610.29%
2021-03-01MODERNA44-65 Yearstotal20.58%
2021-03-01MODERNAtotal20.58%
2021-03-01total20.58%
2021-03-02MODERNA44-65 Years2021-03-0210.29%
2021-03-02MODERNA44-65 Years2021-03-0310.29%
2021-03-02MODERNA44-65 Yearstotal20.58%
2021-03-02MODERNAtotal20.58%
2021-03-02total20.58%
2021-03-03MODERNA17-44 Years2021-03-2510.29%
2021-03-03MODERNA17-44 Yearstotal10.29%
2021-03-03MODERNA44-65 Years2021-03-0810.29%
2021-03-03MODERNA44-65 Years2021-03-2010.29%
2021-03-03MODERNA44-65 Years2021-04-0110.29%
2021-03-03MODERNA44-65 Yearstotal30.87%
2021-03-03MODERNAtotal41.17%
2021-03-03total41.17%
2021-03-04MODERNA44-65 Years2021-03-0510.29%
2021-03-04MODERNA44-65 Years2021-03-2710.29%
2021-03-04MODERNA44-65 Yearstotal20.58%
2021-03-04MODERNAtotal20.58%
2021-03-04total20.58%
2021-03-05MODERNA17-44 Years2021-03-2410.29%
2021-03-05MODERNA17-44 Yearstotal10.29%
2021-03-05MODERNA44-65 Years2021-03-0610.29%
2021-03-05MODERNA44-65 Years2021-03-0710.29%
2021-03-05MODERNA44-65 Years2021-03-2010.29%
2021-03-05MODERNA44-65 Years2021-09-1910.29%
2021-03-05MODERNA44-65 Yearstotal41.17%
2021-03-05MODERNAtotal51.46%
2021-03-05total51.46%
2021-03-06MODERNA44-65 Years2021-03-0910.29%
2021-03-06MODERNA44-65 Yearstotal10.29%
2021-03-06MODERNAtotal10.29%
2021-03-06total10.29%
2021-03-08MODERNA17-44 Years2021-03-1710.29%
2021-03-08MODERNA17-44 Yearstotal10.29%
2021-03-08MODERNA44-65 Years2021-03-0810.29%
2021-03-08MODERNA44-65 Yearstotal10.29%
2021-03-08MODERNAtotal20.58%
2021-03-08total20.58%
2021-03-09MODERNA44-65 Years2021-03-1410.29%
2021-03-09MODERNA44-65 Years2021-03-1610.29%
2021-03-09MODERNA44-65 Years2021-03-2810.29%
2021-03-09MODERNA44-65 Years2021-04-0610.29%
2021-03-09MODERNA44-65 Years2021-05-1110.29%
2021-03-09MODERNA44-65 Years2021-07-2510.29%
2021-03-09MODERNA44-65 Yearstotal61.75%
2021-03-09MODERNAtotal61.75%
2021-03-09total61.75%
2021-03-10MODERNA17-44 Years2021-03-2110.29%
2021-03-10MODERNA17-44 Yearstotal10.29%
2021-03-10MODERNA44-65 Years2021-03-1120.58%
2021-03-10MODERNA44-65 Years2021-03-1220.58%
2021-03-10MODERNA44-65 Years2021-03-2710.29%
2021-03-10MODERNA44-65 Years2021-07-1210.29%
2021-03-10MODERNA44-65 Yearstotal61.75%
2021-03-10MODERNAtotal72.04%
2021-03-10total72.04%
2021-03-11MODERNA44-65 Years2021-03-1220.58%
2021-03-11MODERNA44-65 Years2021-03-1310.29%
2021-03-11MODERNA44-65 Years2021-03-2110.29%
2021-03-11MODERNA44-65 Years2021-03-2310.29%
2021-03-11MODERNA44-65 Years2021-03-2810.29%
2021-03-11MODERNA44-65 Yearstotal61.75%
2021-03-11MODERNAtotal61.75%
2021-03-11total61.75%
2021-03-12MODERNA44-65 Years2021-03-2110.29%
2021-03-12MODERNA44-65 Years2021-04-0210.29%
2021-03-12MODERNA44-65 Years2021-04-2210.29%
2021-03-12MODERNA44-65 Yearstotal30.87%
2021-03-12MODERNAtotal30.87%
2021-03-12total30.87%
2021-03-13MODERNA17-44 Years2021-03-2310.29%
2021-03-13MODERNA17-44 Years2021-03-2710.29%
2021-03-13MODERNA17-44 Yearstotal20.58%
2021-03-13MODERNA44-65 Years2021-03-1410.29%
2021-03-13MODERNA44-65 Years2021-03-1610.29%
2021-03-13MODERNA44-65 Yearstotal20.58%
2021-03-13MODERNAtotal41.17%
2021-03-13total41.17%
2021-03-14MODERNA44-65 Years2021-03-1510.29%
2021-03-14MODERNA44-65 Yearstotal10.29%
2021-03-14MODERNAtotal10.29%
2021-03-14total10.29%
2021-03-15MODERNA44-65 Years2021-03-1610.29%
2021-03-15MODERNA44-65 Years2021-03-2210.29%
2021-03-15MODERNA44-65 Years2021-03-2310.29%
2021-03-15MODERNA44-65 Yearstotal30.87%
2021-03-15MODERNAtotal30.87%
2021-03-15total30.87%
2021-03-16MODERNA17-44 Years2021-04-2810.29%
2021-03-16MODERNA17-44 Yearstotal10.29%
2021-03-16MODERNA44-65 Years2021-03-1710.29%
2021-03-16MODERNA44-65 Years2021-03-2310.29%
2021-03-16MODERNA44-65 Years2021-05-0810.29%
2021-03-16MODERNA44-65 Yearstotal30.87%
2021-03-16MODERNAtotal41.17%
2021-03-16total41.17%
2021-03-17MODERNA44-65 Years2021-03-1910.29%
2021-03-17MODERNA44-65 Years2021-04-0310.29%
2021-03-17MODERNA44-65 Yearstotal20.58%
2021-03-17MODERNAtotal20.58%
2021-03-17total20.58%
2021-03-18MODERNA44-65 Years2021-03-1810.29%
2021-03-18MODERNA44-65 Yearstotal10.29%
2021-03-18MODERNAtotal10.29%
2021-03-18total10.29%
2021-03-19MODERNA17-44 Years2021-04-1510.29%
2021-03-19MODERNA17-44 Yearstotal10.29%
2021-03-19MODERNA44-65 Years2021-03-2710.29%
2021-03-19MODERNA44-65 Yearstotal10.29%
2021-03-19MODERNAtotal20.58%
2021-03-19total20.58%
2021-03-20MODERNA44-65 Years2021-03-2110.29%
2021-03-20MODERNA44-65 Yearstotal10.29%
2021-03-20MODERNAtotal10.29%
2021-03-20total10.29%
2021-03-22MODERNA17-44 Years2021-04-2210.29%
2021-03-22MODERNA17-44 Yearstotal10.29%
2021-03-22MODERNA44-65 Years2021-03-2410.29%
2021-03-22MODERNA44-65 Yearstotal10.29%
2021-03-22MODERNAtotal20.58%
2021-03-22total20.58%
2021-03-23MODERNA44-65 Years2021-03-3110.29%
2021-03-23MODERNA44-65 Yearstotal10.29%
2021-03-23MODERNAtotal10.29%
2021-03-23total10.29%
2021-03-24MODERNA44-65 Years2021-04-0110.29%
2021-03-24MODERNA44-65 Yearstotal10.29%
2021-03-24MODERNAtotal10.29%
2021-03-24total10.29%
2021-03-25MODERNA44-65 Years2021-03-3010.29%
2021-03-25MODERNA44-65 Years2021-04-0510.29%
2021-03-25MODERNA44-65 Years2021-04-0610.29%
2021-03-25MODERNA44-65 Years2021-04-1710.29%
2021-03-25MODERNA44-65 Years2021-06-0510.29%
2021-03-25MODERNA44-65 Yearstotal51.46%
2021-03-25MODERNAtotal51.46%
2021-03-25total51.46%
2021-03-26MODERNA44-65 Years2021-03-2710.29%
2021-03-26MODERNA44-65 Years2021-05-2010.29%
2021-03-26MODERNA44-65 Yearstotal20.58%
2021-03-26MODERNAtotal20.58%
2021-03-26total20.58%
2021-03-29MODERNA44-65 Years2021-03-2910.29%
2021-03-29MODERNA44-65 Years2021-08-0710.29%
2021-03-29MODERNA44-65 Yearstotal20.58%
2021-03-29MODERNAtotal20.58%
2021-03-29total20.58%
2021-03-30MODERNA17-44 Years2021-04-1510.29%
2021-03-30MODERNA17-44 Years2021-05-0710.29%
2021-03-30MODERNA17-44 Yearstotal20.58%
2021-03-30MODERNA44-65 Years2021-03-3010.29%
2021-03-30MODERNA44-65 Years2021-04-0210.29%
2021-03-30MODERNA44-65 Years2021-04-0310.29%
2021-03-30MODERNA44-65 Years2021-04-0410.29%
2021-03-30MODERNA44-65 Yearstotal41.17%
2021-03-30MODERNAtotal61.75%
2021-03-30total61.75%
2021-03-31MODERNA17-44 Years2021-04-0110.29%
2021-03-31MODERNA17-44 Years2021-04-0410.29%
2021-03-31MODERNA17-44 Years2021-04-0710.29%
2021-03-31MODERNA17-44 Yearstotal30.87%
2021-03-31MODERNA44-65 Years2021-04-0610.29%
2021-03-31MODERNA44-65 Years2021-04-0810.29%
2021-03-31MODERNA44-65 Years2021-04-2110.29%
2021-03-31MODERNA44-65 Yearstotal30.87%
2021-03-31MODERNAtotal61.75%
2021-03-31total61.75%
2021-04-01MODERNA44-65 Years2021-04-0210.29%
2021-04-01MODERNA44-65 Years2021-04-1910.29%
2021-04-01MODERNA44-65 Years2021-04-2310.29%
2021-04-01MODERNA44-65 Yearstotal30.87%
2021-04-01MODERNAtotal30.87%
2021-04-01total30.87%
2021-04-03MODERNA17-44 Years2021-04-0310.29%
2021-04-03MODERNA17-44 Yearstotal10.29%
2021-04-03MODERNAtotal10.29%
2021-04-03total10.29%
2021-04-04MODERNA44-65 Years2021-04-0410.29%
2021-04-04MODERNA44-65 Yearstotal10.29%
2021-04-04MODERNAtotal10.29%
2021-04-04total10.29%
2021-04-05MODERNA17-44 Years2021-04-0810.29%
2021-04-05MODERNA17-44 Years2021-04-2410.29%
2021-04-05MODERNA17-44 Yearstotal20.58%
2021-04-05MODERNA44-65 Years2021-04-0510.29%
2021-04-05MODERNA44-65 Yearstotal10.29%
2021-04-05MODERNAtotal30.87%
2021-04-05total30.87%
2021-04-06MODERNA44-65 Years2021-04-0710.29%
2021-04-06MODERNA44-65 Years2021-04-0910.29%
2021-04-06MODERNA44-65 Years2021-04-2310.29%
2021-04-06MODERNA44-65 Yearstotal30.87%
2021-04-06MODERNAtotal30.87%
2021-04-06total30.87%
2021-04-07MODERNA17-44 Years2021-06-0810.29%
2021-04-07MODERNA17-44 Yearstotal10.29%
2021-04-07MODERNA44-65 Years2021-04-1910.29%
2021-04-07MODERNA44-65 Years2021-05-1110.29%
2021-04-07MODERNA44-65 Yearstotal20.58%
2021-04-07MODERNAtotal30.87%
2021-04-07total30.87%
2021-04-08MODERNA44-65 Years2021-04-0110.29%
2021-04-08MODERNA44-65 Years2021-04-0910.29%
2021-04-08MODERNA44-65 Years2021-04-1010.29%
2021-04-08MODERNA44-65 Yearstotal30.87%
2021-04-08MODERNAtotal30.87%
2021-04-08total30.87%
2021-04-09MODERNA17-44 Years2021-04-1010.29%
2021-04-09MODERNA17-44 Yearstotal10.29%
2021-04-09MODERNA44-65 Years2021-04-1210.29%
2021-04-09MODERNA44-65 Years2021-04-1510.29%
2021-04-09MODERNA44-65 Years2021-09-2510.29%
2021-04-09MODERNA44-65 Yearstotal30.87%
2021-04-09MODERNAtotal41.17%
2021-04-09total41.17%
2021-04-10MODERNA17-44 Years2021-04-1110.29%
2021-04-10MODERNA17-44 Years2021-04-1210.29%
2021-04-10MODERNA17-44 Yearstotal20.58%
2021-04-10MODERNAtotal20.58%
2021-04-10total20.58%
2021-04-11MODERNA17-44 Years2021-04-1710.29%
2021-04-11MODERNA17-44 Yearstotal10.29%
2021-04-11MODERNA44-65 Years2021-04-1210.29%
2021-04-11MODERNA44-65 Yearstotal10.29%
2021-04-11MODERNAtotal20.58%
2021-04-11total20.58%
2021-04-12MODERNA17-44 Years2021-04-2110.29%
2021-04-12MODERNA17-44 Yearstotal10.29%
2021-04-12MODERNA44-65 Years2021-04-1210.29%
2021-04-12MODERNA44-65 Years2021-04-1410.29%
2021-04-12MODERNA44-65 Years2021-04-1510.29%
2021-04-12MODERNA44-65 Yearstotal30.87%
2021-04-12MODERNAtotal41.17%
2021-04-12total41.17%
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2021-04-13MODERNA17-44 Yearstotal10.29%
2021-04-13MODERNA44-65 Years2021-04-1810.29%
2021-04-13MODERNA44-65 Years2021-04-2710.29%
2021-04-13MODERNA44-65 Yearstotal20.58%
2021-04-13MODERNAtotal30.87%
2021-04-13total30.87%
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2021-04-14MODERNA17-44 Years2021-04-2810.29%
2021-04-14MODERNA17-44 Yearstotal20.58%
2021-04-14MODERNAtotal20.58%
2021-04-14total20.58%
2021-04-15MODERNA44-65 Years2021-04-1620.58%
2021-04-15MODERNA44-65 Years2021-04-1810.29%
2021-04-15MODERNA44-65 Years2021-05-0310.29%
2021-04-15MODERNA44-65 Years2021-05-1410.29%
2021-04-15MODERNA44-65 Yearstotal51.46%
2021-04-15MODERNAtotal51.46%
2021-04-15total51.46%
2021-04-16MODERNA17-44 Years2021-04-1610.29%
2021-04-16MODERNA17-44 Yearstotal10.29%
2021-04-16MODERNA44-65 Years2021-04-1720.58%
2021-04-16MODERNA44-65 Years2021-04-2310.29%
2021-04-16MODERNA44-65 Years2021-07-1210.29%
2021-04-16MODERNA44-65 Yearstotal41.17%
2021-04-16MODERNAtotal51.46%
2021-04-16total51.46%
2021-04-17MODERNA44-65 Years2021-04-2710.29%
2021-04-17MODERNA44-65 Yearstotal10.29%
2021-04-17MODERNAtotal10.29%
2021-04-17total10.29%
2021-04-19MODERNA17-44 Years2021-04-2010.29%
2021-04-19MODERNA17-44 Yearstotal10.29%
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2021-04-19MODERNA44-65 Yearstotal10.29%
2021-04-19MODERNAtotal20.58%
2021-04-19total20.58%
2021-04-20MODERNA17-44 Years2021-05-0310.29%
2021-04-20MODERNA17-44 Years2021-05-0710.29%
2021-04-20MODERNA17-44 Years2021-05-1310.29%
2021-04-20MODERNA17-44 Yearstotal30.87%
2021-04-20MODERNA44-65 Years2021-05-0810.29%
2021-04-20MODERNA44-65 Yearstotal10.29%
2021-04-20MODERNAtotal41.17%
2021-04-20total41.17%
2021-04-21MODERNA17-44 Years2021-04-2610.29%
2021-04-21MODERNA17-44 Yearstotal10.29%
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2021-04-21MODERNA44-65 Years2021-04-2510.29%
2021-04-21MODERNA44-65 Yearstotal20.58%
2021-04-21MODERNAtotal30.87%
2021-04-21total30.87%
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2021-04-22MODERNA44-65 Yearstotal10.29%
2021-04-22MODERNAtotal10.29%
2021-04-22total10.29%
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2021-04-23MODERNA17-44 Years2021-04-2410.29%
2021-04-23MODERNA17-44 Yearstotal20.58%
2021-04-23MODERNA44-65 Years2021-04-0110.29%
2021-04-23MODERNA44-65 Years2021-04-2310.29%
2021-04-23MODERNA44-65 Years2021-04-2420.58%
2021-04-23MODERNA44-65 Years2021-04-2910.29%
2021-04-23MODERNA44-65 Years2021-08-0110.29%
2021-04-23MODERNA44-65 Yearstotal61.75%
2021-04-23MODERNAtotal82.33%
2021-04-23total82.33%
2021-04-24MODERNA17-44 Years2021-05-2610.29%
2021-04-24MODERNA17-44 Yearstotal10.29%
2021-04-24MODERNAtotal10.29%
2021-04-24total10.29%
2021-04-26MODERNA44-65 Years2021-04-2710.29%
2021-04-26MODERNA44-65 Years2021-04-2910.29%
2021-04-26MODERNA44-65 Years2021-04-3010.29%
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2021-04-26MODERNA44-65 Yearstotal41.17%
2021-04-26MODERNAtotal41.17%
2021-04-26total41.17%
2021-04-28MODERNA44-65 Years2021-04-2810.29%
2021-04-28MODERNA44-65 Years2021-05-0110.29%
2021-04-28MODERNA44-65 Yearstotal20.58%
2021-04-28MODERNAtotal20.58%
2021-04-28total20.58%
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2021-04-29MODERNA44-65 Yearstotal10.29%
2021-04-29MODERNAtotal10.29%
2021-04-29total10.29%
2021-04-30MODERNA44-65 Years2021-05-2110.29%
2021-04-30MODERNA44-65 Years2021-06-0510.29%
2021-04-30MODERNA44-65 Yearstotal20.58%
2021-04-30MODERNAtotal20.58%
2021-04-30total20.58%
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2021-05-01MODERNA17-44 Yearstotal10.29%
2021-05-01MODERNAtotal10.29%
2021-05-01total10.29%
2021-05-03MODERNA17-44 Years2021-05-0420.58%
2021-05-03MODERNA17-44 Yearstotal20.58%
2021-05-03MODERNA44-65 Years2021-05-0410.29%
2021-05-03MODERNA44-65 Years2021-05-1210.29%
2021-05-03MODERNA44-65 Yearstotal20.58%
2021-05-03MODERNAtotal41.17%
2021-05-03total41.17%
2021-05-04MODERNA44-65 Years2021-05-0510.29%
2021-05-04MODERNA44-65 Yearstotal10.29%
2021-05-04MODERNAtotal10.29%
2021-05-04total10.29%
2021-05-05MODERNA17-44 Years2021-05-1010.29%
2021-05-05MODERNA17-44 Yearstotal10.29%
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2021-05-05MODERNA44-65 Years2021-05-1410.29%
2021-05-05MODERNA44-65 Yearstotal30.87%
2021-05-05MODERNAtotal41.17%
2021-05-05total41.17%
2021-05-06MODERNA44-65 Years2021-05-0710.29%
2021-05-06MODERNA44-65 Years2021-05-0910.29%
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2021-05-06MODERNA44-65 Years2021-05-1310.29%
2021-05-06MODERNA44-65 Yearstotal41.17%
2021-05-06MODERNAtotal41.17%
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2021-05-09MODERNA44-65 Yearstotal10.29%
2021-05-09MODERNAtotal10.29%
2021-05-09total10.29%
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2021-05-10MODERNA44-65 Yearstotal10.29%
2021-05-10MODERNAtotal10.29%
2021-05-10total10.29%
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2021-05-11MODERNA17-44 Yearstotal10.29%
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2021-05-11MODERNA44-65 Yearstotal10.29%
2021-05-11MODERNAtotal20.58%
2021-05-11total20.58%
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2021-05-12MODERNA17-44 Yearstotal10.29%
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2021-05-12MODERNA44-65 Yearstotal10.29%
2021-05-12MODERNAtotal20.58%
2021-05-12total20.58%
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2021-05-13MODERNA44-65 Yearstotal10.29%
2021-05-13MODERNAtotal10.29%
2021-05-13total10.29%
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2021-05-14MODERNA44-65 Years2021-06-0410.29%
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2021-05-14MODERNA44-65 Yearstotal30.87%
2021-05-14MODERNAtotal30.87%
2021-05-14total30.87%
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2021-05-15MODERNA44-65 Yearstotal10.29%
2021-05-15MODERNAtotal10.29%
2021-05-15total10.29%
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2021-05-17MODERNA17-44 Yearstotal10.29%
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2021-05-17MODERNA44-65 Yearstotal10.29%
2021-05-17MODERNAtotal20.58%
2021-05-17total20.58%
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2021-05-18MODERNA44-65 Yearstotal30.87%
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2021-05-18total41.17%
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2021-05-19MODERNA17-44 Yearstotal10.29%
2021-05-19MODERNAtotal10.29%
2021-05-19total10.29%
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2021-05-20MODERNA17-44 Yearstotal10.29%
2021-05-20MODERNAtotal10.29%
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2021-05-21MODERNA44-65 Yearstotal20.58%
2021-05-21MODERNAtotal20.58%
2021-05-21total20.58%
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2021-05-22MODERNA44-65 Yearstotal20.58%
2021-05-22MODERNAtotal20.58%
2021-05-22total20.58%
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2021-05-24MODERNAtotal10.29%
2021-05-24total10.29%
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2021-05-25MODERNA44-65 Yearstotal20.58%
2021-05-25MODERNAtotal20.58%
2021-05-25total20.58%
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2021-05-26MODERNA44-65 Yearstotal10.29%
2021-05-26MODERNAtotal10.29%
2021-05-26total10.29%
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2021-05-27MODERNA17-44 Yearstotal10.29%
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2021-05-27MODERNA44-65 Yearstotal10.29%
2021-05-27MODERNAtotal20.58%
2021-05-27total20.58%
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2021-05-28MODERNA44-65 Yearstotal10.29%
2021-05-28MODERNAtotal10.29%
2021-05-28total10.29%
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2021-05-30MODERNA44-65 Yearstotal10.29%
2021-05-30MODERNAtotal10.29%
2021-05-30total10.29%
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2021-06-02MODERNA44-65 Yearstotal20.58%
2021-06-02MODERNAtotal20.58%
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2021-06-09MODERNA44-65 Yearstotal10.29%
2021-06-09MODERNAtotal10.29%
2021-06-09total10.29%
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2021-06-10MODERNA44-65 Yearstotal30.87%
2021-06-10MODERNAtotal30.87%
2021-06-10total30.87%
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2021-06-11MODERNA44-65 Yearstotal10.29%
2021-06-11MODERNAtotal20.58%
2021-06-11total20.58%
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2021-06-12MODERNA44-65 Yearstotal10.29%
2021-06-12MODERNAtotal10.29%
2021-06-12total10.29%
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2021-06-13MODERNA17-44 Yearstotal10.29%
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2021-06-13MODERNA44-65 Yearstotal10.29%
2021-06-13MODERNAtotal20.58%
2021-06-13total20.58%
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2021-06-15MODERNA44-65 Yearstotal20.58%
2021-06-15MODERNAtotal20.58%
2021-06-15total20.58%
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2021-06-18MODERNA44-65 Yearstotal10.29%
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2021-06-18total10.29%
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2021-06-21MODERNA44-65 Yearstotal10.29%
2021-06-21MODERNAtotal30.87%
2021-06-21total30.87%
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2021-06-22MODERNAtotal10.29%
2021-06-22total10.29%
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2021-06-30MODERNA44-65 Yearstotal10.29%
2021-06-30MODERNAtotal10.29%
2021-06-30total10.29%
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2021-07-02MODERNA44-65 Yearstotal10.29%
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2021-07-06MODERNA17-44 Yearstotal10.29%
2021-07-06MODERNAtotal10.29%
2021-07-06total10.29%
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2021-07-13MODERNA17-44 Yearstotal10.29%
2021-07-13MODERNAtotal10.29%
2021-07-13total10.29%
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2021-07-14MODERNA44-65 Yearstotal10.29%
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2021-07-14total10.29%
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2021-07-16MODERNA17-44 Yearstotal10.29%
2021-07-16MODERNAtotal10.29%
2021-07-16total10.29%
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2021-07-18MODERNA17-44 Yearstotal10.29%
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2021-07-18MODERNA44-65 Yearstotal10.29%
2021-07-18MODERNAtotal20.58%
2021-07-18total20.58%
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2021-07-19MODERNA44-65 Yearstotal10.29%
2021-07-19MODERNAtotal10.29%
2021-07-19total10.29%
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2021-07-22MODERNA44-65 Yearstotal20.58%
2021-07-22MODERNAtotal20.58%
2021-07-22total20.58%
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2021-07-24MODERNA17-44 Yearstotal10.29%
2021-07-24MODERNAtotal10.29%
2021-07-24total10.29%
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2021-07-28MODERNA44-65 Yearstotal10.29%
2021-07-28MODERNAtotal10.29%
2021-07-28total10.29%
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2021-07-30MODERNA44-65 Yearstotal20.58%
2021-07-30MODERNAtotal20.58%
2021-07-30total20.58%
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2021-08-01MODERNA17-44 Yearstotal10.29%
2021-08-01MODERNAtotal10.29%
2021-08-01total10.29%
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2021-08-02MODERNA17-44 Yearstotal10.29%
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2021-08-03MODERNA44-65 Yearstotal10.29%
2021-08-03MODERNAtotal10.29%
2021-08-03total10.29%
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2021-08-04MODERNA44-65 Yearstotal20.58%
2021-08-04MODERNAtotal20.58%
2021-08-04total20.58%
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2021-08-05MODERNA44-65 Yearstotal10.29%
2021-08-05MODERNAtotal10.29%
2021-08-05total10.29%
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2021-08-10MODERNA17-44 Yearstotal10.29%
2021-08-10MODERNAtotal10.29%
2021-08-10total10.29%
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2021-08-11MODERNA17-44 Yearstotal10.29%
2021-08-11MODERNA44-65 Years2021-08-1210.29%
2021-08-11MODERNA44-65 Years2021-08-2610.29%
2021-08-11MODERNA44-65 Yearstotal20.58%
2021-08-11MODERNAtotal30.87%
2021-08-11total30.87%
2021-08-13MODERNA17-44 Years2021-08-1610.29%
2021-08-13MODERNA17-44 Yearstotal10.29%
2021-08-13MODERNAtotal10.29%
2021-08-13total10.29%
2021-08-17MODERNA44-65 Years2021-09-0810.29%
2021-08-17MODERNA44-65 Yearstotal10.29%
2021-08-17MODERNAtotal10.29%
2021-08-17total10.29%
2021-08-18MODERNA17-44 Years2021-08-2010.29%
2021-08-18MODERNA17-44 Years2021-08-2410.29%
2021-08-18MODERNA17-44 Yearstotal20.58%
2021-08-18MODERNAtotal20.58%
2021-08-18total20.58%
2021-08-19MODERNA44-65 Years2021-08-2710.29%
2021-08-19MODERNA44-65 Years2021-09-1310.29%
2021-08-19MODERNA44-65 Yearstotal20.58%
2021-08-19MODERNAtotal20.58%
2021-08-19total20.58%
2021-08-25MODERNA44-65 Years2021-08-2610.29%
2021-08-25MODERNA44-65 Years2021-09-0610.29%
2021-08-25MODERNA44-65 Yearstotal20.58%
2021-08-25MODERNAtotal20.58%
2021-08-25total20.58%
2021-08-26MODERNA17-44 Years2021-08-2710.29%
2021-08-26MODERNA17-44 Yearstotal10.29%
2021-08-26MODERNAtotal10.29%
2021-08-26total10.29%
2021-08-27MODERNA44-65 Years2021-08-2910.29%
2021-08-27MODERNA44-65 Years2021-09-1910.29%
2021-08-27MODERNA44-65 Yearstotal20.58%
2021-08-27MODERNAtotal20.58%
2021-08-27total20.58%
2021-08-31MODERNA17-44 Years2021-08-3110.29%
2021-08-31MODERNA17-44 Yearstotal10.29%
2021-08-31MODERNAtotal10.29%
2021-08-31total10.29%
2021-09-02MODERNA44-65 Years2021-09-1410.29%
2021-09-02MODERNA44-65 Yearstotal10.29%
2021-09-02MODERNAtotal10.29%
2021-09-02total10.29%
2021-09-06MODERNA44-65 Years2021-09-0710.29%
2021-09-06MODERNA44-65 Yearstotal10.29%
2021-09-06MODERNAtotal10.29%
2021-09-06total10.29%
2021-09-08MODERNA44-65 Years2021-09-0810.29%
2021-09-08MODERNA44-65 Yearstotal10.29%
2021-09-08MODERNAtotal10.29%
2021-09-08total10.29%
2021-09-13MODERNA17-44 Years2021-09-1510.29%
2021-09-13MODERNA17-44 Yearstotal10.29%
2021-09-13MODERNAtotal10.29%
2021-09-13total10.29%
2021-09-14MODERNA17-44 Years2021-09-1410.29%
2021-09-14MODERNA17-44 Yearstotal10.29%
2021-09-14MODERNAtotal10.29%
2021-09-14total10.29%
2021-09-15MODERNA44-65 Years2021-09-1510.29%
2021-09-15MODERNA44-65 Yearstotal10.29%
2021-09-15MODERNAtotal10.29%
2021-09-15total10.29%
2021-09-23MODERNA44-65 Years2021-09-2710.29%
2021-09-23MODERNA44-65 Yearstotal10.29%
2021-09-23MODERNAtotal10.29%
2021-09-23total10.29%
2021-10-03MODERNA44-65 Years2021-10-0310.29%
2021-10-03MODERNA44-65 Yearstotal10.29%
2021-10-03MODERNAtotal10.29%
2021-10-03total10.29%
UnknownMODERNA17-44 Years2021-08-0110.29%
UnknownMODERNA17-44 Yearstotal10.29%
UnknownMODERNA44-65 Years2021-05-0410.29%
UnknownMODERNA44-65 Yearstotal10.29%
UnknownMODERNAtotal20.58%
Unknowntotal20.58%
total343100%
TOTAL343100%



Case Details

This is page 1 out of 7

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VAERS ID: 918518 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2020-12-31
Onset:2020-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Cardio-respiratory arrest, Death, Resuscitation, Syncope
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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-31
   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: To be determined
Current Illness: To be determined
Preexisting Conditions: To be determined
Allergies: To be determined
Diagnostic Lab Data: Autopsy being performed
CDC Split Type:

Write-up: syncopal episode - arrested - CPR - death


VAERS ID: 920815 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-30
Onset:2021-01-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Per employee health records HTN, DM, Breast CA 2016 with radiation, obesity, gastric sleeve 10 years ago, arthritis, plantar fasciitis, ankle tendonitis, DeQuarvains, carpal tunnel, anxiety
Allergies: Lisinpril, Codeine, Latex , environmental (hay fever)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found deceased in her home, unknown cause, 6 days after vaccine.


VAERS ID: 928933 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Iowa  
Vaccinated:2020-12-23
Onset:2021-01-08
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-08
   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 had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessful


VAERS ID: 929764 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Washington  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorthiazide (by record, not confirmed)
Current Illness:
Preexisting Conditions: Hypertension, sleep apnea, obesity. based on medical record
Allergies: no known allergies recorded in medical record
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was found deceased at home about 24 hours after immunization. Date of Death:: 12/29/2020; estimated time of death 6:00pm


VAERS ID: 930910 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-08
Onset:2021-01-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was refusing to take all medications for over a year
Current Illness: None
Preexisting Conditions: Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, major depressive disorder, aphasia following cerebral infarction, muscle weakness, dysphagia, hypothyrodism, type 2 diabetes, hyperlipidemia, hypomagnesemia, hypokalemia, hypertension, gastro esophageal reflux disease, gastritis, constipation
Allergies: Metformin, morphine, statins, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID vaccination around 12:15pm. Patient was monitored for the appropriate amount of time by nursing staff. Patient passed away at 2:15pm.


VAERS ID: 935511 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-08
Onset:2021-01-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-09
   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: none known of
Preexisting Conditions: history of vaginal adenocarcinoma- removed with surgery in 2019
Allergies: latex (skin reaction)
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received the 1st dose of Moderna and was found deceased in her home the next day.


VAERS ID: 939050 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Cough, Death, Endotracheal intubation, Hemiparesis, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Morbid obesity and hypothyroidism
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated on 12/28. Approximately one day later, develops cough and on azithromycin x 1 week. On 1/3, patient develops left-sided weakness and aphasia. Taken to the hospital, tested COVID+, required intubation -- acute hypoxic respiratory failure secondary to COVID - on H&P. Patient died on 1/4/21 at 7:20am.


VAERS ID: 946293 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-07
Onset:2021-01-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Death, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-12
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alvesco inh, Mepron susp, Coreg, Zetia, Tricor, Umeclidinum, Cellcept, Zyprexa, Prilosec, paxil, Miralax, prednisone, trazodone, xopenex inh
Current Illness: Pulmonary fibrosis on O2
Preexisting Conditions: COPD,Severe pulmonary fibrosis,HTN,GERD
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 51 year old M with h/o O2 dependent COPD, Severe pulmonary fibrosis became increasingly hypoxic around 1800hours 1/7/2021. He was transported to hospital for acute on chronic hypoxia respiratory failure. On 1/12/2021 he decompensated further, and after discussing with family and palliative care, He was changed to comfort care. He expired on 1/12/2021@2325 at medical center.


VAERS ID: 950108 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-05
Onset:2021-01-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Pt. stated she was not ill at the time of vaccination.
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: "Moderna COVID-19 Vaccine EUA" It has been reported to me that pt. had gone into hospital for a heart catheterization on 1/12/2021. It was found during this procedure that pt. had suffered a MI. She was release to home the following day and passed away at her residence on 1/15/2021.


VAERS ID: 961339 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-18
Onset:2021-01-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   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: Wellbutrin, Ambien
Current Illness:
Preexisting Conditions: COPD, Sleep apnea
Allergies: contrast die
Diagnostic Lab Data:
CDC Split Type:

Write-up: possibly got it at clinic, possibly who administered shot. Pts. daughter said the pts boyfriend denied any symptoms the whole day but that in the middle of the night the pt passed away.


VAERS ID: 964401 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-12
Onset:2021-01-16
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt died 4 days after vaccine, no known reaction to the vaccination


VAERS ID: 965256 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Georgia  
Vaccinated:2020-12-23
Onset:2021-01-19
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-19
   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: Atorvastatin calcium 20mg daily
Current Illness:
Preexisting Conditions: Hypertension Hyperlipidemia Obstructive Sleep Apnea Obese Hearing loss Degenerative Disc Lumbar
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found deceased, presumed while exercising


VAERS ID: 966888 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-01-22
Onset:2021-01-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   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: At 04:30 on 1/22/2021, facility was notified of employee death at home.


VAERS ID: 975762 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   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:
Current Illness: N/A
Preexisting Conditions: - Hx of aortic dissection - Hx of mitral valve repair - Ascending aortic aneurysm (HCC) - Hearing loss of right year - Scoliosis of thoracolumbar spine - Fatigue - Overweight
Allergies: - Fish containing products - Kale - PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt deceased


VAERS ID: 977319 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Michigan  
Vaccinated:2020-12-29
Onset:2021-01-25
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Notified by patient''s sister on 1/26/2021 that patient died in his sleep on 1/25/2021. She did not know cause of death.


VAERS ID: 982942 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-21
Onset:2021-01-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: peanuts
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: per recipient spouse - vaccine recipient became ill during the night of 1/21/21 or early morning of 1/22/21 and was deceased in the morning of 1/22/21.


VAERS ID: 985004 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-08
Onset:2021-01-27
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Constipation, Death, Fatigue, Hyperhidrosis, Impaired work ability, Resuscitation, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Cardiac Issues. Hx of cardiac Stent but unknown in-depth.
Allergies: Codeine Penicillin V
Diagnostic Lab Data:
CDC Split Type:

Write-up: The week of 1/18/2021 The patient complained of Abdominal pain and called off work (we are also her employer) She was seen for constipation on 1/20/2021. Employee returned to work on 1/25/2021 Had occasional episodes during work where she would sweat and become tired but would rest until she felt better. On the Night of 1/27/2021 she was feeling fine no issues, later in the shift a co worker found her unresponsive, CPR was initiated but unsuccessful.


VAERS ID: 994913 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-01-30
Onset:2021-01-31
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Death, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-01
   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:

Write-up: patient passed away 2 days after vaccine. patient had temperature, nausea, and vomiting after vaccine.


VAERS ID: 996156 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-01
Onset:2021-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arthralgia, Death, Impaired work ability, Injection site pain, Malaise, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client came to nursing station about 2pm to report she "was not feeling well". Nurses took vital signs, then referred her to the vaccination clinic that was onsite. She was observed by vaccination team for a period of time. She reported shoulder pain radiating into shoulder blade in arm vaccine was received. Vaccination team offered ice pack to her, observed for a period of time, and released back to work. About 10pm that evening, she sent a text to another coworker that her pain was "off the charts" and that she had pain covering her whole left side of her body. She did not come to work in the morning and did not contact work. Well being check was performed at approximately 9am on 2/2/2021 and she was found dead in her home. 911 was immediately called and authorities took over the scene.


VAERS ID: 1003624 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-25
Onset:2021-01-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypotension, Oxygen saturation decreased, Peripheral coldness, Pyrexia, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-01
   Days after onset: 25
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cyancobalamin, insulin detemir, potassium chloride, reno caps, sevelemer, sodium polystyrene sulfonate, midodrine, acetaminophen,
Current Illness: PNA
Preexisting Conditions: MSSA, DM, ESRD/HD, HTN
Allergies: metaformin and sulfa
Diagnostic Lab Data: done at hospital
CDC Split Type:

Write-up: Patient awake at 0300. When going into the room to get him ready for dialysis he was cold to touch, unresponsive other than to sound, and nonverbal. O2 sat was 67 via finger probe. Oxygen immediately initiated and a venturi mask retrieved and initiated. When unable to arouse him via sternal rub this RN called 911. Send to ED. Febrile 39.2 and hypotensive 58/43. Admitted. unknown after that as patient expired in hospital.


VAERS ID: 1006416 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-13
Onset:2021-01-31
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-31
   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: diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of a heart attack on 1/31/21, 2.5 weeks after vaccination


VAERS ID: 1010114 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-01-28
Onset:2021-02-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: anemia, NIDDM, ESRD on Hemodialysis, AFib, CAD S/P CABG, COPD , HTN, recently diagnosed with COVID in September, 2020.
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data: Presumptive negative for COVID
CDC Split Type:

Write-up: Patient passed away (Dead on Arrival on presentation to ER) on 02/03/2021


VAERS ID: 1020702 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-20
Onset:2021-02-09
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: Hydrochlorothiazide, Hydroxyzine, Mirena, Ocrevus, Prednisone, triamcinolone acetonide, valacyclovir, vitamin D 3
Current Illness:
Preexisting Conditions: calcaneal spur displacement of intervertebral disc without myelopathy female stress incontinence foot pain hand joint pain herpes simplex low back pain menorrhagia multiple sclerosis neck pain numbness of lower limb peripheral edema polyneuropathy
Allergies: No known allergies.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Passed away the morning of 2/9/21.


VAERS ID: 1026379 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-09
Onset:2021-02-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: OXYMETAZOLINE HCL 0.05% NASAL SPRAY DISCONTINUED 30 02/09/2021 02/09/2021 02/09/2021 1 USE 1 SPRAY NASAL TWICE A DAY MAX OF 3 DAYS OF USE** DOCUSATE NA 50MG/SENNOSIDES 8.6MG TAB DISCONTINUED 60 02/09/2021 01/20/2021 01/21/2021
Current Illness: HTN-Iron def-h/o PE-chronic renal failure
Preexisting Conditions: HTN-Iron def-h/o PE-chronic renal failure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient 6 hours post vaccination


VAERS ID: 1032575 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-01-19
Onset:2021-01-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Death, Dyspnoea, Malaise, Myalgia, Pyrexia, Respiration abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Two days later passed away; difficulty breathing, shortness of breath; difficulty breathing, gurgling; Not feeling well; Achiness; Severe fever; Chills; A spontaneous report was received from a physician concerning a 56-year-old female patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and developed fever, chills, achiness, shortness of breath, gurgling and unresponsive. The patient''s medical history was not provided. Concomitant product use was not provided. On 19 Jan 2021, prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273 (Lot 042L20A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. After receiving the vaccine on 19 Jan 2021, the patient experienced fever, chills, shortness of breath, gurgling and achiness. On 21 Jan 2021, the patient was found unresponsive. Emergency medical services were called to perform life saving measures however, they were unsuccessful. No further treatment information was provided. The patient died on 21 Jan 2021. The cause of death was reported as unknown. An autopsy was planned.; Reporter''s Comments: This case concerns a 56-year-old, female, who experienced a serious event of death, with many other events after receiving second dose of mRNA-1273 (Lot# 042L20A). Very limited information regarding these events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1037124 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-04
Onset:2021-02-16
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Loss of consciousness, Resuscitation, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plavix 75 mg daily lipitor 20 mg daily aspirin omeprazole
Current Illness: none
Preexisting Conditions: Coronary artery disease, stent placed GERD
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was at a gym watching his daughter. He slumped over unconscious. EMS was called. He was found to be in fine ventricular fibrillation and resuscitation efforts failed. He was brought to Hospital ED where he was pronounced dead. He had underlying cardiac disease but his family requested I report this event as possibly related to the recent COVID vaccination.


VAERS ID: 1037207 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-02-01
Onset:2021-02-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Death, Incoherent, Injection site pain, Liver function test abnormal, Malaise, Nausea, Pyrexia, Urinary retention, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: birth control, and she did do botox
Current Illness: none,
Preexisting Conditions: trigeminal neuralgia - has been in remission since she started doing botox
Allergies: sulfa drugs
Diagnostic Lab Data: contact shock trauma center and the medical examiner
CDC Split Type:

Write-up: She had pain in the injection site Tuesday night and then during Tuesday she got worse with nausea and some fever. By Wednesday she was complaining that she could not pee even though she was drinking a lot of fluids. She continued to complain it was the worst she ever felt and then at 0600 Thursday morning she woke us up and said she needed to go to the hospital. We arrived at the hospital just before 0700 and she immediately threw up in the trash can. We went into a treatment room and they took blood and started fluids as she became incoherent. She said she had taken Tylenol so they started a drug to counter that but her liver function was all wrong and they started to look for a hospital that could transplant a liver. She was air evade about 0930 to Medical center and just over 30 hours latter she was dead. There is a pending autopsy. She was a healthy 39 year old mother who got the shots because she worked as a surgical tech and she was the single mother of a 9 year old little girl.


VAERS ID: 1040633 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-30
Onset:2021-02-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M2OA / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram, Death, Haemorrhagic stroke
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: Levothyroxine 100mcg, one tablet daily
Current Illness:
Preexisting Conditions: Hypothyroidism, recent hypertension
Allergies:
Diagnostic Lab Data: CAT scan (2/6/2021)
CDC Split Type:

Write-up: Death due to hemorrhagic stroke.


VAERS ID: 1040877 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-18
Onset:2021-02-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-18
   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: wellbutrin, crestor, albuterol, deltasone, cozaar, spiriva, coreg
Current Illness: chest pain, COPD, Bipolar, dyslipidemia, stage 3 chronic kidney disease
Preexisting Conditions: as above
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: unknown if related to vaccine. patient received 2nd vaccine at 0830, observed 15 minutes, discharged, arrested at 0915 upon entering her home. vaccine was administered by DOH at their community location. patient was pronounced lifeless in the ED.


VAERS ID: 1043880 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-19
Onset:2021-02-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Aspiration, Death, Insomnia, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin, Vit D3, Vit B12, Plavix, duloxetine, Gabapentin, glipizide, levothyroxine, tolterodine, verapamil, atropine, Flonase, Symbicort, Invega, loperamide, Tylenol, albuterol sulfate
Current Illness: urinary tract infection
Preexisting Conditions: diabetes mellitus with polyneuropathy, schizoaffective disorder, chronic obstructive pulmonary disease, essential hypertension, bipolar disorder, hypothyroidism, history of cerebral infarction, diabetic retinopathy, overactive bladder, Vitamin D deficiency, encephalopathy, chronic kidney disease, seizures
Allergies: iodine, shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received second Moderna COVID-19 vaccination administered in left arm at her assisted living facility by Pharmacist at 1153 on 2/19/2021. Pt was monitored for vaccine reaction with no known adverse reaction. Approximately 18 hours post-vaccine, she was found deceased in her sleep at 0540 on 2/20/21. Per circumstances/pt history, it is presumed that the patient aspirated while sleeping, perhaps secondary to a seizure. Coroner was notified and declined as coroner''s case. VAERS notification being made due to pt death within 24 hours of receiving a vaccine.


VAERS ID: 1051651 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-23
Onset:2021-02-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain, Acidosis, Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Angiogram pulmonary abnormal, Angiogram pulmonary normal, Anion gap, Ascites, Aspartate aminotransferase increased, Atelectasis, Atypical mycobacterial infection, Bilirubin conjugated, Blood albumin, Blood alkaline phosphatase increased, Blood bicarbonate decreased, Blood bilirubin, Blood creatinine increased, Blood glucose decreased, Blood lactic acid, Blood lactic acid normal, Blood pH decreased, Blood pH increased, Blood potassium decreased, Blood urea increased, Cholelithiasis, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Death, Dyspnoea, Enteritis, Fibrin D dimer, Hypoglycaemia, Ileus, International normalised ratio increased, N-terminal prohormone brain natriuretic peptide increased, Nausea, PCO2 increased, Pericardial effusion, Platelet count decreased, Pleural effusion, Proctitis, Retching, Troponin, Varices oesophageal, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-24
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, metoprolol, simvastatin, acetaminophen, ibuprofen, calcium carbonate, furosemide, diphenoxylate/atropine, magnesium chloride, omeprazole, Carafate, testosterone, vitamin D3, levothyroxine
Current Illness: None
Preexisting Conditions: Colon Cancer Hypothyroidism Hyperlipidemia GERD Hypertension
Allergies: NKDA
Diagnostic Lab Data: 2/23/21: White count is 2.1, platelet 26, INR 1.7, PTT 107.5, D-dimer greater than 5000 pH is 7.03 with PCO2 of 50, potassium 3.3, bicarb of 16, anion gap of 21, BUN of 26, creatinine 2.5, glucose of 39, lactic acid of 14.6, total bilirubin of 4.58, direct bilirubin of 3.87, AST 134, ALT of 43, alk phos of 194. Troponin is negative. proBNP of 4229. Albumin 1.9. CT scan of the abdomen pelvis shows complex fluid attenuation the posterior right hepatic lobe, possibly metastasis, nonspecific hepatic morphology, possibly cirrhosis. Small volume ascites, punctate calcified gallstone with pericholecystic fluid related to ascites. Infiltration of the submucosal fat of the ascending colon. Possible wall thickening of a short segment of jejunum possibly infectious or inflammatory process such as enteritis. Distention of a few loops of jejunum which may represent localized ileus. Fluid within the distal thoracic esophagus which can be seen in reflux. Mild wall thickening of the GE junction with intraluminal nodularity which may represent esophageal varices. Limited evaluation of bladder due to incomplete distention with possible mucosal hyperenhancement. CT angiogram of the chest demonstrates no evidence of pulmonary thromboembolic disease. Small segmental and subsegmental pulmonary emboli cannot be excluded. Distention of the entirety of thoracic esophagus with simple fluid. Trace bilateral pleural effusions. Overlying compressive atelectasis. Small pericardial effusion. Small focal atelectasis or atypical infection in the inferior lingula.
CDC Split Type:

Write-up: Abdominal pain, nausea and vomiting, shortness of breath, acidosis, hypoglycemia, death. Onset of abdominal pain was 30 minutes after administration of the vaccine followed by 20+ episodes of vomiting and dry heaving.


VAERS ID: 1051803 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-08
Onset:2021-01-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   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: unknown- not the facility that administered the vaccine
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown- not the facility that administered the vaccine
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: unknown, was informed by Health Director that person had passed away


VAERS ID: 1052106 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-11
Onset:2021-02-17
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood cholesterol increased, Blood creatinine normal, Blood glucose increased, Blood potassium normal, Blood triglycerides increased, Blood urea increased, Cardiac arrest, Death, Low density lipoprotein normal, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 2 tablets bid glipizide 10 mg bid Alopliptan 25 mg daily Prescribed statin, ASA and ace inhibitor but she was not taking them
Current Illness: DM with proteinuria and foot complications hyperlipidemia
Preexisting Conditions: DM with proteinuria and foot complications Renal insufficiency hyperlipidemia alcohol abuse
Allergies: Augmentin and NSAID
Diagnostic Lab Data: none Last hgbA1c was Jan 19 when if was 9.6%. BUN on that date was 36 and creatinine was 1.27. Potassium was 4.6. Random glucose was 185. LDL was 127 and total cholesterol was 211. Triglycerides were 232.
CDC Split Type:

Write-up: While at counseling appointment on February 17 patient had witnessed sudden cardiac arrest and was not able to be resuscitated. She was pronounced dead at 12:09. At the time of death her glucose was about 500.


VAERS ID: 1052172 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, Death, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: statins- stated no allergic reaction but can''t take
Diagnostic Lab Data: Autopsy completed 2/20/2021 at medical school by MD
CDC Split Type: na

Write-up: Agency contacted 2/19 In evening by employer representative- client Died Suddenly after work"


VAERS ID: 1054160 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-11
Onset:2021-02-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Death, Headache, Nausea, Pain in extremity, Seizure
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-15
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: not applicable
Preexisting Conditions: Right VP shunt at birth.
Allergies: Latex and Ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2/12/2021 woke up with sore arm and back. 2/13/2021 woke up with headache around 1am. Headache and nausea all morning. Mid-late afternoon started having seizures. Admitted to Hospital 2/15/2021 expired. Reported per wife on 2/25/2021.


VAERS ID: 1055070 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-19
Onset:2021-02-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   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: Cetirizine, ferrous gluconate, atorvastatin, acetaminophen, aspirin EC, sertraline, clozapine, risperidone, clozapine, polyethylene glycol, sennosides, glipizide, levothyroxine,
Current Illness: Morbid obesity, hypothyroidism, Diabetes, Iron deficiency anemia, QT prolongation, hyperlipidemia, chronic hypoxia, psychosis, luteal phase dysphoria, anxiety, early onset schizophrenia, moderate intellectual disability, left ankle ORIF.
Preexisting Conditions: Same as item 11, remove left ankle ORIF
Allergies: No known allergies
Diagnostic Lab Data: Post pending
CDC Split Type:

Write-up: Client died on 02/21/2021 and had received the second dose of the vaccine series on 02/19/2021.


VAERS ID: 1058569 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-02-25
Onset:2021-02-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-26
   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:

Write-up: PATIENT DIED IN HIS SLEEP NIGHT AFTER ADMINISTRATION


VAERS ID: 1061911 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-28
Onset:2021-01-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Anxiety depression; Blood pressure high; Thyroid disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died at home; Gasping for air/difficulty breathing; Soreness; A spontaneous report was received from a physician concerning a 45 years-old, female patient who experienced soreness/MedDRA PT: pain, gasping for air/difficulty breathing/MedDRA PT: dyspnoea and subsequently died/MedDRA PT: death. The patient''s medical history included blood pressure (disorder not specified), thyroid disorder, depression and anxiety. Concomitant product use included blood pressure medication, thyroid medication and possibly depression and anxiety medication. On 28 Jan 2021, the patient received their first of two planned doses of mRNA-1273 (Lot #007M20A) (route of administration and injection site not provided) for prophylaxis of COVID-19 infection. On 28 Jan 2021, following the vaccination, the patient was fine but had experienced some soreness. Per patient''s coworker, the patient did not take any medication as it made the patient sick. The physician was not aware of any complaints from the vaccine. On 13 Feb 2021 at 3:31am, the patient called 911. Per the 911 call, the patient was gasping for air on the call and having difficulty breathing. The patient subsequently died on 13 Feb 2021 at home. The physician inquired whether Moderna gets involved with the autopsy and logistics of the death of patients and wanted to know the time frame for reporting a death of a patient who received the vaccine. The physician did not know who administered the patient''s vaccine. Action taken with mRNA-1273 in response to the events was not applicable as the patient deceased. The event died was fatal. The outcome for the events soreness and gasping for air/difficulty breathing was unknown. The patient died on 13 Feb 2021. The cause of death was not provided. Plans for an autopsy were not provided.; Reporter''s Comments: Very limited information regarding the event of dyspnea and death has been provided at this time. Further information has been requested. Patient''s medical history of blood pressure is considered a risk factor. Based on the current available information and temporal association between the use of the product and the onset of the pain, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Died at home


VAERS ID: 1068993 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-01-23
Onset:2021-02-20
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Cerebral haemorrhage, Death
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension, morbid obesity
Allergies: Unknown
Diagnostic Lab Data: Autopsy performed 3/1/2021
CDC Split Type:

Write-up: Spontaneous intracerebral hemorrhage and death on 2/20/2021


VAERS ID: 1069316 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-12
Onset:2021-02-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 AR / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-21
   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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: death


VAERS ID: 1069728 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-02
Onset:2021-03-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death, Dizziness, Loss of consciousness, Resuscitation, Seizure like phenomena, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Everything was done in ED in the hospital on early morning of 3/3/2021
CDC Split Type:

Write-up: Patient Started having dizziness, feeling faint at around midnight on 3/3/2021. He then lost consciousness, had seizure-like activity and was taken to hospital via EMS. In the hospital patient was unresponsive and received resuscitation attempts unsuccessfully. Per family, after about 45 minutes, code was called and patient expired.


VAERS ID: 1080430 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-02-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death Narrative: Death was not determined to be related to COVID vaccination. COVID vaccination (dose 1) occurred on 1/27/21 with no noted side effects. Death occurred on 2/14/21.


VAERS ID: 1082707 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-05
Onset:2021-03-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-07
   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: death


VAERS ID: 1084800 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-08
Onset:2021-03-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   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: none reported
Preexisting Conditions: liver transplant. Doctor advised pt to get the covid vaccine.
Allergies: NKDAnone reported
Diagnostic Lab Data: Sent to ME office for autopsy
CDC Split Type:

Write-up: Death. EMS called to residence 9 hours later for cardiac arrest. Pt pronounced at Emergency Room. Pt sent to ME office for autopsy.


VAERS ID: 1085032 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-02-25
Onset:2021-02-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Impaired work ability, Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient received dose #2 of her Moderna COVID vaccine on 2/25/21. Patient called in to work the next day 2/26/21 because she was not feeling well. Patient did not show up to work on Monday 3/1/21 and her supervisor, called the PD to check in on her and she was found deceased in her home.


VAERS ID: 1088184 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-06
Onset:2021-03-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   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: Furosemide, Omeprazole, Xarelto, Vitamin D3, Propranolol, Sucralfate, Spironolactone
Current Illness: Unknown
Preexisting Conditions: Seizures, unknown
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pronounced dead on 3/9/21 approximately 72 hours after receiving vaccination. Unknown symptoms prior.


VAERS ID: 1088615 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-05
Onset:2021-03-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-06
   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: Unknown
Current Illness: Unknown
Preexisting Conditions: Carotid Artery Bruit, Smoker, HTN, family hx of cardiovascular disease Sister MI at 56. 11/2015 Abnormal Stress Echo with elevated values on a lipid profile after c/o chest pain. Other medical history unknown.
Allergies: Morphine, Allegra, and Bee Stings
Diagnostic Lab Data: None available
CDC Split Type:

Write-up: Death within 30 days of vaccination, vaccinated on 3/5/2021 pronounced dead on 3/6/2021. Unknown if any side effects from vaccine. No ER visit found at local hospital.


VAERS ID: 1088830 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-03
Onset:2021-03-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Vitamins Calcium
Current Illness:
Preexisting Conditions: Diabetes Blood pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient died after feeling unwell for about ten minutes.


VAERS ID: 1093986 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received a phone call stating that the patient complained of not feeling well on 3/11/21 while at work and that the patient died that night while at home.


VAERS ID: 1094102 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-02-27
Onset:2021-02-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Death, No adverse event, Toxicologic test, Urine analysis
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: TOXICOLOGY, URINE & BLOOD
CDC Split Type:

Write-up: NO ADVERSE EVENT NOTICE RECEIVED ON DATE OF VACCINE. RECEIVED NOTICE FROM CORONOER THAT THIS PATIENT EXPIRED 2/28/2021. COLLECTED URINE, BLOOD, AND TOXICOLOGY SCREEN. NOT SENT TO HOSPITAL. SENT TO FUNERAL HOME


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