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

Found 34 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 '2' 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
22020-12-23MODERNA44-65 Years2021-02-0225.88%
2020-12-23MODERNA44-65 Yearstotal25.88%
2020-12-23MODERNAtotal25.88%
2020-12-23total25.88%
2021-01-06MODERNA44-65 Years2021-04-2725.88%
2021-01-06MODERNA44-65 Yearstotal25.88%
2021-01-06MODERNAtotal25.88%
2021-01-06total25.88%
2021-02-12MODERNA44-65 Years2021-06-0825.88%
2021-02-12MODERNA44-65 Yearstotal25.88%
2021-02-12MODERNAtotal25.88%
2021-02-12total25.88%
2021-02-26MODERNA44-65 Years2021-03-1425.88%
2021-02-26MODERNA44-65 Yearstotal25.88%
2021-02-26MODERNAtotal25.88%
2021-02-26total25.88%
2021-03-12MODERNA44-65 Years2021-05-0525.88%
2021-03-12MODERNA44-65 Yearstotal25.88%
2021-03-12MODERNAtotal25.88%
2021-03-12total25.88%
2021-03-15MODERNA44-65 Years2021-04-0525.88%
2021-03-15MODERNA44-65 Yearstotal25.88%
2021-03-15MODERNAtotal25.88%
2021-03-15total25.88%
2021-03-17MODERNA17-44 Years2021-04-0825.88%
2021-03-17MODERNA17-44 Yearstotal25.88%
2021-03-17MODERNA44-65 Years2021-08-1325.88%
2021-03-17MODERNA44-65 Yearstotal25.88%
2021-03-17MODERNAtotal411.76%
2021-03-17total411.76%
2021-03-25MODERNA44-65 Years2021-08-1625.88%
2021-03-25MODERNA44-65 Yearstotal25.88%
2021-03-25MODERNAtotal25.88%
2021-03-25total25.88%
2021-03-29MODERNA17-44 Years2021-04-0225.88%
2021-03-29MODERNA17-44 Yearstotal25.88%
2021-03-29MODERNAtotal25.88%
2021-03-29total25.88%
2021-03-31MODERNA44-65 Years2021-04-2625.88%
2021-03-31MODERNA44-65 Yearstotal25.88%
2021-03-31MODERNAtotal25.88%
2021-03-31total25.88%
2021-04-01MODERNA44-65 Years2021-07-1425.88%
2021-04-01MODERNA44-65 Yearstotal25.88%
2021-04-01MODERNAtotal25.88%
2021-04-01total25.88%
2021-04-06MODERNA44-65 Years2021-04-0725.88%
2021-04-06MODERNA44-65 Yearstotal25.88%
2021-04-06MODERNAtotal25.88%
2021-04-06total25.88%
2021-04-10MODERNA44-65 Years2021-04-1125.88%
2021-04-10MODERNA44-65 Yearstotal25.88%
2021-04-10MODERNAtotal25.88%
2021-04-10total25.88%
2021-04-14MODERNA17-44 Years2021-08-2025.88%
2021-04-14MODERNA17-44 Yearstotal25.88%
2021-04-14MODERNAtotal25.88%
2021-04-14total25.88%
2021-04-15MODERNA44-65 Years2021-06-1525.88%
2021-04-15MODERNA44-65 Yearstotal25.88%
2021-04-15MODERNAtotal25.88%
2021-04-15total25.88%
2021-04-17MODERNA44-65 Years2021-05-1725.88%
2021-04-17MODERNA44-65 Yearstotal25.88%
2021-04-17MODERNAtotal25.88%
2021-04-17total25.88%
2021-04-27MODERNA44-65 Years2021-09-2525.88%
2021-04-27MODERNA44-65 Yearstotal25.88%
2021-04-27MODERNAtotal25.88%
2021-04-27total25.88%
2021-04-28MODERNA44-65 Years2021-10-0225.88%
2021-04-28MODERNA44-65 Yearstotal25.88%
2021-04-28MODERNAtotal25.88%
2021-04-28total25.88%
2021-04-29MODERNA44-65 Years2021-06-1825.88%
2021-04-29MODERNA44-65 Years2021-08-2925.88%
2021-04-29MODERNA44-65 Yearstotal411.76%
2021-04-29MODERNAtotal411.76%
2021-04-29total411.76%
2021-05-10MODERNA17-44 Years2021-08-1025.88%
2021-05-10MODERNA17-44 Yearstotal25.88%
2021-05-10MODERNAtotal25.88%
2021-05-10total25.88%
2021-05-12MODERNA44-65 Years2021-05-1225.88%
2021-05-12MODERNA44-65 Yearstotal25.88%
2021-05-12MODERNAtotal25.88%
2021-05-12total25.88%
2021-05-15MODERNA44-65 Years2021-07-2725.88%
2021-05-15MODERNA44-65 Years2021-08-1812.94%
2021-05-15MODERNA44-65 Yearstotal38.82%
2021-05-15MODERNAtotal38.82%
2021-05-15PFIZER/BIONTECH44-65 Years2021-08-1812.94%
2021-05-15PFIZER/BIONTECH44-65 Yearstotal12.94%
2021-05-15PFIZER/BIONTECHtotal12.94%
2021-05-15total411.76%
2021-05-18MODERNA44-65 Years2021-06-0325.88%
2021-05-18MODERNA44-65 Years2021-08-1825.88%
2021-05-18MODERNA44-65 Yearstotal411.76%
2021-05-18MODERNAtotal411.76%
2021-05-18total411.76%
2021-05-26MODERNA17-44 Years2021-05-2825.88%
2021-05-26MODERNA17-44 Yearstotal25.88%
2021-05-26MODERNAtotal25.88%
2021-05-26total25.88%
2021-05-29MODERNA44-65 Years2021-09-0225.88%
2021-05-29MODERNA44-65 Yearstotal25.88%
2021-05-29MODERNAtotal25.88%
2021-05-29total25.88%
2021-06-04MODERNA44-65 Years2021-09-3025.88%
2021-06-04MODERNA44-65 Yearstotal25.88%
2021-06-04MODERNAtotal25.88%
2021-06-04total25.88%
2021-06-12MODERNA44-65 Years2021-08-3025.88%
2021-06-12MODERNA44-65 Yearstotal25.88%
2021-06-12MODERNAtotal25.88%
2021-06-12total25.88%
2021-06-17MODERNA44-65 Years2021-08-2825.88%
2021-06-17MODERNA44-65 Yearstotal25.88%
2021-06-17MODERNAtotal25.88%
2021-06-17total25.88%
2021-07-10MODERNA44-65 Years2021-08-1225.88%
2021-07-10MODERNA44-65 Yearstotal25.88%
2021-07-10MODERNAtotal25.88%
2021-07-10total25.88%
2021-10-04MODERNA44-65 Years2021-10-0412.94%
2021-10-04MODERNA44-65 Yearstotal12.94%
2021-10-04MODERNAtotal12.94%
2021-10-04SANOFI PASTEUR44-65 Years2021-10-0412.94%
2021-10-04SANOFI PASTEUR44-65 Yearstotal12.94%
2021-10-04SANOFI PASTEURtotal12.94%
2021-10-04total25.88%
total68200%
TOTAL† 68† 200%
† Because some cases have multiple vaccinations and symptoms, a single case can account for multiple entries in this table. This is the reason why the Total Count is greater than 34 (the number of cases found), and the Total Percentage is greater than 100.



Case Details

VAERS ID: 1079976 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L29A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Death, Dysgeusia, Exposure to SARS-CoV-2, Feeling abnormal, Gastrointestinal tract irritation, Headache, Malaise, Micturition urgency, Pain, Pollakiuria, Resuscitation, SARS-CoV-2 test negative, Somnolence, Syncope, Upper respiratory tract infection
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-02
   Days after onset: 41
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: After 1st vaccination (12/23/20): Triamterene/HCTZ, Losinopril, DayQuil, Mucinex, prescribed Augmentin 12/25/20 After 2nd (1/25/21): Addition of Zinc, Quercetin, Vitamin C, Augmentin rx''d 2/1/21
Current Illness:
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12/23/20 (Moderna #1) - Malaise, cough on 12/24, went to walk-in on 12/25 c/o cough, malaise, rx''d Augmentin x14d, Rapid covid negative (and PCR resulted negative). 12/27 slept all day, 12/28 back to work. 1/12/21 metallic taste in mouth, severe GI sx, malaise, aches, headache. 1/14 seen at walk-in and covid swabbed Negative. 1/21/21 exposed to parents who found out they were covid + on 1/22/21. 1/25/21 (Moderna #2) - Continued with persistent cough and GI sx. Then also developed urinary frequency and urgency. Seen at urgent care 2/1 c/o cough, dx URI, rx''d augmenting. Woke up morning of 2/2/21 abruptly, stood up, said something was wrong, and collapsed. CPR attempted immediately, EMS brought him to ER where he was pronounced dead.


VAERS ID: 1160874 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-26
Onset:2021-03-12
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01021A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 01021A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Death, Electrocardiogram, Fatigue, Laboratory test
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-14
   Days after onset: 2
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: Tylenol, Albuterol sulfate, azelastine, buspirone, duloxetine, immune globulin 10%, levothyroxine, lisinopril, loratadine, lorazepam, prednisone, tramadol, hydrochlorothiazide.
Current Illness: Hypertension, hypothyroidism, pulmonary fibrosis, sarcoidosis
Preexisting Conditions: Pulmonary fibrosis, cervicalagia, hypoxemia, pulmonary disease, non-rheumatic aortic valve stenosis, pain, weakness
Allergies: Iodine and iodine containing products, azathioprine
Diagnostic Lab Data: Labs done in healthcare center and hospital unrelated to adverse event. EKG done in hospital, unrelated.
CDC Split Type:

Write-up: Patient was seen in ED on 03/12/2021. Symptoms included fatigue and weakness, she was flown out to hospital. She passed away on 03/14/2021 in hospital.


VAERS ID: 1186348 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-17
Onset:2021-03-24
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Antinuclear antibody negative, Blood culture negative, Brain natriuretic peptide increased, Bronchoalveolar lavage, Cardiac arrest, Cardiogenic shock, Cough, Death, Double stranded DNA antibody, Dyspnoea, Echocardiogram normal, Endotracheal intubation, HIV test negative, Haemoglobin decreased, Hypotension, Hypoxia, Intensive care, Leukocytosis, Life support, Lung infiltration, Pulse absent, Renal impairment, SARS-CoV-2 test negative, Septic shock, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: budesonide-formoteroL (SYMBICORT) 160-4.5 mcg/actuation inhaler; eucalyptus oil/menthol/camphor (VICKS VAPORUB); fluticasone (FLONASE) 50 mcg/actuation nasal spray; guaiFENesin (MUCINEX FAST-MAX CHEST-CONGEST) 100 mg/5 mL liquid;
Current Illness:
Preexisting Conditions: Asthma, lupus
Allergies: Penicillin G, Hydroxychloroquine
Diagnostic Lab Data: Too many to list
CDC Split Type:

Write-up: Copied from MD discharge note - Patient is a 38 y.o. female with PMH significant for asthma and lupus not on any treatment admitted on 3/27/2021 with progressive shortness of breath and cough for months, found to have hypoxia, bilateral multifocal infiltrate without pulmonary embolism on CTA, leukocytosis, elevated troponin, elevated BNP, normal EF on echocardiogram. COVID- 19 tests were negative 4 times in the last 1 week. Blood cultures were negative. Urine and strep antigens are negative. HIV-1 also negative. Rheum consulted for hx of lupus. They did not feel this was lupus pneumonitis. Negative anti-dsDNA/SSA/SSB and RF. Pts resp status continued to decline. She was intubated on 4/3 and transferred to the ICU. Bronch washings were also neg for COVID. Despite neg cultures pt was given multiple rounds of abx including vanc, merrem, azithromycin, cefepime, without benefit. IV steroids added for possible reactive pneumonitis. Pt with shock, likely multifactorial including septic and cardiogenic. Multiple pressors maximized and BP remained low. Nephro following for worsening renal function. CRRT initiated to attempt to correct electrolyte and acidosis. Pt did not tolerate CRRT after several adjustments by neprho, pts electrolytes continued to drift from normal. Hgb dropped and CRRT held. Pt went into cardiac arrest at 1329 on 4/8/21. After several rounds of epinephrine and optimized ACLS, no pulse was recovered and ROSC was not achieved. Family notified of death at 1344 on 4/8/21


VAERS ID: 1207822 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-07
   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: Hydromorphone, Cyclobenzaprine, Lisinopril, Duloxetine, Sildenafil, Trazodone, Amoxicillin, Sulfate Thoxazole, Buspirone, Metformin, Omeprazole, Carvedilol, Ibuprofen, Pregabalin, Tamsulosin, Gabapentin
Current Illness: back surgery 5 days prior
Preexisting Conditions: Intervertebral disc. disorders with radiculopathy, hypoxemia, atelectasis, type 2 diabetes, essential hypertension, chronic obstructive pulmonary disease, alcohol dependence, major depressive disorder, benign prostatic hyperplasia, gastro-esophageal reflux disease, nicotine dependence, spinal stenosis-lumbar region, syncope and collapse
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse symptoms from vaccination. Decedent died day after 2nd vaccination, death not related to vaccination


VAERS ID: 1238235 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Death, Fatigue, Nausea, Unresponsive to stimuli
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   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:
Current Illness: None.
Preexisting Conditions: PTSD and chronic pain (patient was a veteran)
Allergies: Patient''s wife stated that patient did not eat pork. She is unsure if that is due to allergy.
Diagnostic Lab Data: Wife stated that an autopsy was conducted and that she should be getting the results this week.
CDC Split Type:

Write-up: Information received by wife. Patient was fatigued 4/10/21 after vaccination. His wife stated that she talked with him and he seemed fine. When his wife went to bed early that evening, the patient was sitting in the recliner in the living room. On the morning of 4/11/21, patient''s wife found him unresponsive in the recliner. She called an ambulance but patient was deceased. Patient''s wife stated that she noted a trashcan next to the chair the patient was sitting in. The trashcan did not have emesis in it but patient''s wife assumes he had been nauseated that evening before he passed away.


VAERS ID: 1259763 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-04-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Death, Dyspepsia, Fatigue, Headache, Myocardial infarction, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific dysfunction (narrow), 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: 2021-04-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: High cholesterol
Allergies: none
Diagnostic Lab Data: I don''t have anything
CDC Split Type:

Write-up: Fever, chills, headache, and tiredness (2nd day of receiving the 2nd dose) Feeling good on the 3rd day Headache, stomach burn, throwing up, and heart attack (4th day of receiving the 2nd dose) Passed away on April 2, 2021


VAERS ID: 1268440 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-04-26
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood glucose normal, Blood pH decreased, Cardiac arrest, Death, Fibrin D dimer increased, International normalised ratio normal, Platelet count normal, SARS-CoV-2 test negative, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), 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), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Diabetic
Preexisting Conditions: Cardiac cath with angioplasty in 2001
Allergies: unknown
Diagnostic Lab Data: ABG-pH 6.97 PTT 13.8 sec INR 1.0 Troponin 26/CK 423/CK-MB 4.4 Platelets 198 D dimer 1.49 COVID negative Glucose 177
CDC Split Type:

Write-up: Death due to cardiac arrest on 4/26/2021


VAERS ID: 1310622 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-06
Onset:2021-04-26
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A17691231 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   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: None
Preexisting Conditions: None known
Allergies: Unknown
Diagnostic Lab Data: Will need to request.
CDC Split Type:

Write-up: Developed symptoms around 4/25, presented to ED with complaints of chest pain and something being stuck in his throat. Subsequently died on 4/27.


VAERS ID: 1365485 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-26
Onset:2021-05-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autopsy, Chills, Cough, Death, Dyspnoea, Injection site pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Coroner''s autopsy
CDC Split Type:

Write-up: On 05/27/2021 the decedent began complaining of shortness of breath, cough, fever, chills, and pain at the injection site. On 05/28/2021 the decedent complained of the same symptoms.


VAERS ID: 1369340 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-05-12
Onset:2021-05-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Condition aggravated, Death, Embolism, Fatigue, Hypertension
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Hypertension (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Various medications related to Pulmonary Arterial Hypertension
Current Illness: See below
Preexisting Conditions: Pulmonary Arterial Hypertension, Chronic Kidney Disease, Deep Vein Thrombosis and Pulmonary Embolism
Allergies: Unknown
Diagnostic Lab Data: I have not seen the coroner''s report, but another family member said that the cause of death was Cardiopulmonary Arrest due to Embolism with chronic kidney disease and hypertension contributing.
CDC Split Type:

Write-up: My brother took the day off work on May 12, 2021 to receive his 2nd dose of the Moderna vaccine. He communicated with friends later that same day saying he was tired and needed to rest. On May 13, 2021, a work colleague followed up with a text message to see how he was doing to which my brother did not respond. This same colleague went to his house a few days later to find him dead lying on his couch.


VAERS ID: 1399375 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-18
Onset:2021-06-03
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death, 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: 2021-06-03
   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: Heart Murmur
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Coroner stated that 3 weeks after patient received 2nd dose of COVID-19 Moderna vaccine, patient collapsed from cardiac arrest, which lead to death.


VAERS ID: 1414988 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-17
Onset:2021-05-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Blood glucose normal, Cardiac arrest, Death, Pulse absent
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-17
   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: not that report source is aware of
Current Illness: none
Preexisting Conditions: none
Allergies: not that report source is aware of
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the 2nd vaccine on 5/15/21, on 5/16 patient had a "stomach ache", on 5/17 he went to work. At 9:30am, the camera''s show him going into the women''s restroom to service it, a lady tried to go into the restroom and could not go in, she called the supervisor, when the supervisor arrived there was no pulse. Report source believes he goes into work around 7:00AM. Report sources states she was told " his blood sugar was not elevated". Report source states that the death certificate states he had a cardiac arrest.


VAERS ID: 1430563 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-15
Onset:2021-04-05
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Decreased appetite, Dyspnoea, Fatigue, Headache, Loss of consciousness, Nausea, Pain, Thrombotic thrombocytopenic purpura
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Renovascular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On April 2, 2021, person went to the ED at 10:15 AM, where she complained of shortness of breath, fatigue, mild headache and nausea. Patient symptoms were going on for about 3 days. She also reported feeling a bit achy and decreased appetite. She was treated and discharged home the same day. It was later reported by a family member that this person was found unconscious on floor of her bedroom by family members and taken to hospital where she passed away. It was reported hat Doctors were thinking that this was caused by a rare blood disorder (Thrombotic thrombocytopenic purpura, a disease which causes small blood clots and interrupts the blood''s ability to deliver oxygen properly).


VAERS ID: 1437378 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-03-12
Onset:2021-05-05
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-05-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Chronic Kidney Disease
Allergies: Unknown
Diagnostic Lab Data: Positive COVID-19 Antigen test on 04/23/2021
CDC Split Type: 3664158

Write-up: Died of COVID-19 illness on 05/05/2021


VAERS ID: 1502028 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-12
Onset:2021-06-08
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: POSITIVE COVID 5/27/2021
CDC Split Type:

Write-up: ADMITTED TO HOSPITAL AND SUBSEQUESTLY DIED


VAERS ID: 1519797 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-01
Onset:2021-07-11
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood lactic acid, Death, Prothrombin time prolonged, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: anemia in chronic kidney disease, asthma, charcot''s syndrome, chf, chronic renal failure, DM, GERD, HTN, Morbid obesity
Allergies: lisinopril
Diagnostic Lab Data: WBC 7/12 13.3: 7/14 29.9. Protime 7/14 20.3. Lactic Acid 7/13 11.1,
CDC Split Type:

Write-up: Admit 7/1-7/4. Re-Admission 7/11. Expired 7/14.


VAERS ID: 1549046 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-15
Onset:2021-07-24
   Days after vaccination:70
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Death, Endotracheal intubation, General physical health deterioration, Mechanical ventilation, Muscular weakness, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, Ultram, Zyloprim, Amitriptyline, Vit D, ferrous sulfa, Prozac, Prinivil, multivitamin, naprosyn, Vit B
Current Illness: unknown
Preexisting Conditions: DM, HTN, OSA, morbid obesity, hypothyroidism
Allergies: no known allergies
Diagnostic Lab Data: SARS COV2 COVID PCR 07/24/2021
CDC Split Type:

Write-up: Admitted 07/24/07/27 for weakness in legs, found to have O2 sat of 50% on room air. COVID test positive on 7/24 and pt diagnosed with acute hypoxemic respiratory failure due to COVID-19 . She was also found to be in acute renal failure. Pt was intubated, placed on vent and started on CRRT. She received Moderna vaccine, 2nd dose on May 15, 2021. On admission, pt denied any shortness of breath, body aches, headache, fever or chills. Patient condition deteriorated. was made comfort care on 7/27 and expired 7/27/21.


VAERS ID: 1553645 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-10
Onset:2021-08-10
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute chest syndrome, Blood creatinine increased, Blood lactic acid increased, Blood potassium decreased, Bradycardia, Bronchoscopy abnormal, COVID-19, Cardio-respiratory arrest, Chest X-ray abnormal, Coma scale abnormal, Computerised tomogram head normal, Death, Endotracheal intubation, General physical health deterioration, Haemoglobin decreased, Heart rate decreased, Hypertriglyceridaemia, Mental status changes, Occult blood positive, Oxygen saturation decreased, Pneumonia staphylococcal, Pulmonary oedema, Pulse absent, Respiratory failure, Resuscitation, SARS-CoV-2 test positive, Sickle cell anaemia with crisis, Sputum culture positive, Transfusion, Unresponsive to stimuli, Vaginal haemorrhage, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Dyslipidaemia (narrow), Haematopoietic erythropenia (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient is a 36 y.o. female with a past medical history notable for Hemolytic anemia on Rituxin monthly, Follows with Dr., chronic pain, depression, hypertension, migraines, sickle cell disorder, and thyroid disease who presents as a transfer from ER due to sickle cell crisis. Patient presented to ER with AMS, family reported finding patient unresponsive at home this am. Per record GCS was 5-7 when EMS arrived. Her sats were in the 60s. Patient was found to have a fentanyl patch which she is prescribed. She did not appear to be improving. She was subsequently intubated. She was somewhat difficult to oxygenate. Bronchoscopy showed copious edema bilaterally. Chest x-ray showed diffuse pulmonary edema. Her hemoglobin was found to be 4.9. She was noted to have some vaginal bleeding. Occult blood testing was positive. Per report patient''s pulse bradied down into the 30s. It was unclear if she had a pulse so CPR was started. She quickly regained ROSC. Her heart rate improved to the 90s. She was given 1 unit of blood, started on propofol and epinephrine. Creatinine was 1.2. Potassium was 3.2, and it was replaced. WBC 10,Initial head CT scan was nondiagnostic due to limited patient cooperation. Repeat CT head was negative for acute abnormality. Patient was started on cefepime. She was transferred here for higher level of care. She is subsequently being transferred to another facility for further evaluation. On arrival here patient is intubated, sedated on propofol, in no distress. Vital signs stable. Patient tested positive for COVID-19. Started on Decadron and remdesivir. Critical care consulted. Has developed hypertriglyceridemia. Additionally, sputum culture growing MSSA consistent with superimposed MSSA pneumonia. Patient on cefepime. Patient had general worsening of her condition with worsening respiratory issues. On the night of 810, patient coded multiple times. Family visually made the decision to make patient DNR. Hemoglobin dropped consistent with acute chest syndrome. Lactic acid was greater than 18. Patient coded 1 more time and expired early this morning.


VAERS ID: 1553728 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-15
Onset:2021-06-15
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Congestive cardiomyopathy, Death
SMQs:, Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   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: Tylenol and Ibuprofen
Current Illness: No
Preexisting Conditions: No
Allergies: Allergic to peas
Diagnostic Lab Data: Autopsy done after death.
CDC Split Type:

Write-up: There were no signs or symptoms. Patient received his last Covid19 vaccine on 5/13/21. He passed away on 06/15/2021. The diagnosis on the autopsy report shows that he died from Dilated Cardiomyopathy. There was no evidence of trauma and a clean toxicity report. He has no previous diagnosed health problems.


VAERS ID: 1591538 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-07-30
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-16
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amantadine; amlodipine; gabapentin; haloperidol; Humalog; Levemir; levetiracetam; omeprazole; rosuvastatin; warfarin
Current Illness: unknown
Preexisting Conditions: Aphasia, apical thrombosis, embolic stroke, GERD, HTN, T1DM, hyperlipidemia, schizophrenia
Allergies: Aspirin, hydrochlorothiazide and penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was admitted on 7/30/21 for SARS-CoV-2 and remained hospitalized until 8/16/2021 when he expired.


VAERS ID: 1617479 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-10
Onset:2021-08-01
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Atypical pneumonia, B-cell lymphoma, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic lymphocytic leukaemia, Computerised tomogram abdomen abnormal, Death, Dyspnoea, Flow cytometry, Hyperkalaemia, Hypertension, Leukocytosis, Lymphadenopathy, Nucleic acid test, Obesity, Organ failure, Patient isolation, Pneumonia, Pulse abnormal, Red blood cell sedimentation rate increased, SARS-CoV-2 test positive, Sepsis, Unresponsive to stimuli, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Malignant lymphomas (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-12
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 10 MG PO Tablet Take 1 tablet by mouth once for 1 dose. 8/9/19 8/9/19 hydroCHLOROthiazide (HYDRODIURIL) 12.5 MG PO Tablet Take 2 tablets by mouth daily for 30 days. 8/9/19 9/8/19
Current Illness:
Preexisting Conditions: Edema 8/22/2014 HTN (hypertension) 8/22/2014
Allergies: NKDA
Diagnostic Lab Data: SARS-COV-2, Detected: 07/31/21
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. She received the Moderna vaccine (2nd dose in series) on 07/10/21. Hospitalized from 08/01/21 - 08/12/21 (discharged and then admitted 2 hours later, result was death in ED). Below is copied from discharge summary: Patient is a 50 y/o morbidly obese female admitted on 8/2/2021 due to acute respiratory failure due to COVID 19 pneumonia. Severe Sepsis with acute organ dysfunction/ Acute respiratory failure with hypoxia 2/2 COVID 19: - Now on 4L , oxygen delivered at bedside - Chest Xray showed bilateral atypical findings - CRP 63, sed rate 22. - DVT ppx given while inpatient - dexamethasone completed x10 days on 8/10/2021 - atorvastatin given during admission - Completed Remdesevir 8/5/2021 - Isolation Chronic lymphocytic leukemia - Leukocytosis due to CLL Flow cytometry with CD+5 mature B cell lymphoma CT abdomen showing lymphadenopathy Out patient hematology follow up, no need for acute intervention AKI: resolved -Cr back to baseline Hyperkalemia: -Resolved Arterial hypertension -Controlled - continue amlodipine + HCTz Morbid Obesity, BMI of$g 40s: -would benefit from lifestyles modifications regarding low fat diet, weight loss and daily excercise -F/U with PCP Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge. ED admission 2 hours later: 50 y.o. female presents c/o SOB. Pt was discharged from hospital today and was known covid positive. She was discharged with home O2. At home, patient''s mother noticed that she was having more difficulty breathing than usual, prompting her to call 911. Pt arrived via EMS, which states she became unresponsive on arrival with a faint pulse. She quickly lost her pulse after her arrival here. Hx limited by events/condition of patient. The history is provided by the EMS personnel, a parent and medical records. The history is limited by the condition of the patient.


VAERS ID: 1617585 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-29
Onset:2021-05-31
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Autopsy, Congestive cardiomyopathy, Death, Fatigue, Headache
SMQs:, Cardiomyopathy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Autopsy performed
CDC Split Type:

Write-up: Dilated cardiomyopathy- right ventricle. CAUSED DEATH!!!! Complained of a headache and tired two hours prior.


VAERS ID: 1641668 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-14
Onset:2021-08-14
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A212A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cerebral hypoperfusion, Death, Dyspnoea, Hypoxia, Magnetic resonance imaging head abnormal, Mental status changes, SARS-CoV-2 test positive, Speech disorder, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira 40mg every 14 days starting 2 weeks after second; budesonide 9mg daily; carvedilol 25mg BID; clonidine 0.1mg BID; colesevelam 625mg BID; Vitamin D2 1,250mcg weekly; fluoxetine 10mg daily; fluoxetine 20mg daily; fluticasone 50mcg each
Current Illness: latent TB
Preexisting Conditions: HTN, UC, T2DM, GAD
Allergies: NKDA
Diagnostic Lab Data: Standard NAA detected SARS-CoV-2 on 8/14/21
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/18/2021 and 4/14/2021. Patient presented on 8/14/21 via EMS with shortness of breath and AMS. Per EMS, patient was found unresponsive and short of breath by family member for an unknown duration. EMS was called, with SpO2 of approximately 50%. EMS reports administering 20L O2 by NC and nonrebreather which improved SpO2 to 94% with improved mental status. Per chart review patient symptoms began around 8/5/21 and she tested positive 8/11/21. On admission, patient knew name, responded to pain, and followed commands- otherwise, was unable to communicate. MRI revealed Bilateral globus pallidi infarcts probably related to hypoxic ischemic injury, possibly due to hypoxia from COVID pneumonia. Based on irreversible state of mental status, patient was recommended to hospice team. Patient was transferred to inpatient hospice care on 8/19/21. Patient expired on 8/20/21.


VAERS ID: 1655865 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-07-31
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, Candida infection, Cardiogenic shock, Catheter placement, Coagulopathy, Culture urine positive, Death, Intra-aortic balloon placement, Pneumonia staphylococcal, Pyrexia, Renal impairment, Renal replacement therapy, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban 5 mg BID, Carvedilol 4.6875 mg BID, Duloxetine 60 mg QD, GLipizide 5 mg QD, Hydralazine 25 mg TID, Insulin aspart 10 units TID, Isosorbide dinatrate 10 mg BID, Pioglitazone 15 mg QD, Potassium chloride 20 mEq BID, Spironolactone 25
Current Illness:
Preexisting Conditions: CHF, Diabetes Mellitus, Hypertension
Allergies: Codeine (Hallucinations), Morphine (Hallucinations)
Diagnostic Lab Data: COVID-19 Positive test on 8/17/2021 @ 1109
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/21/2021 and 5/18/2021. Patient admitted on 7/31/2021 for cardiogenic shock complicated by acute renal failure, coagulopathy and acute respiratory failure. To assist in management of the cardiogenic shock pt was placed on axillary IABP and dobutamine for inotropic support. Pt was decongested with combination of aquadex and diuretics with improvement in filling conditions. Unfortunately, patient developed persistent fever on 8/11 and was placed on broad spectrum antibiotics, ID was consulted and underwent extensive infectious evaluation.She did have MRSA in pneumonia PCR and candida albicans has grown in urine culture. On 8/16/21 morning pt decompensated hemodynamicallly requiring levophed and vasopressin and continued evaluation revealed that pt had positive IgM COVID antibodies and it was suspected that pt developed a new COVID infection. She continued to decline over the next 48 hours with worsening hemodynamics and renal function and therefore a dialsysis catheter was placed and pt was started on renal replacement therapy. Family was kept uptodate about the patients clinical status and at this point decided to transition focus of care to comfort. Pt then expired the morning of 8/18/21.


VAERS ID: 1660763 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-15
Onset:2021-05-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Accidental overdose, Death, Gastrooesophageal reflux disease, Interchange of vaccine products, Lymphoma, Victim of abuse
SMQs:, Drug abuse and dependence (broad), Gastrointestinal nonspecific dysfunction (narrow), Malignant lymphomas (narrow), Medication errors (narrow), Haematological malignant tumours (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-18
   Days after onset: 94
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hiv
Current Illness:
Preexisting Conditions: Hiv
Allergies:
Diagnostic Lab Data: So many I need a book please contact me for these about 20 in a few months 60 on 1 yr
CDC Split Type:

Write-up: Wrong diagnosis Dr told us hiv barely detectable then said gallbladder then walked in ov stating well good news its not cancer . he told patient he had no choice but to get the covid vaccine even tho he didn''t want or understand it at all he offered no info no time and threatened patient he would not prescribe his hiv pills unless he was vaccinated fully . patient had too much trust . Dr gave him two different types and he was scheduling athird patient side affects were ignored and told it was normal due to injection he soon after was hospitallzed having lymph nodes cancer and all the tests ran by Dr were not found abbott said well I never looked at imaging and we we re sure it is acid reflex . another doctor a specialist said he shpuld not have given him that type of vaccine with his medical jistory and allergies. Dr told us at hospital dont try goodbye because patient had only 6 months if that to live he walked put two weeks later we went to specialost who said he was wrong and didnt know why Dr said that but to cover his butt because of the wrong dying of covid vaccines. Patient died and the hospital staff said either vaccine caused this or overdose when shift change happened because he was given too many pain meds and three kinds . no one even knew je was in the room he was peed even tho they said he couldnt he had food on him all over and he was on liquod diet he was dirty no water no machines hooled up not even an IV help we need justice story gets more detailed I have pics and med rec this doctor wwas wrong abiut it all even vaccine .


VAERS ID: 1683354 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-29
Onset:2021-08-11
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Asthenia, Blood antidiuretic hormone, Blood gases abnormal, Bradycardia, COVID-19, Cardiac arrest, Chest tube insertion, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Endotracheal intubation, Fatigue, General physical health deterioration, Hypotension, Inappropriate schedule of product administration, Mechanical ventilation, Nausea, Pain, Pneumonia staphylococcal, Pneumothorax, Pulseless electrical activity, Resuscitation, SARS-CoV-2 test positive, Sinus tachycardia, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Medication errors (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-02
   Days after onset: 22
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 22 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Clonazepam 0.5 mg BID prn, Insulin Aspart; 0-20 units TID, Insulin glargine 13 units QD, Magnesium Oxide 800 mg BID, Mirtazepine 15 mg QHS, Mycophenolate 720 mg BID, Ondansetron 4 mg Q8H prn, Prednisone 2.5 mg QD, Pantopro
Current Illness:
Preexisting Conditions: Dyslipidemia, Essential Hypertension, H/O Kidney Transplant (2 years prior), Anxiety, Type 2 DM, Immunosupression; cataracts, Parathyroid disease, ESRD on Dialysis
Allergies: Tide Detergent (Rash)
Diagnostic Lab Data: Positive COVID-19 on 8/11/2021 using the Roche LIAT SARS Assay platform using PCR or equivalent nucleic acid amplification technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/1/2021 and 5/29/2021. Presented to ED on 8/11/2021 with complaints of worsening symptoms over the past 10-11 days including generalized fatigue, body aches, weakness, decreased appetite, nausea, vomiting, diarrhea, dyspnea, and cough. Intubated 8/19. His course was complicated by L pneumothorax requiring Left chest tube placement X 2. He was given Decadron 10 d through 8/21. Completed course of Remdesevir 5 days. Course complicated by MSSA pneumonia and concern for fungal pneumonia. Was being treated with Ancef and Micafungin. However he rapidly declined on 9/2. The patient was with significant. hypotension and bradycardia, despite vasopressin and levophed gtts. Atropine x 1 given. Patient with full cardiac arrest at 1255 and CPR was initiated. Epinephrine 1mg given. 1257 pulse check revealed a pulse that progressed into vtach at 1259, shock x 1 at 200J with PEA and subsequent sinus tachycardia. 1303 patient again went into vtach and another shock x 1 at 200J given and amiodarone bolus of 150mg administered. Return of sinus tachycardia. ABG revealed acidosis and 3 amps of bicarb were administered. At that time the patient''s family was called and the wife and daughter arrived at bedside. The family decided at that time to make the patient comfort care. He was taken off the ventilator and passed at 1350.


VAERS ID: 1683357 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-29
Onset:2021-08-12
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C12A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, COVID-19, Chest X-ray abnormal, Culture urine positive, Death, Dyspnoea, General physical health deterioration, Lung opacity, Mechanical ventilation, Pseudomonas infection, Pseudomonas test positive, SARS-CoV-2 test positive, Septic shock, Sputum culture positive, Staphylococcal infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-29
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 18 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aripiprazole 5 mg daily, azelastine 2 sprays twice daily, aspirin 81 mg daily, buspar 30 mg twice daily cholecalciferol 2000 units daily, desvenlafaxine 100 mg daily, fenofibrate 145 mg daily, hydroxyzine 50 mg every 8 hours as needed for a
Current Illness:
Preexisting Conditions: anemia, anxiety, benign prostatic hyperplasia, depression, diabetes mellitus, hyperlipidemia, insomnia, neuropathy, chronic kidney disease (stage III), hypertension
Allergies: NSAIDs, sulfonamide
Diagnostic Lab Data: COVID Positive on 8/12/2021; chest x-ray: bilateral patchy airspace opacities concerning for multifocal pneumonia on 8/12/2021; serum creatinine 5.71 on 8/29/2021; urine culture positive for pseudomonas aeruginose on 8/26/2021, sputum culture postive for MRSA on 8/28/2021
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/25/2021 and 4/29/2021. Presented to ED on 8/12/2021 with complaints of dyspnea for 1 week requiring oxygen. Patient was placed on oxygen and eventually required mechanical ventilation. Patient had septic shock and acute kidney injury. Medications administered: dexamethasone, ascorbic acid, ceftriaxone, azithromycin, micafungin, remdesivir, piperacillin/tazobactam, tocilizumab, prednisone, and vancomycin. Patient continued to decompensate and expired at 14:44 on 8/29/2021.


VAERS ID: 1688944 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-17
Onset:2021-08-14
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, General physical health deterioration, Lung infiltration, Nausea, Nephropathy, Nucleic acid test, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-28
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol 12.5mg BID, Norco 5-325mg take 1 tab cont. q6h prn, Mag Ox 400mg BID, Cellcept 250mg 3 tabs in the morning and nightly, Nifedipine 60mg daily, omeprazole 40mg BID, prednisone 10mg daily, remipril 5mg nightly, Bactrim 400-80mg dai
Current Illness: Umbilical Hernia
Preexisting Conditions: CHF, HTN, Kidney Transplant s/p 15 years
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive 8/14/21: This sample was analyzed using the Biofire Torch system using PCR or equivalent Nucleic Acid Amplification
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 05/20/2021 and 06/17/2021. Presented to ED on 8/14 with complaints of shortness of breath and coughing. Noticed symptoms of chills, nausea, and abdominal pain on 8/11. In ED pt was febrile, tachycardic, and tachypneic. CXR showed bilateral infiltrates. Patient required HFNC at 75-90% and Non-rebreather. Patient was proned. During stay, patient received zosyn, vacomycin,prednisone, ceftriaxone, and decadron. Renal disease precluded use of remdesivir. Patient continued to decline and expired on 8/28/21.


VAERS ID: 1753284 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-08-04
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Laboratory test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID infection. Specimen collected on 8/11/21. Patient died on 8/13/21.


VAERS ID: 1754275 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-09-30
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1762703 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7319KA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   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: None discussed or known.
Preexisting Conditions: Pt discussed having heart issues and diabetes during administration, as we discussed possibly considering other vaccines such as pneumonia and shingles vaccines in the future. Nothing documented. Pt did not fill maintenance medications at our pharmacy. Was a new patient to us at time of vaccination.
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt received vaccines at our pharmacy the morning of 10/4/21. She was monitored for 15 minutes after vaccination and no reactions were noted or observed in the patient waiting time. She left without any known complications. On 10/5/21, the Coroner came to the pharmacy with documents to retrieve medical records for the patient as she had "went into cardiac arrest yesterday and needed these records for the autopsy investigation." After contacting my direct supervisor and he contacted necessary persons to confirm the release of the PHI, we called him back to inform him he could come to pick up records. There was no communication in between the time the patient left the pharmacy without complications from the vaccines and the time the coroner came to pharmacy to retrieve patient records for her death.


VAERS ID: 1768225 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-12
Onset:2021-08-08
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, Cough, Death, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-30
   Days after onset: 22
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: Fever, Aches, Shortness of breath/difficulty breathing, Cough Cause of death: ACUTE HYPOXIC RESPIRATORY FAILURE, COVID PNEUMONIA


VAERS ID: 1768599 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-09-18
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Death, Pneumonia
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 14
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J18.9 - Pneumonia, unspecified organism J96.01 - Acute respiratory failure with hypoxia


VAERS ID: 1768972 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-27
Onset:2021-09-10
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Computerised tomogram abdomen abnormal, Confusional state, Death, Depressed level of consciousness, Disturbance in attention, Dyspnoea, General physical health deterioration, Pneumonia, Pneumonitis, Pyrexia, SARS-CoV-2 test positive, Urine analysis, Urine analysis normal
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg QD, Buspirone 5 mg BID, Calcium Citrate +Vit D; BID, Cholecalciferol 50 mcg QD, Duloxetine 60 mg QD, Esomeprazole 40 mg QD, Furosemide 20 mg QD, Lasmiditan 50 mcg QD, Mycophenolate 500 mg BID, Nitrofurantoin 50 mg QD, Prednis
Current Illness:
Preexisting Conditions: Renal transplant, Liver transplant, Degenerative joint disease, Depression, Anxiety, GERD, Chronic Immunosuppression, Chronic pain syndrome, Benign neoplasm of colon, S/P insertion of spinal cord stimulator, Osteoporosis, S/P kyphoplasty, panlobular emphysema, H/O myocardial infarction, Nicotine dependence, Combined systolic/diastolic CHF, CAD, Migraine, Essential hypertension, H/O cerebral infarction due to embolism of right cerebellar artery, Unintentional weight loss, polyneuropathy, hyperlipidemia, hypothyroidism.
Allergies: Topiramate, Nortriptyline, NSAID, Hydromorphone, Phenytoin
Diagnostic Lab Data: Positive COVID-19 test on 9/16/2021 using an unspecified platfrom using PCR or equivalent technology.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/31/2021 and 4/27/2021. Presented to ED on 9/10/2021 with complaint of confusion, as per family this happens when patient has urinary tract infection. Patient stated that she took a home urinary tract infection test kit which resulted positive. She was evaluated for urinary tract infection, but urinalysis was unremarkable. Chest x-ray was normal, but she underwent CT of the abdomen and pelvis which did show findings in the lung bases consistent with pneumonia versus pneumonitis. She was prescribed doxycycline, but stopped taking it after 2 days due to nausea. Subsequently changed to levofloxacin on 9/14/2021 during follow-up clinic visit. On 9/16/2021 patient presented to ED with shortness of breath, labored breathing, fever and chills. Placed on 6L O2 NC. Despite aggressive treatment, she has deteriorated and is no longer alert but is obtunded. Family has decided to transition to comfort care. Patient expired 9/25/2021.


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