|
| VAERS ID: | 1373776 (history) | | Form: | Version 2.0 | | Age: | 61.0 | | Sex: | Female | | Location: | New York |
| Vaccinated: | 2021-03-30 | | Onset: | 2021-03-30 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-04 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EP7533 / 2 | RA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Blood test, Body temperature, Cerebral haemorrhage, Chills, Culture, Diarrhoea, Endocarditis, Gait disturbance, Hypoaesthesia, Magnetic resonance imaging, Pyrexia, Sepsis
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-14
Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: METHOTREXATE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Scleroderma
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: blood tests; Result Unstructured Data: Test Result:Unknown results; Test Date: 2021; Test Name: fever; Result Unstructured Data: Test Result:went up over 103 Fahrenheit; Test Date: 2021; Test Name: Cultures; Result Unstructured Data: Test Result:Unknown results; Test Date: 2021; Test Name: MRIs; Result Unstructured Data: Test Result:bleed on her brain; Comments: and the infection had spread to her heart valves
CDC Split Type: USPFIZER INC2021600632 Write-up: bleed on her brain; the infection had spread to her heart valves; she could not walk; legs went numb; sepsis; fever / fever went up over 103 F; chills; diarrhea; This is a spontaneous report received from a contactable consumer. A 61 years old female received the second single dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot EP7533) on 30Mar2021 (at 61 years of age), in right arm, for COVID-19 immunisation. The patient received the first dose of BNT162B2 vaccine on 09Mar2021 (lot EN6202), at 61 years of age, in right arm. No other vaccines were given within 4 weeks prior to the COVID vaccine. Medical history included connective tissue disorder - scleroderma. The patient was not pregnant at the time of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. Concomitant medication included methotrexate. On 30Mar2021, within a few hours of receiving the second vaccination, she had fever, chills and diarrhea. By 4:30 AM on 31Mar2021 she could not walk and her legs went numb. An ambulance was called and the EMTs had to carry her out of the house. She was taken to hospital where they started treating with antibiotics her for an infection but her fever went up over 103 F, so they ventilated her to try to control the fever. They did blood tests during that time and got the infections disease unit trying to figure out what was causing her symptoms. Doctors diagnosed sepsis. They continued to do blood test and cultures but could not determine the cause. They did Magnetic Resonance Imaging (MRIs) as follow-ups because she was not responding. The fever never went down. She was awake for a few days (ventilator still in) and then started getting worse again. They did an MRI and found a bleed on her brain and the infection had spread to her heart valves. She died on 14Apr2021 after 15 days of hospital care and Intensive Care Unit (ICU) care. The events were reported with a fatal outcome. It was unknown if autopsy was performed. Since the vaccination, the patient had not been tested for COVID-19.; Reported Cause(s) of Death: chills; diarrhea; she could not walk; legs went numb; sepsis; bleed on her brain; the infection had spread to her heart valves; fever / fever went up over 103 F |
|
| VAERS ID: | 1378167 (history) | | Form: | Version 2.0 | | Age: | 71.0 | | Sex: | Female | | Location: | California |
| Vaccinated: | 2020-02-01 | | Onset: | 2020-02-01 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-07 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | AR / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Asthenia, Bedridden, Blindness, Cough, Decreased appetite, General physical health deterioration, Mobility decreased, Pulmonary thrombosis, Pyrexia, Thrombosis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (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: 2020-05-31
Days after onset: 119
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 95 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Stage 4 lung cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: The night after receiving the vaccine, the patient began having continuous fevers and coughs. It was later discovered that there were blood clots in the lung and legs. Patient health rapidly declined during hospitalization period. Mobility, apetite and overall strength and energy decreased. Patient was fully bedridden and soon lost eye sight. |
|
| VAERS ID: | 1381212 (history) | | Form: | Version 2.0 | | Age: | 65.0 | | Sex: | Female | | Location: | New Jersey |
| Vaccinated: | 2021-03-07 | | Onset: | 2021-03-07 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-08 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EN6206 / 2 | LA / - |
Administered by: Unknown Purchased by: ?
Symptoms: Abdominal pain upper, Back disorder, COVID-19, Drug ineffective, Dyspnoea, Endoscopy, Pneumonia, Respiratory failure, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-16
Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 39 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Back disorder
Allergies:
Diagnostic Lab Data: Test Name: Endoscopy; Result Unstructured Data: Test Result:GERD or abdomen problem; Test Name: Covid 19; Test Result: Positive
CDC Split Type: USPFIZER INC2021616303 Write-up: Hypoxic respiratory failure; pneumonia; Stomach cramps; Could not breathe well; She had back problems; COVID-19; COVID-19; This is a spontaneous report from a contactable consumer (patient''s husband). A 65-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 07Mar2021 (Lot Number: EN6206) at the age of 65 years, as single dose for covid-19 immunisation. Medical history included back disorder from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Previously the patient received the first dose of bnt162b2 on 14Feb2021 at the age of 65 years, lot number: ENG201, injection in arm, possibly in left arm: patient had no problems with the first shot. The patient experienced covid-19 (death, medically significant) on 07Mar2021, hypoxic respiratory failure (death, hospitalization) on 08Mar2021, pneumonia (death, hospitalization) on 08Mar2021, stomach cramps (non-serious) on an unspecified date with outcome of unknown, could not breathe well (non-serious) on an unspecified date with outcome of unknown, she had back problems (non-serious) on an unspecified date with outcome of unknown. Patient went to Emergency Room (ER) 8 hours later administration of the second dose and on 08Mar2021 was admitted to hospital. Patient was in hospital from 08Mar2021 till she died. Patient was positive for covid 19 on unknown date. She was diagnosed with covid when she went to ER. Patient was on a ventilator. The patient underwent lab tests and procedures which included endoscopy: gerd or abdomen problem on unspecified date, COVID test: positive on unknown date. Therapeutic measures were taken as a result of hypoxic respiratory failure and pneumonia (on ventilator). The patient died on 16Apr2021. An autopsy was not performed. It was stated that cause of death on death certificate listed as Covid 19, pneumonia, hypoxic respiratory failure. Follow attempts are needed. Further information is expected; Reported Cause(s) of Death: COVID-19; Drug ineffective; pneumonia; Respiratory failure |
|
| Vaccinated: | 2021-05-18 | | Onset: | 2021-05-18 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-08 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 035C21A / 2 | LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-19
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: Lisinopril 5mg PO daily, ASpirin EC 81mg PO daily, Tylenol 650mg PO Q4-6 hr PRN, Colace 100 mg PO BID PRN, Metoprolol 50 mg PO BID
Current Illness: none
Preexisting Conditions: Cataract
Allergies: No Known allergies
Diagnostic Lab Data:
CDC Split Type: Write-up: Patient found deceased in his room on 5/19/21 at approximately 9:35am |
|
| VAERS ID: | 1382493 (history) | | Form: | Version 2.0 | | Age: | 74.0 | | Sex: | Male | | Location: | Minnesota |
| Vaccinated: | 2021-02-28 | | Onset: | 2021-02-28 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-08 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 013A21A / 1 | - / IM |
Administered by: Other Purchased by: ?
Symptoms: Fatigue, Feeding disorder, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-02
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: Many prescription medications
Current Illness: None
Preexisting Conditions: Heart disease , Diabetes , sleep apnea
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type: Write-up: headaches, nausea, tired , all over run down, not able to eat |
|
| Vaccinated: | 2021-01-14 | | Onset: | 2021-01-14 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-09 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | RA / SYR |
Administered by: Other Purchased by: ?
Symptoms: COVID-19 pneumonia, Diabetes mellitus, Headache, Iron deficiency anaemia, Pain in extremity, SARS-CoV-2 test positive, Supraventricular tachycardia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Supraventricular tachyarrhythmias (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-09
Days after onset: 114
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 97 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: High blood pressure medications; pain medications
Current Illness: Reflex Sympathetic Dystrophy; high blood pressure
Preexisting Conditions: Reflex Sympathetic Dystrophy; high blood pressure
Allergies: N/A
Diagnostic Lab Data: positive COVID test 1/21/2021
CDC Split Type: Write-up: Initially sore arm; severe headache. positive COVID test on 1/21/2021 - doctors assume he was positive at time of vaccination but we didn''t know it yet; severe covid pneumonia; supraventricular tachycardia; diabetes; iron deficiency anemia |
|
| VAERS ID: | 1386097 (history) | | Form: | Version 2.0 | | Age: | 75.0 | | Sex: | Female | | Location: | Illinois |
| Vaccinated: | 2021-05-11 | | Onset: | 2021-05-11 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-09 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 033C21A / 2 | RA / IM |
Administered by: Senior Living 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: 2021-05-11
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: vancomycin HCI 125mg capsules, Spironolactone tablet 50mg,SI Tagliptin Phosphate tablet 25mg, multi-vitamin, Midodrine HCI tablet 2.5, Melatonin tablet 5mg, Levothyroxine sodium tablet 25 MCG, Heparin Sodium solution 1000 unit/ml, Glimepiri
Current Illness: enterocolitis due to clostridium difficile, cerebral infarction, chronic congestive heart failure, DMII with diabetic neuropathy, chronic kidney disease, atherosclerosis of native arteries of right leg with ulceration of lower leg, HTN, Asthma, Hypothyroidism, other symptoms and signs involving cognitive functions following cerebral infarction, Anemia, Hyperlipidemia, cardiomegaly, Anxiety disorder, schizoaffective disorder, muscle weakness, lack of coordination, need for assistance with personal care, Nonrheumatic Aortic (valve) stenosis, Hypotension, Cardiac murmur, Orthopnea, long term current use of anticoagulants, long term use of insulin, personal history of Covid-19, Tubal ligation status.
Preexisting Conditions: diabetes type 2 with neuropathy chronic congestive heart failure
Allergies: no known allergies
Diagnostic Lab Data: unknown
CDC Split Type: Write-up: patient died of cardiac arrest that night in hospital |
|
| VAERS ID: | 1386585 (history) | | Form: | Version 2.0 | | Age: | 58.0 | | Sex: | Female | | Location: | California |
| Vaccinated: | 2021-06-08 | | Onset: | 2021-06-08 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-09 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EW0168 / 1 | LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Acute myocardial infarction, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood chloride normal, Blood creatine increased, Blood glucose increased, Carbon dioxide decreased, Cardiac arrest, Chest X-ray abnormal, Death, Eosinophil percentage decreased, Glycosylated haemoglobin increased, Haematocrit normal, Haemoglobin normal, High density lipoprotein decreased, Lung opacity, Lymphocyte percentage decreased, Monocyte percentage increased, Neutrophil percentage increased, Platelet count decreased, Troponin I increased, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad) 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, gabapentin, Lispro insulin, clopidogrel
Current Illness: Diabetes, Hypertension, PVD
Preexisting Conditions: SEE # 11
Allergies: Sulfa, citrus.
Diagnostic Lab Data: 06/08/21. WBC 12.4, Hgb 15, HCT 44, PLT 132, K+ 3.1,CL 101, GLUCOSE 405, CREATININE 1.35, CO2 18, TROPI 0.59, AST 114, ALT 81, ALP 152, ALB 2.4.
CDC Split Type: Write-up: 06/08/2021-Received vaccine at Urgent Clinic. Pt found down at home. Brought to Hospital ED, with cardiac arrest (STEMI), where she later died. |
|
| Vaccinated: | 2021-03-06 | | Onset: | 2021-03-06 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-10 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EN6206 / 1 | RA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Body temperature increased, Brain injury, Death, Intensive care, Pain in extremity, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-21
Days after onset: 14
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: The vaccine was administered at 12:30 pm on Saturday, March 6, 2021. That night around 7:00 pm he called to tell me that his arm was hurting. That was the last time anyone heard from him. Two days later on the evening of Monday, March 8, 2021, he was found unresponsive in his home. When the ambulance arrived they found he had a temperature of 115 degrees. He was taken to the emergency room and placed in the critical care unit. It was determined that he suffered an anoxic brain injury and would never recover. He passed away on March 21, 2021. |
|
| VAERS ID: | 1391469 (history) | | Form: | Version 2.0 | | Age: | 65.0 | | Sex: | Male | | Location: | Massachusetts |
| Vaccinated: | 2021-02-22 | | Onset: | 2021-02-22 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 2 | - / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Carditis, Confusional state, Dysarthria, Hepatic failure, Mobility decreased
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-17
Days after onset: 83
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 120 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Kidney disease
Allergies:
Diagnostic Lab Data: 2/23/21-- 5/17/21
CDC Split Type: Write-up: Slurred speech, loss of use of limbs, confusion, heart inflammation and liver failure |
|
| VAERS ID: | 1391500 (history) | | Form: | Version 2.0 | | Age: | 53.0 | | Sex: | Male | | Location: | Massachusetts |
| Vaccinated: | 2021-05-15 | | Onset: | 2021-05-15 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 2 | LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Cardiac failure congestive, Death, Dyspnoea, Laboratory test, Mechanical ventilation, SARS-CoV-2 antibody test negative, SARS-CoV-2 test negative, Seizure, Thrombosis
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-25
Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: obesity
Allergies:
Diagnostic Lab Data: Yes, extensive. You will need medical records. He had 3 covid tests and 1 antibody test all negative for Covid.
CDC Split Type: Write-up: Patient had his 2nd Moderna vaccine at pharmacy at 2:00 and was struggling to breathe a few hours later. We were at the emergency room around 6:00pm and he was placed on a ventilator between midnight and 1:00am. He died 10 days later after experiencing clots that led to seizures and congestive heart failure. I have a death certificate if needed. |
|
| Vaccinated: | 2021-03-04 | | Onset: | 2021-03-04 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-11 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / UNK | - / - |
Administered by: Public Purchased by: ?
Symptoms: Death, Hypertensive heart disease
SMQs:, Hypertension (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-05
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: none
Preexisting Conditions:
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type: Write-up: Death Certificate 4/22/2021 Cause of Death - Hypertensive Cardiovascular Disease |
|
| Vaccinated: | 2021-06-11 | | Onset: | 2021-06-11 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-13 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 038C21A / 2 | LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Cardiac arrest, Death, Loss of consciousness, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-11
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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none listed
Diagnostic Lab Data: unknown
CDC Split Type: Write-up: Patient received 2nd Moderna shot on 6/11/21 at 10:32am. Went home after the shot and didn''t feel well, so he laid down to rest. His wife checked on him and he was unconscious, so she called 911. Patient was taken to local hospital and died of Cardiac Arrest sometime between his vaccine and 7pm on 6/11/21. |
|
| VAERS ID: | 1396032 (history) | | Form: | Version 2.0 | | Age: | 48.0 | | Sex: | Male | | Location: | South Carolina |
| Vaccinated: | 2021-06-11 | | Onset: | 2021-06-11 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-14 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | ER8735 / 1 | LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-11
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: Enalapril-HCTZ, prednisone, Albuterol nebulizer
Current Illness: states that asthma has been doing well lately
Preexisting Conditions: Asthma, Hypertension, MR
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type: Write-up: Patient had no reaction at time of vaccination; was monitored for 15 minutes prior to leaving clinic. This nurse was notified today by ER Physician that the patient came into the ER around 8pm (on the night of the same day that he received his vaccine in the early morning hours) with c/o shortness of breath. It was reported that the patient had taken nebulizer treatments at home with no relief. Symptoms began around 5:30pm. Patient ambulated into ER at time of visit but during the visit became unresponsive. Patient was intubated and coded with time of death called at 9:52pm. Patient has history of asthma. |
|
| Vaccinated: | 2021-03-02 | | Onset: | 2021-03-02 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-14 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Arteriosclerosis, Autopsy, Bronchial irritation, Coronary artery disease, Death, Dyspnoea, Emphysema, Enteritis, Eosinophilia, Hypertension, Myocardial fibrosis, Myocarditis, Oedema, Respiratory viral panel, Resuscitation, SARS-CoV-2 test negative, Toxicologic test normal, Tryptase, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-11
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 medications included apple cider vinegar, atenolol, cinnamon bark, Lofibra, Glucotrol, Lisinopril, metformin, multivitamin, pioglitazone, potassium, nystatin cream.
Current Illness: Unknown
Preexisting Conditions: PMH includes cardiovascular disease, diabetes, severe obesity (BMI 45.3), prostate cancer.
Allergies: He had a history of allergies to Januvia and cephalexin.
Diagnostic Lab Data: Full autopsy performed on 3/12/2021. Findings included: lungs - emphysema with mild to focally moderate lymphoplasmacytic inflammation of bronchi, with rare to moderate eosinophils, with bronchial mast cells with associated tissue edema; heart - interstitial fibrosis, CAD with multiple areas of lymphoplasmacytic inflammation within the epicardium with rare eosinophils and scattered mast cells in myocardium and within epicardial fat near AV node; small intestine- intense eosinophilic enteritis and some areas of scattered eosinophilic inflammation; bone marrow - eosinophils identified, all cell lines present; cause of death hypertensive and atherosclerotic cardiovascular disease, contributing causes pending. Postmortem SARS-CoV-2 and respiratory pathogen panel negative; tryptase 11.11 ng/ml; toxicology negative.
CDC Split Type: Write-up: Worsening abdominal pain and distention on 3/2/21 which progressed to include shortness of breath for which he did not seek medical care. He was found unresponsive on the couch on 3/11/21 and resuscitation was unsuccessful. |
|
| VAERS ID: | 1399868 (history) | | Form: | Version 2.0 | | Age: | 76.0 | | Sex: | Male | | Location: | Minnesota |
| Vaccinated: | 2021-04-20 | | Onset: | 2021-04-20 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-15 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EW0162 / 1 | LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-20
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: Unkonwn
Current Illness: Unknown, none listed.
Preexisting Conditions: Unkown, none listed
Allergies: None Known
Diagnostic Lab Data:
CDC Split Type: Write-up: Family reported that the patient died 6 hours after being vaccinated. |
|
| VAERS ID: | 1400009 (history) | | Form: | Version 2.0 | | Age: | 88.0 | | Sex: | Male | | Location: | Connecticut |
| Vaccinated: | 2021-03-30 | | Onset: | 2021-03-30 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-15 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN | 1805018 / 1 | RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-13
Days after onset: 44
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 received COVID 19 vaccination on 3/30/2021 as part of vaccination program. Per obituary, he died at home on 5/13/2021 |
|
| VAERS ID: | 1402213 (history) | | Form: | Version 2.0 | | Age: | 86.0 | | Sex: | Female | | Location: | South Carolina |
| Vaccinated: | 2021-02-17 | | Onset: | 2021-02-17 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-16 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 037K20A / 2 | LA / SYR |
Administered by: Senior Living Purchased by: ?
Symptoms: Cerebrovascular accident, Death, Pruritus
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-23
Days after onset: 64
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Carotid artery narrowing
Preexisting Conditions: Carotid artery narrowing
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: Pt had severe itching started shortly after 2nd shot. MD stated pt having histamine response and Atarax started 3x/day to control itching symptoms. After several weeks pt stated atarax making her drowsy and requested to decrease to 2x/day. Pt started itching severely again after frequency decreased and pt requested to be put back to 3x/day. Shortly after pt had massive stroke which led to her death a couple of days later on 4/23/2021 |
|
| VAERS ID: | 1402355 (history) | | Form: | Version 2.0 | | Age: | 70.0 | | Sex: | Female | | Location: | Massachusetts |
| Vaccinated: | 2021-02-01 | | Onset: | 2021-02-01 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-16 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | - / - |
Administered by: Public Purchased by: ?
Symptoms: Asthenia, Cardiac ablation, Death, Gait inability, Intensive care, Movement disorder
SMQs:, Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-15
Days after onset: 41
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: liver transplant in 2012 before liver transplant she had unknown liver failure 2000 she had a heart attack and she got stints in her heart 2015 she had a cabbage done on her heart
Allergies: dial soap
Diagnostic Lab Data: march the 7th she was rushed to er and was transferred to icu to a new hospital until she passed ran many test but husband wasnt sure of all because he wasnt allowed to be in the icu heart abalsion was one of them
CDC Split Type: Write-up: day after vax she became weak, couldn''t walk, couldn''t move arms/legs |
|
| Vaccinated: | 2021-05-12 | | Onset: | 2021-05-12 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-16 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EW0170 / 1 | LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Acute myocardial infarction, Acute respiratory failure, Chest X-ray abnormal, Death, Dyspnoea, Electrocardiogram abnormal, Laboratory test abnormal, Malaise, Myocardial infarction
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-19
Days after onset: 7
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: AMITRIPTYLINE, AMLODIPINE, BISOPROLOL/HYDROCHLOROTHIAZIDE, BUSPIRONE, DONEPEZIL, PAXIL, NP THYROID, ZOLPIDEM
Current Illness: NONE
Preexisting Conditions: HYPERTENSION DIET-CONTROLLED DIABETES MELLITUS ANXIETY DISORDER MEMORY IMPAIRMENT
Allergies: SULFA
Diagnostic Lab Data: Labwork, EKG and CXR all confirmed a non ST wave MI
CDC Split Type: Write-up: Patient experienced malaise and shortness of breath within 2-3 hours of getting the shot. Progressed over the next 48 hours and then presented to ER where she was diagnosed with acute hypoxic respiratory failure due to a myocardial infarction. Transferred to care center on 05/15/2021. Patient nor her family desired any heroic measures due to her age and comfort measures were instituted. She expired on 05/19/2021. Prior to the vaccination, patient had been active, going to the YMCA to exercise 4 times weekly. She had no previous history of previous cardiac or respiratory problems. |
|
| VAERS ID: | 1402834 (history) | | Form: | Version 2.0 | | Age: | 70.0 | | Sex: | Male | | Location: | California |
| Vaccinated: | 2021-03-29 | | Onset: | 2021-03-29 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-16 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 012A21A / 1 | - / - |
Administered by: Private Purchased by: ?
Symptoms: Asthenia, Cerebrovascular accident, Condition aggravated, Myocardial infarction, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-06
Days after onset: 38
Permanent Disability? No
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: Baby Aspirin 81mg, Allopurinol 100mg, Atorvastatin, Buspirone 5mg, Clopidogrel, Ezetimibe 10mg, Finasteride 5mg, Insulin, Isosorbide Mononitrate 60 mg, Lisinopril 40mg, Melatonin 3mg only at night, Nifedipine, Sertraline 100mg.
Current Illness:
Preexisting Conditions: Heart failure, diabetes, strokes.
Allergies: Penicillin.
Diagnostic Lab Data:
CDC Split Type: Write-up: Strokes, very weak, vomiting, suffered mild heart attack. |
|
| VAERS ID: | 1403394 (history) | | Form: | Version 2.0 | | Age: | 90.0 | | Sex: | Female | | Location: | Indiana |
| Vaccinated: | 2021-06-15 | | Onset: | 2021-06-15 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-16 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN | 042A21 / 1 | LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-16
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: Acetaminophen 1000 mg PO Q8H PRN, Amlodipine Besylate 10 mg PO Daily, Hydralazine Hcl 25 mg PO TID, Levothyroxine 125 Mcg, Melatonin 10 mg, Zemplar 1 mcg Mo, We, Fr
Current Illness:
Preexisting Conditions: Acute kidney injury superimposed on chronic kidney disease, Dehydration, Fall, Hyperkalemia,
Allergies: Hydrocodone
Diagnostic Lab Data:
CDC Split Type: Write-up: Approximately 01:56 the following morning, patient expired |
|
| VAERS ID: | 1410203 (history) | | Form: | Version 2.0 | | Age: | 61.0 | | Sex: | Female | | Location: | Indiana |
| Vaccinated: | 2021-05-01 | | Onset: | 2021-05-01 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-18 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 2 | - / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-14
Days after onset: 44
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure meds, doesnt know the name
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type: Write-up: pt developed pulmonary embolism and passed away 6/14/2021 |
|
| VAERS ID: | 1410676 (history) | | Form: | Version 2.0 | | Age: | 35.0 | | Sex: | Female | | Location: | Kentucky |
| Vaccinated: | 2021-01-29 | | Onset: | 2021-01-29 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-18 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 025J20A 030L20 / UNK | LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Arteriosclerosis coronary artery, Asthenia, Bone pain, Chest pain, Condition aggravated, Cough, Death, Fatigue, Feeling abnormal, Hypoglycaemia, Lethargy, Myocardial infarction, Myocardial ischaemia, Pain, Resuscitation, Rhinorrhoea, Seizure
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Osteonecrosis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-13
Days after onset: 73
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control
Current Illness: With her first vaccine on 12-31-2020, she experienced a runny nose, sniffles, and cough. Felt a little tired.
Preexisting Conditions: After her second vaccine, she became weaker and very fatigued. She just kept saying she felt funny that something wasn''t right. On April 12, 2020 she had a hypoglycemic attack at work and they gave her a glucose tablet along with a soda and snack but her sugar came up to normal. After getting home from work, she laid down for a while because she was tired and said she just needed a nap. after a while, she got up and cooked. afterwards she was going to hunt for mushrooms but came back after about half an hour and tired and not feeling right once again. Her fianc? called me at 11:33 p.m. saying that I needed to get over here right away that patient was in bad shape. Once I got over there I checked her blood sugar level and it was good. As she began to tell me by motioning that she was hurting from her color bone and over chest she then proceeded to tell us that her right arm and thumb felt weird. She then went into a seizure. We called 911 and reported her that she had a hypoglycemic attack earlier in the day and that she had just seized and now was having a heart attack and CPR was being performed. The ambulance came 40 minutes later telling us that dispatch messed up the call. They pronounced our daughters'' death at 0121 on April 13, 2021 due to ischemic heart disease due to coronary artery atherosclerosis.
Allergies: none
Diagnostic Lab Data:
CDC Split Type: Write-up: ACHE, RUNNY NOSE, COUGH, LETHARGIC |
|
| Vaccinated: | 2021-04-10 | | Onset: | 2021-04-10 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-19 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EW0150 / 1 | - / SC |
Administered by: Private Purchased by: ?
Symptoms: Abnormal behaviour, Blood test, COVID-19, Delirium, Dyspnoea, Gait inability, Headache, Laboratory test, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow) Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-05-16
Days after onset: 36
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 40 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin, Glipizide, Bumetanide, Torsemide, Furosemide, Metazalone, Abuterol, Symbicort, Eliquis, Tamulosin, Alendronate, Gabapentin, Carvedilol, Farxiga, CoQ10, Multivitamins.
Current Illness:
Preexisting Conditions: CHF, diabetes, COPD
Allergies: none
Diagnostic Lab Data: Blood work, covid test (positive) lab tests.
CDC Split Type: Write-up: Patient had bad headache within the hour, difficulty breathing soon after, became delirious, couldn''t make sense, couldn''t walk and had to call EMS. |
|
| VAERS ID: | 1413849 (history) | | Form: | Version 2.0 | | Age: | 78.0 | | Sex: | Female | | Location: | Missouri |
| Vaccinated: | 2021-05-18 | | Onset: | 2021-05-18 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-21 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | UN / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Arteriosclerosis, Chronic obstructive pulmonary disease, Death, Dyspnoea, Resuscitation
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-18
Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: COPD She was a resident at the Senior Living facility. My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m. She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing. Around 1:40, the nursing home called to let me know CPR was being performed. My sister rushed to the site and she was pronounced dead around 2:10. p.m.
Preexisting Conditions: COPD The death states she died of Atherosclerotic Heart Disease
Allergies: No
Diagnostic Lab Data: Death certificate
CDC Split Type: Write-up: COPD She was a resident at the Senior Living facility. My mother received the vaccine on Tuesday, May 18, 2021 at approximately 11:00 a.m. She was left by herself and called around at 11:32 to say she got the vaccine and she was having a hard time breathing. Around 1:40, the nursing home called to let me know CPR was being performed. My sister rushed to the site and she was pronounced dead around 2:10. p.m. |
|
| Vaccinated: | 2021-03-26 | | Onset: | 2021-03-26 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-21 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: COVID-19 pneumonia, Chills, Death, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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: 2021-06-21
Days after onset: 87
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 35 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Warfarin, Bystolic, Losartan, allopurinol
Current Illness: none
Preexisting Conditions: heart valve replacement from a birth defect in his heart when he was born
Allergies: none
Diagnostic Lab Data: the file is too large to attach.
CDC Split Type: Write-up: My husband fell ill within hours of getting the first dose of the vaccine, he started running fever, chills, body aches-within 7 days he was admitted to the hospital and 12 hours after admission to the hospital he was diagnosed with Covid Pneumonia. or they thought- his lungs were showing signs of being attacked. He had no illness, no fever, no underlying health concerns, no allergies, he was not over weight, he was not diabetic, he was still young and within 6 weeks of getting the vaccine he was dead. Doctors could do nothing to save his life. The Moderna vaccine killed my husband and it is killing other perfectly healthy people. |
|
| Vaccinated: | 2021-03-18 | | Onset: | 2021-03-18 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / UNK | - / - |
Administered by: Other Purchased by: ?
Symptoms: Death, Diarrhoea, Fatigue, Myalgia, Nausea, Sudden death, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-21
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: Cyclobenzaprine, Atorvastatin, Lorsartan, Hydroxyzine and Vitamin B-12
Current Illness: None known
Preexisting Conditions: Hyperlipidemia, hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type: Write-up: Nausea, vomiting, diarrhea, muscle pain with fatigue with the first and second dose. Was reported to not be able to hold anything down with second dose and sudden death while sleeping (nap for fatigue). Found dead in bed 3/21/2021. No allergic reactions were reported. No unusual electrolyte findings suggested the cause. |
|
| Vaccinated: | 2021-03-20 | | Onset: | 2021-03-20 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-23 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | - / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Asthenia, Chills, Fall, Haemorrhage, Myocardial infarction, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-23
Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes (was on anti-diabetic medicine.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212 Write-up: Died due to heart attack; Lot of blood was on the floor; He fell on bathroom tiles; Feeling weakness/Could not coming out of bed; Fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (Died due to heart attack) and HAEMORRHAGE (Lot of blood was on the floor) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes (was on anti-diabetic medicine.). On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Mar-2021, the patient experienced ASTHENIA (Feeling weakness/Could not coming out of bed), PYREXIA (Fever) and CHILLS (Chills). On 23-Mar-2021, the patient experienced MYOCARDIAL INFARCTION (Died due to heart attack) (seriousness criteria death and medically significant), HAEMORRHAGE (Lot of blood was on the floor) (seriousness criterion medically significant) and FALL (He fell on bathroom tiles). The patient died on 23-Mar-2021. The reported cause of death was Heart attack. It is unknown if an autopsy was performed. At the time of death, HAEMORRHAGE (Lot of blood was on the floor), FALL (He fell on bathroom tiles), ASTHENIA (Feeling weakness/Could not coming out of bed), PYREXIA (Fever) and CHILLS (Chills) outcome was unknown. Concomitant medication included was anti-diabetic medicine. The treatment information was not provided. Very limited information regarding this events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this events has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: heart attack |
|
| VAERS ID: | 1420121 (history) | | Form: | Version 2.0 | | Age: | 91.0 | | Sex: | Female | | Location: | Arizona |
| Vaccinated: | 2021-03-31 | | Onset: | 2021-03-31 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-23 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 2 | LA / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Death, Inappropriate schedule of product administration, Vaccination site pain
SMQs:, Medication errors (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-09
Days after onset: 70
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20211 Write-up: passed away; received second vaccine 44 days after receiving the first dose; Pain the injection site from the first dose; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away) in a 91-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 31-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 31-Mar-2021, the patient experienced VACCINATION SITE PAIN (Pain the injection site from the first dose). On 14-May-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received second vaccine 44 days after receiving the first dose). On 05-Apr-2021, VACCINATION SITE PAIN (Pain the injection site from the first dose) had resolved. On 14-May-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received second vaccine 44 days after receiving the first dose) had resolved. The patient died on 09-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) and mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was reported. Company comment: This report refers to a case of Inappropriate schedule of product administration for mRNA-1273, with associated Adverse Events of Vaccination site pain and Death in a 91-year-old female subject who died 25 days after receiving second dose of vaccine. Very limited information regarding these events has been provided at this time. Further information has been requested. This case was linked to US-MODERNATX, INC.-MOD-2021-132760 (Linked Report). Most recent FOLLOW-UP information incorporated above includes: On 14-Jun-2021: Case upgraded to Serious due to death.; Sender''s Comments: This report refers to a case of Inappropriate schedule of product administration for mRNA-1273, with associated Adverse Events of Vaccination site pain and Death in a 91-year-old female subject who died 25 days after receiving second dose of vaccine. Very limited information regarding these events has been provided at this time. Further information has been requested. US-MODERNATX, INC.-MOD-2021-132760:Son; Reported Cause(s) of Death: Unknown cause of death |
|
| Vaccinated: | 2021-02-25 | | Onset: | 2021-02-25 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-23 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 024M20A / 1 | LA / SYR |
Administered by: Private 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aciphex Vit E 400mg Metoprolol 100mg Aspirin 81mg B Complex Vit 2 50,000mg Trulicity 1.5 shot Pralvent 1.5 shot Fish Oil COQ10 SG 100 Clindamycin 150mg Colace Flomax .4 1000mg Metformin
Current Illness: Had Stint and Quadruple by pass, High Cholesterol, High Triglycerides, Coronary Heart Disease, Sleep Apnea, Acid Reflex, Diabetes Had Surgery 1 week prior for prostrate cancer.
Preexisting Conditions:
Allergies: Penicillin Suffa Terramycin All Statin - drugs
Diagnostic Lab Data:
CDC Split Type: Write-up: Patient died |
|
| VAERS ID: | 1423241 (history) | | Form: | Version 2.0 | | Age: | 81.0 | | Sex: | Female | | Location: | Indiana |
| Vaccinated: | 2021-01-12 | | Onset: | 2021-01-12 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-24 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | AR / SYR |
Administered by: Other Purchased by: ?
Symptoms: Death, Dyspnoea, Endotracheal intubation, Mechanical ventilation, Mobility decreased, Peripheral swelling, Posture abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-19
Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID positive in December 2020
Preexisting Conditions: COPD, CHF, Kidney Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: Within 24 hours, my mom''s arms swelled up from shoulder to fingertips and she had never had swelling in her arms prior. She also was hanging her head as if she had fallen asleep, but actually was unable to lift her head. 4 days following the vaccine she started having breathing issues and was intubated, we had the ventilator removed (she was actually a DNR and was not supposed to be intubated). On January 19, 2021 she died. She went into this facility for rehab regarding an infection she had in her leg. |
|
| VAERS ID: | 1423625 (history) | | Form: | Version 2.0 | | Age: | 79.0 | | Sex: | Female | | Location: | Michigan |
| Vaccinated: | 2021-05-06 | | Onset: | 2021-05-06 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-24 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / 2 | UN / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: 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: 2021-05-18
Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: *Azelastine HCL 0.05 Ophthalmic Solution; *Celecoxib 200 MG Oral Capsule; -Citalopram Hydrobromide 10 MG Oral Tablet; *Fexofenadine HCL 180 MG Oral Tablet; *Fluticasone Propionate 50 MCG/ACT Nasal Suspension; Lovastatin 40 MG Oral Tablet; *
Current Illness: Dementia
Preexisting Conditions:
Allergies: *Demeral *Macrolides and Ketolides *Penicillin G Benzathine *Seasonal Allergies
Diagnostic Lab Data:
CDC Split Type: Write-up: Two hours after receiving her 2nd dose of the Pfizer Covid Vaccine, patient had a Stroke (large brain bleed). She never recovered and passed away May 18th, 2021 |
|
| Vaccinated: | 2021-06-19 | | Onset: | 2021-06-19 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-24 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 047C21A / 2 | LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-19
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: The pharmacist was contacted by patients daughter on 6/23/2021. She said that patient was found deceased on the morning of 6/20/2021. They believe he passed away sometime on 6/19/2021. |
|
| Vaccinated: | 2021-01-16 | | Onset: | 2021-01-16 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-25 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL9261 / 2 | RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Chest pain, Computerised tomogram abdomen, Death, Dyspnoea, Fatigue, Flank pain, Full blood count, Hepatic enzyme increased, Illness, Intensive care, Metabolic function test, Platelet count increased, Urine analysis normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-25
Days after onset: 159
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ropinirole, ,dabigatran, famotidine, KCl, ASA, Docusate, Trospium, Telmisartan, Fluticasone, HCTZ, montelukast, omeprazole, simvastatin, fexofenadine, losartan, metoprolol, pregabalin
Current Illness: Acute right sided abdominal pain onset 4 months after vaccination. HTN, Chronic back/leg pain, CAD, GERD,DM2, BPH, Sleep apnea
Preexisting Conditions: HTN, Chronic back/leg pain, CAD, GERD,DM2, BPH, Sleep apnea
Allergies: nkda
Diagnostic Lab Data: Contact MC
CDC Split Type: Write-up: On May 6, 2021, patients were relatively normal. On June 4th he started complaining of right sided abdominal pain along with increasing generalized weakness/fatigue. On June 10th CT Abdomen/Pelvis ordered by PCP, it was completed on 6/16/21. On 6/17/21 patient started c/o of right flank pain as well as ongoing right abdominal pain, U/A collected, normal results. On 6/22/21 patient contact PCP office c/o acute shortness of breath, chest pain and increased weakness. He was advised to call 9-1-1 and go to the ER. He was transported to local Medical Center and found to have extremely elevated platelet count as well as elevated liver enzymes. He was admitted to the ICU he ultimately succumbed to this acute illness on 6/25/21 |
|
| VAERS ID: | 1427402 (history) | | Form: | Version 2.0 | | Age: | 61.0 | | Sex: | Female | | Location: | California |
| Vaccinated: | 2021-06-23 | | Onset: | 2021-06-23 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-25 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 025C21A / 2 | LA / IM |
Administered by: School Purchased by: ?
Symptoms: Death, Dyspnoea, Injection site pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-24
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: albuterol, zolpidem, sertraline, amlodipine Methamphetamine user
Current Illness:
Preexisting Conditions: Hypertensive and atherosclerotic cardiovascular disease, chronic methamphetamine use, pulmonary emphysema, anxiety disorder
Allergies: Not known
Diagnostic Lab Data:
CDC Split Type: Write-up: 6/23/2021 - pain at injection site, shortness of breath 6/24 /2021 - found dead in bed at 7AM |
|
| VAERS ID: | 1427475 (history) | | Form: | Version 2.0 | | Age: | 87.0 | | Sex: | Female | | Location: | Minnesota |
| Vaccinated: | 2021-02-17 | | Onset: | 2021-02-17 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-25 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 006M20A / 2 | - / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-27
Days after onset: 98
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: Patient was hospitalized within 60 days of receiving a COVID vaccine series and later died |
|
| Vaccinated: | 2021-05-21 | | Onset: | 2021-05-21 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-25 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 041C21A / UNK | AR / SYR |
Administered by: Pharmacy Purchased by: ?
Symptoms: Death, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-21
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: insulin, lipitor, not sure what else
Current Illness: Type 1 Diabetes; hospitalized May 16-18 acute ketoacidosis
Preexisting Conditions: Type 1 Diabetes
Allergies: don''t know of any
Diagnostic Lab Data: The final autopsy has not yet been completed, and I don''t know if they''re even checking for Covid-19 vaccine reaction.
CDC Split Type: Write-up: Patients appointment was either 2:15 or 2:30. His Apple watch recorded it''s last heart beat reading at 3:15 pm, 05/21/2021, within an hour after receiving his second Moderna Covid-19. His heart rate increased rapidly from 3:00 to 3:15, reading 104 - 106 - 108 - 116 bpm. I can provide a photo of these last four readings if you need them. I don''t know other symptoms. His body was found by police who were called for a well-check three days later, 05/24/2021. Patient died unattended, at home, alone. I only know for sure the vaccine was administered at a Target store near his home. Patient texted me at 2:48pm saying that Target gave him a $5 coupon for getting his vaccine, and he was going to use it to buy Tylenol. |
|
| VAERS ID: | 1428029 (history) | | Form: | Version 2.0 | | Age: | 32.0 | | Sex: | Female | | Location: | Georgia |
| Vaccinated: | 2021-06-23 | | Onset: | 2021-06-23 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-25 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 009D21A / 2 | LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Death
SMQs: Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-23
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: Flagyl, Quinolones
Diagnostic Lab Data: N/A
CDC Split Type: Write-up: N/A -- patient was perfectly fine during wait time |
|
| VAERS ID: | 1431331 (history) | | Form: | Version 2.0 | | Age: | 79.0 | | Sex: | Male | | Location: | Tennessee |
| Vaccinated: | 2021-06-26 | | Onset: | 2021-06-26 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-28 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 029L20A / 2 | - / IM |
Administered by: Public Purchased by: ?
Symptoms: Asthenia, COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-26
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:
Current Illness:
Preexisting Conditions: DM, HTN, Seizure Disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: Patient received second COVID vaccine on 2/3/2021. Was admitted to Medical Center on 6/15/21 for generalized weakness and tested positive for COVID 19 on 6/15/2021. Patient was also positive for COVID 19 in November 2020. Patient expired on 6/26/2021 while hospitalized. |
|
| VAERS ID: | 1431733 (history) | | Form: | Version 2.0 | | Age: | 71.0 | | Sex: | Male | | Location: | California |
| Vaccinated: | 2021-03-27 | | Onset: | 2021-03-27 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-28 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 2 | - / - |
Administered by: Private Purchased by: ?
Symptoms: Agitation, Asthenia, Biliary colic, Blood test abnormal, Cardiac failure congestive, Death, Diagnostic procedure, Drainage, Dyspnoea, Hallucination, Hepatic pain, Hyperventilation, Illness, Laboratory test, Pleural effusion, Pneumonia, Renal impairment, Sleep disorder, Ventricular assist device insertion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Gallbladder related disorders (narrow), Biliary tract disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-19
Days after onset: 84
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 32 days
Extended hospital stay? No
Previous Vaccinations: The first vaccine. Other than that, no.
Other Medications: He was taking normal supplements to maintain health for his age.
Current Illness: None. He felt bad (flu like symptoms) after the first shot (2/27/21) for about two weeks but recovered.
Preexisting Conditions: He had a heart attack in 2006 and bypass surgery. Over the years he had stents put in but didn''t have problems - worked out with a trainer regularly, cared for his 5 year old granddaughter after school, maintained a property in the mountains - no problem.
Allergies: Unknown
Diagnostic Lab Data: You name it, they did it. You have the three hospitals and they probably have reams of test results. They did not suggest that this was an adverse reaction to the vaccine nor did they indicate it was natural - we are the ones who chronicled the series of events and felt compelled to report.
CDC Split Type: Write-up: I am filing this on behalf of my sister, who feels it needs to be reported but she is too grief-stricken to do this herself. The morning after the second shot, my sister texted that her husband was up at least 10 times during the night, and five times the next night. He was agitated and hallucinating (swatting at bugs that weren''t there.) For the next four weeks he had progressively more difficult breathing, and on 4/28 a liter of fluid was drained from his chest. He continued to have difficulty breathing and was taken by ambulance to Hospital on May 2 where they again drained his chest and diagnosed him with pneumonia. A nurse told him they were seeing a number of cases of fluid around the lungs (his fluid was around the lungs, not in them) after COVID vaccines. He was sent home May 4 and commented that it was strange his cardiologist hadn''t visited. Almost immediately he was experiencing liver and gall bladder pain, even though tests for those showed the two organs were healthy. On May 8 my sister said patient woke up hyperventilating, which also became more frequent. On the 9th his daughter told me the labs were not trending well, and on May 10 he saw his cardiologist. He diagnosed him with congestive heart failure and got him an appointment at the Heart Hospital on May 17 - he explained congestive heart failure is scary but can be managed through programs at the heart hospital. He began sleeping outside because it made it easier to breathe. On May 15 he was advised to go to the ER/Hospital for tests the heart hospital would need and, once there, they discovered his kidneys weren''t functioning and he was admitted immediately. He spent 17 days at Hospital- if the kidneys improved, the heart got worse. If the heart improved, the kidneys failed. He was released on June 2. On June 7 my brother took him to get blood work done - Patient was too weak to get in and out of the car by himself. The blood work came back bad, and on June 8 he was admitted to the Heart Hospital. On June 10 he was transferred to the Regional Community Hospital to be closer to his cardiologist. From there he continued to decline, and the doctors wanted to do surgery for a LVAD but couldn''t. To help him get stronger, he had an impeller put in by catheter on June 19 and died that night. His own cardiologist said congestive heart failure is manageable. The symptoms started the night of the second vaccine and his illness wasn''t gradual - he went off a cliff. With all the heart problems appearing in males, we don''t think this was coincidence. |
|
| Vaccinated: | 2021-05-19 | | Onset: | 2021-05-19 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-28 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EW0169 / 2 | UN / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Aphasia, Chills, Death, Hot flush
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-21
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: unknown
Preexisting Conditions: epilepsy, high blood pressure, high cholesteral, overweight
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type: Write-up: Trouble speaking, cold chills, hot flashes. Death on 5/21 |
|
| Vaccinated: | 2021-03-08 | | Onset: | 2021-03-08 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-06-29 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EM6205 / 2 | RA / SYR |
Administered by: Military Purchased by: ?
Symptoms: Abnormal behaviour, Anal incontinence, Cognitive disorder, Confusional state, Death, Dementia, Gait disturbance, General physical health deterioration, Hypokinesia, Limb reduction defect, Movement disorder, Muscle tightness, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Congenital, familial and genetic disorders (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-09
Days after onset: 92
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: He was on Tansusin, Megesterol, Aso (over the counter bladder drug), and anti-depressant/pain medication Duloxetine.
Current Illness: The only issues he had from the first vaccine. He slept for 14hr a day for the first 5 days after the first vaccination. Mild fever 101, like he had the flu -- body aches, headaches. After the vaccine he couldn''t get warm enough. We are talking about someone that could live by himself up until March 8th.
Preexisting Conditions: He had just been officially diagnosed dementia, actually it wasn''t till after the vaccination 2nd dose. But we knew he had some form before.
Allergies: No
Diagnostic Lab Data: I''m sure they did tests but I don''t know what they were.
CDC Split Type: vsafe Write-up: On March 8 we went and got the 2nd vaccine and he came home with a fever and confusion and I guess dementia just seeming crazy. He was eating dinner on March 9 sitting at the bar with my Mom and for whatever reason when she got back to him (with 5minutes) he was on the floor balled up in a ball, all his muscles were tight- it was hard for us to get him to stretch or even move, unable to move or control his bowels. I went and got him and put him in bed, in the middle of the night he woke up and was going crazy. My Mom called the ambulance and they took him to the hospital and he stayed for 3 days. They got him some Occupation therapy and they were able to snap him out a little bit. They helped him walk a little it was hard because he has only one arm. We ended up taking him to a nursing home for physical rehab for him to snap out of it but after 2 weeks in the home his brain and cognition and physical abilities deteriorated everyday. To the point we had to send him to a behavioral health hospital who tried to get him on medication to keep him from getting violent- he was there for 31 days and sent back to nursing home and lasted 3 weeks and then he passed away. It was just rapid exponential deteriorated from day to day and was unbelievable to watch. Every Dr. that saw him said that the vaccine was a contributor to his rapid decline. |
|
| Vaccinated: | 2021-06-29 | | Onset: | 2021-06-29 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-07-01 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EW0161 / 2 | LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Cyanosis, Death, Hypotonia, Pallor, Secretion discharge, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad) Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-06-29
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: acute respiratory failure
Preexisting Conditions: muscle weakness, cognitive communication defecit, dysphagi following cerebral infarction, pneumonia, malignant melanoma of skin, hx of covid, type 2 diabetes, epilepsy, hypercholersterolemia, morbid obesity, GERD, Hypothyroidism, gastrostomy, PVD, anemia, quadriplegia, dependence on Vent
Allergies: IV dye, latex, tape
Diagnostic Lab Data:
CDC Split Type: Write-up: secretions and vomitting at 11pm...suctioned. 2:25 am 6/30 vent alarm. pt pale, bp 72/38 pulse 46 , cyanotic lips, limp, resps 11. pt passed at 2:30 |
|
| Vaccinated: | 2021-04-28 | | Onset: | 2021-04-28 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-07-01 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 026A21A / 2 | RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia, Death
SMQs:, Guillain-Barre syndrome (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-05-05
Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: losartan fish oils, cholecalciferol, calcium acetate aspirin, amlodipine, acetaminophen, aspirin/hydrocodone
Current Illness:
Preexisting Conditions: Diabetes II, hypertension, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type: Write-up: Family stated patient had been weaker since "last covid shot". Patient death 5-5-2021 - 1 week after vaccination |
|
| VAERS ID: | 1445735 (history) | | Form: | Version 2.0 | | Age: | 90.0 | | Sex: | Male | | Location: | New Jersey |
| Vaccinated: | 2021-03-04 | | Onset: | 2021-03-04 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-07-03 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 022N20A / 1 | - / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Blood iron, Blood iron decreased, Chills, Death, Decreased appetite, Kidney infection, Nausea, Pneumonia, Polymerase chain reaction
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow) Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-03-23
Days after onset: 18
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: AMIODARONE; DIURETIC [HYDROCHLOROTHIAZIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aspiration pneumonia (Had Aspiration Pneumonia prior to vaccination and was hospitalized.); Heart valve replacement; Intubation; Stent placement (Received a heart stent 7 years ago.)
Allergies:
Diagnostic Lab Data: Test Date: 20210314; Test Name: Low Iron Levels; Result Unstructured Data: Had very low Iron levels.; Test Name: PCR tests; Test Result: Negative ; Result Unstructured Data: Had several Negative PCR tests every time he was hospitalized
CDC Split Type: USMODERNATX, INC.MOD20212 Write-up: Possible Kidney Infection; Possible Pneumonia; Passed away; Low Iron Levels; Lack of appetite continued after first shot; Nauseous; Felt Cold (Chills); This spontaneous case was reported by an other caregiver and describes the occurrence of KIDNEY INFECTION (Possible Kidney Infection), PNEUMONIA (Possible Pneumonia) and DEATH (Passed away) in a 90-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 022N20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Aspiration pneumonia (Had Aspiration Pneumonia prior to vaccination and was hospitalized.), Stent placement (Received a heart stent 7 years ago.), Heart valve replacement on 12-Jan-2021 and Intubation. Concomitant products included AMIODARONE and HYDROCHLOROTHIAZIDE (DIURETIC [HYDROCHLOROTHIAZIDE]) for an unknown indication. On 04-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Mar-2021, the patient experienced CHILLS (Felt Cold (Chills)). On 14-Mar-2021, the patient experienced KIDNEY INFECTION (Possible Kidney Infection) (seriousness criteria death, hospitalization, medically significant and life threatening), PNEUMONIA (Possible Pneumonia) (seriousness criteria death, hospitalization, medically significant and life threatening), DECREASED APPETITE (Lack of appetite continued after first shot), NAUSEA (Nauseous) and BLOOD IRON DECREASED (Low Iron Levels). On 23-Mar-2021, DECREASED APPETITE (Lack of appetite continued after first shot) and BLOOD IRON DECREASED (Low Iron Levels) outcome was unknown and CHILLS (Felt Cold (Chills)) and NAUSEA (Nauseous) had resolved. The patient died on 23-Mar-2021. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 14-Mar-2021, Blood iron: (Low) Had very low Iron levels.. On an unknown date, Polymerase chain reaction: (Negative) Had several Negative PCR tests every time he was hospitalized. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Reporter states that her Husband passed away on 23MAR2021 but his death was not vaccine related. Had damaged his esophagus while intubating him. He was not doing great but he was functional prior to vaccination. On 14MAR2021 he was hospitalized. Doctors did not know what was wrong with him. His doctor stated that he had Kidney infection or pneumonia but all tests were normal. Reporter stated that the Doctors do not know what was happening to him but it was not vaccine related. Concomitant medications included Defibrillator along with above mentioned medications.; Sender''s Comments: This fatal case concerns a 90-year-old male hospitalized with serious unexpected events of kidney infection, pneumonia, death and nonserious decreased appetite, blood iron decreased, chills and nausea. Event latency 11 days after first dose mRNA-1273. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Possible Kidney Infection; Possible Pneumonia; Passed away |
|
| VAERS ID: | 1445766 (history) | | Form: | Version 2.0 | | Age: | 67.0 | | Sex: | Female | | Location: | New Jersey |
| Vaccinated: | 2021-03-01 | | Onset: | 2021-03-01 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-07-03 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | - / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Intracardiac thrombus, Nausea
SMQs:, Acute pancreatitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-08
Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212 Write-up: she died from a blood clot that ran into her heart; felt very very tired; nauseas for the first couple of days; nauseas for the first couple of daysdidn''t eat well for the first couple of days; This spontaneous case was reported by a consumer and describes the occurrence of INTRACARDIAC THROMBUS (she died from a blood clot that ran into her heart), FATIGUE (felt very very tired), NAUSEA (nauseas for the first couple of days) and DECREASED APPETITE (nauseas for the first couple of daysdidn''t eat well for the first couple of days) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In March 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In April 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In March 2021, the patient experienced NAUSEA (nauseas for the first couple of days) (seriousness criterion death) and DECREASED APPETITE (nauseas for the first couple of daysdidn''t eat well for the first couple of days) (seriousness criterion death). On 04-Apr-2021, the patient experienced FATIGUE (felt very very tired) (seriousness criterion death). On 08-Apr-2021, the patient experienced INTRACARDIAC THROMBUS (she died from a blood clot that ran into her heart) (seriousness criteria death and medically significant). The patient died on 08-Apr-2021. The reported cause of death was she died from a blood clot that ran into her heart. It is unknown if an autopsy was performed. As per source document the patient received the 2nd dose on 4 or 5 April 2021 and she died from a blood clot that ran into her heart on 8Apr2021. Treatment medication was not reported. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Relevant concomitant medications were not provided by the reporter.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: she died from a blood clot that ran into her heart |
|
| VAERS ID: | 1446611 (history) | | Form: | Version 2.0 | | Age: | 63.0 | | Sex: | Female | | Location: | Minnesota |
| Vaccinated: | 2021-06-30 | | Onset: | 2021-06-30 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-07-04 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | - / 2 | - / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-07-03
Days after onset: 3
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: Sob, death |
|
| VAERS ID: | 1446639 (history) | | Form: | Version 2.0 | | Age: | 61.0 | | Sex: | Male | | Location: | North Carolina |
| Vaccinated: | 2021-04-29 | | Onset: | 2021-04-29 | | Days after vaccination: | 0 | | Submitted: | 0000-00-00 | | Entered: | 2021-07-04 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route | | COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 043B21A / 2 | AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Acute respiratory failure, Anticoagulant therapy, Atrial fibrillation, Biopsy bone marrow, Biopsy skin, Blood test, Cardio-respiratory arrest, Cerebrovascular accident, Chest X-ray, Chronic eosinophilic leukaemia, Colonoscopy, Computerised tomogram head abnormal, Death, Electrocardiogram, Endoscopy, Eosinophil count increased, Eosinophilia, Gastrointestinal tube insertion, Intensive care, Large intestinal ulcer, Magnetic resonance imaging head abnormal, Mechanical ventilation, Muscle spasms, Myalgia, Oesophageal ulcer, Pyrexia, Rash, Thrombosis, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), 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, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Gastrointestinal ulceration (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Haematological malignant tumours (narrow) Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-03
Days after onset: 35
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 33 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: daily baby aspirin
Current Illness: tendonitis in elbow
Preexisting Conditions: occasional lower back pain
Allergies: bee stings
Diagnostic Lab Data: May1-June 2 2021 -daily routine blood work, EKGs, bone marrow biopsy, chest x-rays, skin biopsy, genetic testing, endoscopy, colonoscopy, CT scans, MRI; all is visible in 3200 page all medical testing viewable in patient''s 3200 page electronic Hospital medical record
CDC Split Type: Write-up: My husband passed away June 3, 2021 resulting from complications which began a few hours after receiving his 2nd Moderna shot on April 29, 2021. He never tested positive for Covid19, however his first symptoms were the typical fever, muscle aches, rash. He declined daily from a host of mysterious symptoms including full body rash, blood clots, muscle spasms, atrial fibrillation, ulcers lining his esophagus and colon, and exorbitant WBC (157K) with extremely high eosinophils (90%). He was treated with a host of drugs including antibiotics, steroids, blood thinners, ivermectin and finally chemotherpay (Campath). His ICU team included hematology, pulmonology, ... oncology and infectious disease. After an incredible amount of diagnostic testing ( daily routine blood work, EKGs, chest x-rays, CT scans, MRI, bone marrow biopsy, endoscopy, colonoscopy, skin biopsy, genetic testing) no definitive diagnosis could be made, however, he was given the possible diagnosis of chronic eosinophilia leukemia in late May. The big question among the medical staff was, "Did the shot trigger something?" He was eventually treated with the chemotherapy drug Campath, which reduced the WBC and EOs some, but his organs, especially, lungs had been very compromised by the high WBC and eosinophils. Several days after being placed on a ventilator and given a feeding tube at the end of May, a CT scan and MRI confirmed patient had suffered multiple strokes. He passed away a half hour after being taken off the ventilator the morning of June 3, 2021. His death certificate read: A. cardiopulmonary arrest B. acute hypoxic respiratory failure C. hypereosinophila |
|
