Source: Search Results from the VAERS Database (medalerts.org)
VAERS ID:909095 (history) Form:Version 2.0 Age:66.0 Sex:Male Location:Colorado Vaccinated:2020-12-23Onset:2020-12-25 Days after vaccination:2Submitted:0000-00-00Entered:2020-12-25Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA011J20A / 1RA / IMAdministered by: Senior Living Purchased by: ? Symptoms: Foaming at mouth, Pain in extremity, Pallor, Pulse absent, Respiratory arrest, Somnolence, Unresponsive to stimuli SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-25 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Tamsulosin 0.4mg, Lactobacillus tablet, Nephro-vite tablet 0.8mg, Allopurinol 100mg, ferrous gluconate 324mg, melatonin 6mg, lisinopril 2.5mg, colace 100mg, metamucil powder, aspirin 81mg, amidoarone 200mg, hydrooxyzine 25mg, cholestyramine Current Illness: End stage renal disease with dependence on renal dialysis, COPD, cirrhosis of the liver, hypokalemia, gout, heart failure, hyperlipidemia, atrial fibrillation. Preexisting Conditions: Refused dialysis frequently resulting in episodes of hypokalemia and hospitalization, resident dependent on supplemental oxygen. The resident refused to go to dialysis on 12/23/2020 and said he was feeling fine. Allergies: alprazolam, Lorazepam Diagnostic Lab Data: None CDC Split Type:Write-up: on 12/24/2020 the resident was sleepy and stayed in bed most of the shift. He stated he was doing okay but requested pain medication for his legs at 250PM. At 255AM on 12/25/2020 the resident was observed in bed lying still, pale, eyes half open and foam coming from mouth and unresponsive. He was not breathing and with no pulse |
VAERS ID: 914917 (history) Form: Version 2.0 Age: 63.0 Sex: Male Location: Illinois Vaccinated: 2020-12-19 Onset: 2020-12-23 Days after vaccination: 4 Submitted: 0000-00-00 Entered: 2020-12-30 Vaccination / Manufacturer Lot / Dose Site / Route COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / UNK – / – Administered by: Work Purchased by: ? Symptoms: Death, Myocardial infarction SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow) Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-23 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: Atenolol, Chlorthalidone, Tamsulosin Current Illness: None Preexisting Conditions: hypertension Allergies: None Diagnostic Lab Data: Death certificate CDC Split Type: Write-up: Death by massive heart attack. Pfizer-BioNTech COVID-19 Vaccine EUA |
VAERS ID: 918065 (history) Form: Version 2.0 Age: 64.0 Sex: Male Location: California Vaccinated: 2020-12-30 Onset: 2021-01-01 Days after vaccination: 2 Submitted: 0000-00-00 Entered: 2021-01-04 Vaccination / Manufacturer Lot / Dose Site / Route COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 – / IM Administered by: Other Purchased by: ? Symptoms: Death, Unresponsive to stimuli SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-01 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: – Invega Trenza 546mg Q3months – Lithium 300mg BID – Oxybutynin 5mg QID – lipitor 20mg QHS – cogentin 2mg BID – Norvasc 5mg QD – Dyazide Capsule 37.5-25 MG (Triamterene-HCTZ) QD Current Illness: – covid-19 Preexisting Conditions: – SCHIZOPHRENIA, UNSPECIFIED – ANEMIA, UNSPECIFIED – OVERWEIGHT – OVERACTIVE BLADDER – ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS – HYPOTHYROIDISM DUE TO MEDICAMENTS AND OTHER EXOGENOUS SUBSTANCES – NICOTINE DEPENDENCE, UNSPECIFIED, UNCOMPLICATED – CHRONIC VIRAL HEPATITIS C – UNSPECIFIED AGE-RELATED CATARACT – ESSENTIAL (PRIMARY) HYPERTENSION – CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED – UNSPECIFIED CONVULSIONS – INHALANT ABUSE, UNCOMPLICATED – OTHER SEIZURES Allergies: – Clozaril – Tegretol Diagnostic Lab Data: N/A CDC Split Type: Write-up: 1/1/2020: Residents was found unresponsive. Pronounced deceased at 6:02pm VAERS ID: 918388 (history) Form: Version 2.0 Age: 65.0 Sex: Female Location: Florida Vaccinated: 2020-12-30 Onset: 2021-01-01 Days after vaccination: 2 Submitted: 0000-00-00 Entered: 2021-01-04 Vaccination / Manufacturer Lot / Dose Site / Route COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM Administered by: Senior Living Purchased by: ? Symptoms: Death, Pulse absent, Respiratory arrest, Resuscitation, Unresponsive to stimuli SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-01 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Albuteral Sulfate Amlodipine Carvedilol Ipratropium Levetiracetam Olanzapine Sodium Chloride Symbicort Valproic Acid Current Illness: No acute illness at time of vaccination. History of: CVA SCPT Dementia Seizure Disorder HTN COPD Preexisting Conditions: As noted above Allergies: NKA Diagnostic Lab Data: CDC Split Type: Write-up: Resident found unresponsive without pulse, respirations at 04:30 CPR performed, expired at 04:52 by Rescue VAERS ID: 918418 (history) Form: Version 2.0 Age: 65.0 Sex: Male Location: Florida Vaccinated: 2020-12-30 Onset: 2021-01-01 Days after vaccination: 2 Submitted: 0000-00-00 Entered: 2021-01-04 Vaccination / Manufacturer Lot / Dose Site / Route COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM Administered by: Senior Living Purchased by: ? Symptoms: Dyspnoea, Hospice care, Hypoxia, Oxygen saturation decreased, Pulse absent, Respiratory arrest, Respiratory tract congestion SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad) Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-03 Days after onset: 2 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Mucomyst ASA Benadryl Periactin Colace Ferrous Sulfate Folic Acid Gabapentin Sennosides Albuterol Ipratropium Melatonin MVI Oxycodone Polyethylene Glycol Seroquel Rosuvastatin Valproic Acid Venlafaxine Vitamin C Current Illness: Hypoxia started on 1/1/2021. History of: Osteomyelitis CVA Pain Pressure Ulcers PVD Hepatitis C COPD HTN HLD Constipation SCPT Anemia Seizure disorder Depression AKA Preexisting Conditions: As noted above Allergies: NKA Diagnostic Lab Data: low oxygen saturation CDC Split Type: Write-up: Resident became SOB, congested and hypoxic requiring oxygen, respiratory treatments and suctioning. Stabilized after treatment and for the next 72 hours with oxygen saturations in the 90s. On 1/3/2021 was found without pulse and respirations. Resident was a DNR on Hospice. VAERS ID: 918518 (history) Form: Version 2.0 Age: 50.0 Sex: Female Location: Nebraska Vaccinated: 2020-12-31 Onset: 2020-12-31 Days after vaccination: 0 Submitted: 0000-00-00 Entered: 2021-01-04 Vaccination / Manufacturer Lot / Dose Site / Route COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / IM Administered by: Private Purchased by: ? Symptoms: Autopsy, Cardio-respiratory arrest, Death, Resuscitation, Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-31 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? Yes Hospitalized? No Previous Vaccinations: Other Medications: To be determined Current Illness: To be determined Preexisting Conditions: To be determined Allergies: To be determined Diagnostic Lab Data: Autopsy being performed CDC Split Type: Write-up: syncopal episode – arrested – CPR – death VAERS ID:914604 (history) Form:Version 2.0 Age:74.0 Sex:Male Location:Michigan Vaccinated:2020-12-16Onset:2020-12-20 Days after vaccination:4Submitted:0000-00-00Entered:2020-12-30Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHEH9899 / 1- / IMAdministered by: Other Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-20 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: Spouse awoke 12/20 and found spouse dead. Client was not transferred to hospital. |
Vaccinated: | 2020-12-30 |
Onset: | 2021-01-04 |
Days after vaccination: | 5 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | – / 1 | – / IM |
Administered by: Private Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-04
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Per employee health records HTN, DM, Breast CA 2016 with radiation, obesity, gastric sleeve 10 years ago, arthritis, plantar fasciitis, ankle tendonitis, DeQuarvains, carpal tunnel, anxiety
Allergies: Lisinpril, Codeine, Latex , environmental (hay fever)
Diagnostic Lab Data:
CDC Split Type:
Write-up: Found deceased in her home, unknown cause, 6 days after vaccine.
VAERS ID:921547 (history) Form:Version 2.0 Age:65.0 Sex:Male Location:Arkansas Vaccinated:2021-01-02Onset:2021-01-04 Days after vaccination:2Submitted:0000-00-00Entered:2021-01-05Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA- / 1RA / IMAdministered by: Senior Living Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-04 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Acetaminophen Tablet 325 MG Give 2 tablet by mouth every 6 hours as needed for Pain. elevated Temp. Phone Active 05/08/2020 05/08/2020 AmLODIPine Besylate Tablet 10 MG Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYP Current Illness: CEREBRAL INFARCTION, UNSPECIFIED(I63.9), LONG TERM (CURRENT) USE OF ASPIRIN(Z79.82), VITAMIN DEFICIENCY, UNSPECIFIED(E56.9), ACUTE KIDNEY FAILURE, UNSPECIFIED(N17.9), HYPERKALEMIA(E87.5), ACUTE RESPIRATORY FAILURE, UNSPECIFIED WHETHER WITH HYPOXIA OR HYPERCAPNIA(J96.00), PURE HYPERCHOLESTEROLEMIA, UNSPECIFIED(E78.00), PAIN IN RIGHT FOOT(M79.671), ESSENTIAL (PRIMARY) HYPERTENSION(I10), ACIDOSIS(E87.2), ABNORMAL LEVELS OF OTHER SERUM ENZYMES(R74.8), HYPERLIPIDEMIA, UNSPECIFIED(E78.5), DISORDER OF THYROID, UNSPECIFIED(E07.9), GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS(K21.9), MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, UNSPECIFIED SITE(M62.50), MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, MULTIPLE SITES(M62.59), COGNITIVE COMMUNICATION DEFICIT(R41.841), UNSPECIFIED LACK OF COORDINATION(R27.9), OTHER DYSPHAGIA (R13.19), OTHER CHRONIC PAIN(G89.29), HYPOTHYROIDISM, UNSPECIFIED(E03.9), DRY EYE SYNDROME OF UNSPECIFIED LACRIMAL GLAND (H04.129), METABOLIC ENCEPHALOPATHY(G93.41), UNSPECIFIED CONVULSIONS(R56.9), POLYNEUROPATHY, UNSPECIFIED(G62.9), TYPE 1 DIABETES MELLITUS WITH UNSPECIFIED DIABETIC RETINOPATHY WITHOUT MACULAR EDEMA(E10.319), NASAL CONGESTION(R09.81), BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC(J40), HYPOKALEMIA(E87.6), ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED(D72. 829), OTHER MALAISE(R53.81), CELLULITIS OF RIGHT LOWER LIMB(L03.115), CELLULITIS OF LEFT LOWER LIMB(L03.116), EDEMA, UNSPECIFIED (R60.9), IRON DEFICIENCY ANEMIA, UNSPECIFIED(D50.9), CUTANEOUS ABSCESS, UNSPECIFIED(L02.91), COVID-19(U07.1) Preexisting Conditions: UNCONTROLLED DIABETES MELLITUS ON INSULIN Allergies: NKDA Diagnostic Lab Data: N/A CDC Split Type:Write-up: DEATH ON 1/4/2021, RESIDENT RECIEVED VACCINE ON 1/2/20 |
VAERS ID:921667 (history) Form:Version 2.0 Age:39.0 Sex:Female Location:Ohio Vaccinated:2020-12-29Onset:2021-01-03 Days after vaccination:5Submitted:0000-00-00Entered:2021-01-05Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHEL0140 / 1LA / IMAdministered by: Senior Living Purchased by: ? Symptoms: Autopsy, Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-03 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: LTCF Pfizer Vaccine clinic conducted 12/29/2020 Vaccine lead received a call indicating that a staff member deceased somewhere between 1/3/2021 and 1/4/2021. Cause of death is unknown, and an autopsy is being performed. |
VAERS ID:921768 (history) Form:Version 2.0 Age:58.0 Sex:Female Location:Washington Vaccinated:2021-01-04Onset:2021-01-04 Days after vaccination:0Submitted:0000-00-00Entered:2021-01-05Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHEL0140 / 1UN / IMAdministered by: Private Purchased by: ? Symptoms: Cardiac arrest, Death, Dizziness, Dyspnoea, Fatigue, Feeling hot, Hot flush, Lethargy, Nausea, Respiratory rate decreased, Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (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 (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-04 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: None Known Diagnostic Lab Data: Autopsy scheduled for 01/07/2021 CDC Split Type:Write-up: Vaccine received at about 0900 on 01/04/2021 at her place of work, Medical Center, where she was employed as a housekeeper. About one hour after receiving the vaccine she experienced a hot flash, nausea, and feeling like she was going to pass out after she had bent down. Later at about 1500 hours she appeared tired and lethargic, then a short time later, at about 1600 hours, upon arrival to a friends home she complained of feeling hot and having difficulty breathing. She then collapsed, then when medics arrived, she was still breathing slowly then went into cardiac arrest and was unable to be revived. |
VAERS ID:922977 (history) Form:Version 1.0 Age:71.0 Sex:Male Location:New York Vaccinated:2020-12-21Onset:2020-12-27 Days after vaccination:6Submitted:2020-12-28 Days after onset:1Entered:2021-01-05 Days after submission:8Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA011J20A / 2LA / –Administered by: Other Purchased by: Other Symptoms: Pyrexia, Respiratory depression, SARS-CoV-2 test positive SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-28 Days after onset: 1 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: Fever, RespDepression & COVID positive REMDESIVIR (EUA) 200 mg x1 then 100 mg daily |
VAERS ID:923993 (history) Form:Version 2.0 Age:62.0 Sex:Male Location:North Carolina Vaccinated:2020-12-30Onset:2021-01-02 Days after vaccination:3Submitted:0000-00-00Entered:2021-01-06Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA039K20A / 1AR / IMAdministered by: Private Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-02 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: No Preexisting Conditions: History of stage II (T3N0) appendiceal carcinoma – s/p resection Dec 2014. CAD s/p stenting Diabetes Mellitus Hyperlipidemia Hypertension Glaucoma Allergies: Hay fever Diagnostic Lab Data: CDC Split Type:Write-up: Patient was vaccinated Dec 30, 2020. Prime dose of Moderna vaccine. Observed for full 15 minutes post-injection. No complaints when asked during observation. Released. Subsequently, vaccine clinic staff learned from the patient”s supervisor that on Jan 4, 2021 that the patient had expired on Jan 2, 2021. By report from the supervisor, the patient was found dead at his home. The patient”s primary care provider was unaware of his death when contacted by this reporter today (Jan 6, 2021). Electronic Medical Record without any information since the vaccination. |
VAERS ID:924464 (history) Form:Version 2.0 Age:61.0 Sex:Female Location:Iowa Vaccinated:2021-01-05Onset:2021-01-06 Days after vaccination:1Submitted:0000-00-00Entered:2021-01-06Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH- / UNK- / –Administered by: Private Purchased by: ? Symptoms: Cardiac arrest, Condition aggravated, Haemoptysis, Lung neoplasm malignant SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (broad)Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-06 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? Yes Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: COPD, lung cancer Preexisting Conditions: COPD, lung cancer Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: coughing up blood, significant hemoptysis — $g cardiac arrest. started day after vaccine but likely related to ongoing progression of lung cancer |
Vaccinated: | 2021-01-04 |
Onset: | 2021-01-06 |
Days after vaccination: | 2 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-07 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 37K20A / 1 | RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Death, Malaise
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-06
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Diabetes, renal insufficiency
Preexisting Conditions: Diabetes, renal insufficiency
Allergies: Penicillin, ibuprofen
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient did not report any signs or symptoms of adverse reaction to vaccine. Patient suffered from several comorbidities (diabetes and renal insufficiency). Patient reported not feeling well 01/06/2021 and passed away that day.
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-06 |
Days after vaccination: | 1 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 026L20A / 1 | RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-06
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amiodarone Hcl, Carvedilol, Ferrous sulfate, Eliquis (cont)
Current Illness: Atrial fibrillation, Anemia, 1st degree AV block, CDK stage 4,
Preexisting Conditions: CDK stage 4, Atrial fibrillation, 1st degree AV block, Patient was under hospice care
Allergies: Aldactone, contrast dye
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Resident passed away in her sleep
Vaccinated: | 2020-12-23 |
Onset: | 2021-01-08 |
Days after vaccination: | 16 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 025J202A / 1 | RA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Death, Resuscitation
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessful
VAERS ID:929764 (history) Form:Version 2.0 Age:45.0 Sex:Male Location:Washington Vaccinated:2020-12-28Onset:2020-12-29 Days after vaccination:1Submitted:0000-00-00Entered:2021-01-08Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA025L20A / 1LA / IMAdministered by: Private Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-29 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Hydrochlorthiazide (by record, not confirmed) Current Illness: Preexisting Conditions: Hypertension, sleep apnea, obesity. based on medical record Allergies: no known allergies recorded in medical record Diagnostic Lab Data: CDC Split Type:Write-up: The patient was found deceased at home about 24 hours after immunization. Date of Death:: 12/29/2020; estimated time of death 6:00pm |
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-08 |
Days after vaccination: | 3 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 039K2020A / 1 | LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unkown
Preexisting Conditions: unknown
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type: VFC # 21109
Write-up: Notified today that he passed away. No other details known at this time.
Vaccinated: | 2021-01-08 |
Onset: | 2021-01-08 |
Days after vaccination: | 0 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 012L20A / 1 | LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was refusing to take all medications for over a year
Current Illness: None
Preexisting Conditions: Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, major depressive disorder, aphasia following cerebral infarction, muscle weakness, dysphagia, hypothyrodism, type 2 diabetes, hyperlipidemia, hypomagnesemia, hypokalemia, hypertension, gastro esophageal reflux disease, gastritis, constipation
Allergies: Metformin, morphine, statins, latex
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient received COVID vaccination around 12:15pm. Patient was monitored for the appropriate amount of time by nursing staff. Patient passed away at 2:15pm.
Vaccinated: | 2021-01-07 |
Onset: | 2021-01-08 |
Days after vaccination: | 1 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | – / UNK | UN / UN |
Administered by: Unknown Purchased by: ?
Symptoms: Death, Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2001-01-08
Days after onset: 7305
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Diarrhea followed by death 24 hrs after vaccination
Vaccinated: | 2021-01-07 |
Onset: | 2021-01-08 |
Days after vaccination: | 1 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL3248 / 2 | AR / SYR |
Administered by: Private Purchased by: ?
Symptoms: Death, Dizziness, Headache, Pyrexia, Respiratory arrest, Resuscitation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-10
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: Unknown
Current Illness: none known
Preexisting Conditions: hypertension, hyperlipidemia.
Allergies: Statin – muscle aches
Diagnostic Lab Data: autopsy pending
CDC Split Type:
Write-up: 1/7-21 – Received second dose of pfizer covid-19 vaccine 1/8/21 – Fever, dizziness, headache 1/10/21 0250 was found not breathing. EMS performed CPR and patient deceased
Vaccinated: | 2020-12-17 |
Onset: | 2020-12-23 |
Days after vaccination: | 6 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 1 | LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Cardiac arrest, Cardiac disorder, Intensive care, Withdrawal of life support
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: 2020-12-30
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: Amlodipine, Atorvastatin, Xarelto, Aspirin (These were medications listed with our office in 2019. Unknown if this patient was still taking at time of vaccination).
Current Illness:
Preexisting Conditions: High blood pressure. Congenital unicuspid aortic valve s/p aortic valve replacement 2001 & 2011. Pacemaker placement 2011. Melanoma
Allergies: None known.
Diagnostic Lab Data: Unknown.
CDC Split Type:
Write-up: The patient had an apparent cardiac arrest on 12/23/20 and was admitted to the ICU. He was taken off of life support on 12/30/20. He had known cardiac disease.
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-05 |
Days after vaccination: | 0 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK5730 / 2 | AR / SYR |
Administered by: Work Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-09
Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:
Write-up: Patient died, I have a copy of his vaccination card
Vaccinated: | 2021-01-08 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 012L20A / 1 | LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metform, atorvastin
Current Illness: Diabetes, Hypertension, Sleep Apnea, Obese
Preexisting Conditions: Hx smoking
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pronounced dead 1/9/2021 at 12:42. Received first dose of vaccine 1/8/2021
Vaccinated: | 2021-01-08 |
Onset: | 2021-01-09 |
Days after vaccination: | 1 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EJ1685 / 1 | RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Brain death, Bronchial secretion retention, Cardio-respiratory arrest, Death, Dyspnoea, Electroencephalogram abnormal, Intensive care, Mechanical ventilation, Resuscitation, SARS-CoV-2 test negative, Withdrawal of life support
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Respiratory failure (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-10
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Diazepam, Doxepin HCL, Duloxetine, Juven POW, Lamotri Levothyroxin, Loratadine, Melatonin, Mucus Relief, Olanzapine, Prazosin HCL, Pregabalin,
Current Illness: Recent g-tube placement, Several hospitalizations over the pas few months due to low Oxygen Levels.
Preexisting Conditions: Major depression, borderline personality disorder, Cerebral Palsy, History of dissected left carotid artery
Allergies: Penicillin
Diagnostic Lab Data: COVID-19 test administered – 1/9/2021 – Negative 2 EEGs were performed on 1/9/2021 and both indicated she had not brain activity
CDC Split Type:
Write-up: Staff member checked on her at 3am and patient stated that she felt like she couldn”t breathe. 911 was called and taken to the hospital. While in the ambulance, patient coded. Patient was given CPR and “brought back”. Once at the hospital, patient was placed on a ventilator and efforts were made to contact the guardian for end of life decisions. Two EEGs were given to determine that patient had no brain activity. Guardian, made the decision to end all life saving measures. Patient was taken off the ventilator on 1/9/2021 and passed away at 1:30am on 1/10/2021. The initial indication from the ICU doctor was the patient had a mucus plug that she couldn”t clear.
Vaccinated: | 2021-01-07 |
Onset: | 2021-01-08 |
Days after vaccination: | 1 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 025J202A / 1 | – / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death, Fall, Posture abnormal, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient was a resident in Group Home Current Medications Treatments/PRN Medications: Start Date: 04/02/14: Benztropine 2mg tab BID (8-8) 02/27/15: Midodrine (Proamatine) 5mg tab TID (8-12-8) 12/30/15: Cetirizine 10mg tab daily @8am 1
Current Illness: No Acute Illnesses
Preexisting Conditions: Diagnosis: – Impulse Control Disorder – Epilepsy – Tardive Dyskinesia – Ulcerative Proctitis and Colitis – Mental Retardation (mod) – Hammer toes (bilat.) – Dermatitis (scalp/torso) – Seborrheic keratosis of left armpit – Major Depression – Infantile Meningitis – History of Squamous Cell Carcinoma (L arm)
Allergies: Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Staff reported that patient was found Friday morning (Jan 8) sitting at a table with his head tilted forward and unresponsive to verbal or physical stimuli. Staff lowered patient to floor and started CPR. EMS was called and continued CPR at scene, however they were not able to revive patient. Patient was pronounced dead at the scene. Staff written statements following the death of patient show that he had a fall about 1 hr. prior. It is unknown if this fall contributed to patient”s death. An autopsy has been requested.
Vaccinated: | 2021-01-08 |
Onset: | 2021-01-09 |
Days after vaccination: | 1 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | D12L20A / 1 | RA / IM |
Administered by: Public Purchased by: ?
Symptoms: Autopsy, Blood test, Culture tissue specimen, Death, Toxicologic test, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-09
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Oxybutynin, Fosamax, Prednisone, Meloxicam, Eliquis, Bumetanide, Triamcinolone cream, Klor-Con, Lisinopril, Promethazine,
Current Illness: Cellulitis of left lower limb (12/2020)
Preexisting Conditions: Hypertension
Allergies: No known allergies
Diagnostic Lab Data: Postmortem examination was performed at the State Medical Examiner Office on January 10, 2021 (MEC21-0019). Tissue samples were obtained for histology and red top/tiger top/purple top tubes of blood were obtained for potential further studies. Samples of blood and vitreous humor were also obtained and submitted to AXIS Laboratories for toxicologic analysis.
CDC Split Type:
Write-up: Patient received COVID-19 (Moderna) vaccine from the Health Department on afternoon of January 8, 2021 and went to sleep approximately 2300 that night. Was found unresponsive in bed the following morning and pronounced dead at 1336 on January 9, 2021
Vaccinated: | 2021-01-04 |
Onset: | 2021-01-04 |
Days after vaccination: | 0 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | – / UNK | – / – |
Administered by: Unknown Purchased by: ?
Symptoms: Agitation, Death, Decreased appetite, Dehydration, Dyspnoea, Malaise, Pallor, Restlessness, Tachyphrenia, Unresponsive to stimuli, Vaccination complication, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-06
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ; ; ;
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021011383
Write-up: he passed away; not responsive; mind just seemed like it was racing; body was hyper dried; Restless; not feeling well; ate a bit but not much; kind of pale; Agitated; Vomiting; trouble in breathing; This is a spontaneous report from a contactable consumer (brother of the patient). A 54-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, on 04Jan2021 (at the age of 54-years-old) as a single dose for COVID-19 immunization. Medical history included diabetes and high blood pressure. Concomitant medications included metformin (MANUFACTURER UNKNOWN) taken for diabetes, glimepiride (MANUFACTURER UNKNOWN) taken for diabetes, lisinopril (MANUFACTURER UNKNOWN), and amlodipine (MANUFACTURER UNKNOWN). The patient experienced not feeling well, ate a bit but not much, kind of pale, vomiting, trouble in breathing, and agitated on 04Jan2021; body was hyper dried and restless on 05Jan2021; mind just seemed like it was racing on 06Jan2021; and not responsive and he passed away on 06Jan2021 at 10:15 (reported as: around 10:15 AM). The clinical course was reported as follows: The patient received the vaccine on 04Jan2021, after which he started not feeling well. He went right home and went to bed. He woke up and ate a bit but not much and then was kind of pale. The patient then started to vomit, which continued throughout the night. He was having trouble in breathing. Emergency services were called, and they took his vitals and said that everything was okay, but he was very agitated; reported as not like this prior to the vaccine. The patient was taken to urgent care where they gave him an unspecified steroid shot and unspecified medication for vomiting. The patient was told he was probably having a reaction to the vaccine, but he was just dried up. The patient continued to vomit throughout the day and then he was very agitated again and would fall asleep for may be 15-20 minutes. When the patient woke up, he was very restless (reported as: his body was just amped up and could not calm down). The patient calmed down just a little bit in the evening. When the patient was awoken at 6:00 AM in the morning, he was still agitated. The patient stated that he couldn”t breathe, and his mind was racing. The patient”s other brother went to him and he was not responsive, and he passed away on 06Jan2021 around 10:15 AM. It was reported that none of the symptoms occurred until the patient received the vaccine. Therapeutic measures were taken as a result of vomiting as aforementioned. The clinical outcome of all of the events was unknown; not responsive was not recovered, the patient died on 06Jan2021. The cause of death was unknown (reported as: not known by reporter). An autopsy was not performed. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.; Reported Cause(s) of Death: not responsive and he passed away
VAERS ID:935511 (history) Form:Version 2.0 Age:56.0 Sex:Female Location:South Dakota Vaccinated:2021-01-08Onset:2021-01-09 Days after vaccination:1Submitted:0000-00-00Entered:2021-01-11Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNAMODERNA / 1LA / IMAdministered by: Private Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-09 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: unknown Current Illness: none known of Preexisting Conditions: history of vaginal adenocarcinoma- removed with surgery in 2019 Allergies: latex (skin reaction) Diagnostic Lab Data: unknown CDC Split Type:Write-up: Patient received the 1st dose of Moderna and was found deceased in her home the next day. |
VAERS ID:935815 (history) Form:Version 2.0 Age:63.0 Sex:Male Location:California Vaccinated:2021-01-05Onset:2021-01-05 Days after vaccination:0Submitted:0000-00-00Entered:2021-01-11Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHEK9231 / UNK- / –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: 2021-01-05 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: Difficulty breathing, death. |
Vaccinated: | 2020-12-22 |
Onset: | 2021-01-11 |
Days after vaccination: | 20 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 039K20A / 1 | RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-11
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: See Continuation Field
Current Illness: Whiplash injury to neck. Sprain of ligaments of cervical spine
Preexisting Conditions: Septal defect (heart), chronic sinusitis
Allergies: Ceftriaxone
Diagnostic Lab Data: None associated.
CDC Split Type:
Write-up: Patient received the vaccine on 12/22/20 without complication. It was reported today that the patient was found unresponsive and subsequently expired at home on 1/11/21.
VAERS ID:937434 (history) Form:Version 2.0 Age:70.0 Sex:Male Location:Montana Vaccinated:2021-01-07Onset:2021-01-11 Days after vaccination:4Submitted:0000-00-00Entered:2021-01-12Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA025J20 / 1- / IMAdministered by: Other Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-12 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 known Preexisting Conditions: only had 1 lung Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: Pt expired due to possible cardiac arrest. Unsure if this was vaccine related. |
Vaccinated: | 2020-12-23 |
Onset: | 2021-01-04 |
Days after vaccination: | 12 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL0140 / 1 | LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-04
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown, not reported
CDC Split Type:
Write-up: unsure if related to vaccine, but was notified by her next of kin that she died on 1/4/2021. No reports of side effects or hospitalization were reported to the facility prior to the notification of death.
Vaccinated: | 2021-01-02 |
Onset: | 2021-01-07 |
Days after vaccination: | 5 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | – / 1 | – / IM |
Administered by: Other Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-07
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:
Write-up: patient reported expired 1/7/2021
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-08 |
Days after vaccination: | 3 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK9231 / 1 | – / IM |
Administered by: Public Purchased by: ?
Symptoms: Abdominal X-ray, Aneurysm, Angiogram cerebral, Arteriogram carotid, Cerebellar haemorrhage, Cerebrovascular accident, Chest X-ray, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram pelvis, Computerised tomogram spine, Computerised tomogram thorax
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-01-10
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin; vitamin D
Current Illness: none mentioned
Preexisting Conditions: no significant past medical history
Allergies: latex
Diagnostic Lab Data: CT brain head; CT cervical spine; chest xray; CT chest, abdomen, pelvis; abdominal xray; CT angiogram neck & brain
CDC Split Type:
Write-up: on 1/8/2021 17:30 patient taken to ER, cerebellar hemorrhage, stroke, aneurysm
VAERS ID:939050 (history) Form:Version 2.0 Age:32.0 Sex:Female Location:New York Vaccinated:2020-12-28Onset:2020-12-29 Days after vaccination:1Submitted:0000-00-00Entered:2021-01-12Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA039K20A / 1LA / IMAdministered by: Private Purchased by: ? Symptoms: Aphasia, Cough, Death, Endotracheal intubation, Hemiparesis, Respiratory failure, SARS-CoV-2 test positive SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-04 Days after onset: 6 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Unknown Current Illness: Unknown Preexisting Conditions: Morbid obesity and hypothyroidism Allergies: Unknown Diagnostic Lab Data: CDC Split Type:Write-up: Patient vaccinated on 12/28. Approximately one day later, develops cough and on azithromycin x 1 week. On 1/3, patient develops left-sided weakness and aphasia. Taken to the hospital, tested COVID+, required intubation — acute hypoxic respiratory failure secondary to COVID – on H&P. Patient died on 1/4/21 at 7:20am. |
Vaccinated: | 2020-12-22 |
Onset: | 2020-12-31 |
Days after vaccination: | 9 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EL1284 / 1 | – / IM |
Administered by: Work Purchased by: ?
Symptoms: Sudden cardiac death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-31
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Sudden cardiac death
VAERS ID:914805 (history) Form:Version 2.0 Age:63.0 Sex:Male Location:Illinois Vaccinated:2020-12-28Onset:2020-12-29 Days after vaccination:1Submitted:0000-00-00Entered:2020-12-30Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHEH9899 / 1LA / IMAdministered by: Other Purchased by: ? Symptoms: Death SMQs:Life Threatening? No Birth Defect? No Died? Yes Date died: 2020-12-29 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Asa-81mg, Lisinopril 10mg daily, ferrous sulfate-325, MVI with min, zyprexia-20mg, Flomax-0.4, famotidine-20mg, vit C, carbamazepine-250mg bid, Depakote-750mg bid, metformin-1000 bid, sertraline-100 bid, albuterol,buspar-10mg TID, Fibercon- Current Illness: none Preexisting Conditions: dysphagia, violent behaviors, depressive disorder, schizophrenia, aspiration, gerd, hyperlipidemia, dipolar, rectal bleeding, HTN Allergies: NKA Diagnostic Lab Data: CDC Split Type:Write-up: RESIDENT CODED AND EXPIRED |
VAERS ID:940955(history)Form:Version 2.0 Age:66.0 Sex:Female Location:New York Vaccinated:2021-01-11Onset:2021-01-11 Days after vaccination:0Submitted:0000-00-00Entered:2021-01-13Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHEL1284 / 2LA / OTAdministered by: Other Purchased by: ?
Symptoms:Autopsy, Cardiac arrest, Death, Pulse absent, Respiratory arrest, SARS-CoV-2 test negative
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), COVID-19 (broad)Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-11
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ; ; EFFEXOR; ; ABILIFY; ; CRANBERRY; ; TYLENOL; ; LASIX [FUROSEMIDE]; IPRATROPIUM/ALBUTEROL; ; SENNA [SENNA ALEXANDRINA LEAF]; POLYETHYLENE GLYCOL 3350;
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, the patient was diagnosed with COVID-19); Diastolic heart failure; Epilepsy; Morbid obesity; Pulmonary hypertension; Spinal stenosis
Allergies:
Diagnostic Lab Data: Test Date: 20210111; Test Name: pulseless; Result Unstructured Data: Test Result:pulseless; Test Date: 20210111; Test Name: breathless; Result Unstructured Data: Test Result:breathless; Test Date: 20210106; Test Name: Covid-19 PCR; Result Unstructured Data: Test Result:Negative (Nasal Swab)
CDC Split Type: USPFIZER INC2021018488Write-up: Cardiac Arrest; Patient was found pulseless and breathless 20 minutes following the vaccine administration.; Patient was found pulseless and breathless 20 minutes following the vaccine administration.; This is a spontaneous report from a contactable other healthcare professional (HCP). A 66-year-old female patient (pregnant at the time of vaccination: no) received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL1284) via intramuscular at left arm on 11Jan2021 12:15 PM at single dose for COVID-19 immunization. Medical history included diastolic CHF, spinal stenosis, morbid obesity, epilepsy, pulmonary hypertension and COVID-19 (Prior to vaccination, the patient was diagnosed with COVID-19). The patient received medication within 2 weeks of vaccination included amiodarone, melatonin, venlafaxine hydrochloride (EFFEXOR), ibuprofen, aripiprazole (ABILIFY), lisinopril, cranberry capsules, diltiazem, paracetamol (TYLENOL), famotidine, furosemide (LASIX [FUROSEMIDE]), ipratropium bromide, salbutamol sulfate (IPRATROPIUM/ALBUTEROL), buspirone, senna alexandrina leaf (SENNA [SENNA ALEXANDRINA LEAF]), polyethylene glycol 3350 and morphine. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient used took Penicillin, propranolol, quetiapine, topiramate, Lamictal and had allergy to them. Patient used took the first dose of BNT162B2 (lot number: EJ1685) via intramuscular at right arm on 21Dec2020 12:00 PM at single dose for COVID-19 immunization. Since the vaccination, the patient been tested for COVID-19 (Sars-cov-2 PCR) via nasal swab on 06Jan2021, covid test result was negative. Patient was found pulseless and breathless 20 minutes following the vaccine administration (11Jan2021 12:30 AM). MD found no signs of anaphylaxis. Patient died on 11Jan2021 12:30 AM because of cardiac arrest. No treatment received for the events. Outcome of pulseless and breathless was unknown. the autopsy was performed, and autopsy remarks was unknown. Autopsy-determined cause of death was unknown. It was reported as non-serious, not results in death, Life threatening, caused/prolonged hospitalization, disabling/Incapacitating nor congenital anomaly/birth defect.; Sender”s Comments: Based on the available information this patient had multiple underlying medical conditions including morbid obesity, diastolic CHF, epilepsy, pulmonary hypertension and COVID-19 diagnosed prior to vaccination. All these conditions more likely contributed to patients cardiac arrest resulting in death. However, based on a close temporal association (“Patient was found pulseless and breathless 20 minutes following the second dose of BNT162B2 vaccine administration, contributory role of BNT162B2 vaccine to the onset of reported events cannot be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Cardiac arrest; Autopsy-determined Cause(s) of Death: autopsy remarks was unknown. Autopsy-determined cause of death was unknown
VAERS ID:941811 (history) Form:Version 2.0 Age:56.0 Sex:Female Location:Louisiana Vaccinated:2021-01-04Onset:2021-01-11 Days after vaccination:7Submitted:0000-00-00Entered:2021-01-13Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (MODERNA)) / MODERNA011J20A / 1LA / IMAdministered by: Senior Living Purchased by: ?
Symptoms: Albumin urine present, Bacterial test positive, Chest X-ray abnormal, Death, Hypoxia, Lung infiltration, Pyrexia, Respiratory distress, Respiratory failure, SARS-CoV-2 test negative, Sepsis, Urine leukocyte esterase positive, White blood cell count normal, White blood cells urine positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Haldol 2mg TWICE DAILY, DEPAKENE 750MG THREE TIMES
Current Illness: NONE
Preexisting Conditions: HUNTINGTON”S CHOREA, HTN, HLP, HYPOTHYROID, DEPRESSION, CONSTIPATION, AND DYSPHAGIA
Allergies: NKDA & NO FOOD ALLERGIES
Diagnostic Lab Data: CXR on 1/11/21: Suspicion of minimal infrahilar infiltrates bilaterally. U/A on 1/11/21: Leuk Esterase 3+, Albumin 2+, Few Bacteria, White cells 10 CBC on 1/11/21: WBC 8.9
CDC Split Type:Write-up: Resident began having fever on 1/11/21 @0600. VS= T-102 B/P- 100/57 P- 112 RR- 24 O2 Sat 92% on RA. MD called. Rapid COVID Test was negative. CBC,CMP, U/A were ordered as well as CXR. Resident”s condition declined. At 3:00pm resident started having respiratory distress and hypoxia O2 Sat 89%. Supplemental O2/mask @ 5LPM. Neb TX, EKG, and Rocephin 1 GM ordered. Condition worsened. Resident sent to nearest ER for evaluation. Later in the evening the staff AT Medical Center called to inform staff that resident had expired @ 2230 as a result of Respiratory Failure and Sepsis.
Vaccinated: | 2021-01-02 |
Onset: | 2021-01-08 |
Days after vaccination: | 6 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-13 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | FL0142 / 1 | LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Dyspnoea, Livedo reticularis, Pain, Pulse absent, Tremor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Parkinson-like events (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), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ativen, Butrans Patch, Tylenol, Potassium Citrate-Citric Acid
Current Illness: Medical diagnosis: quadriplegia, Atherosclerotic heart disease
Preexisting Conditions: see #11.
Allergies: Amoxicillin, Clavulanic Acid, Codeine, Morphine, Pencillin
Diagnostic Lab Data:
CDC Split Type:
Write-up: No adverse effects from vaccination seen on 1/2/21. On 1/6/21 resident was seen by Dr and her baclofen pump was refilled with 20 ml Baclofen 4,000mcg/ml. ITB Rate increased by 6% to 455.5 mcg/day simple continuous rate over 3 days. On 1/8/21 at 0615 resident was shaking, lower extremities mottled, Sa02 70%, pulse 45. Oxygen started at 2 L/m per NC. At 0715 her primary physician was notified as well as her daughter. Oxygen increased to 4 L/min, sats at 83%. SOA noted, reported all over pain. At 0850 when they attempted to reposition the resident, she was not responsive. Licensed nurse assessed her and no heartbeat heard or pulse found.
VAERS ID:942106 (history) Form:Version 2.0 Age:54.0 Sex:Male Location:California Vaccinated:2021-01-08Onset:2021-01-09 Days after vaccination:1Submitted:0000-00-00Entered:2021-01-13Vaccination / ManufacturerLot / DoseSite / RouteCOVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECHUNKNOWN / UNK- / –Administered by: Private Purchased by: ? Symptoms: Abdominal pain, Cardiac arrest, Chest pain, Pain, Pulse absent, Resuscitation SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad)Life Threatening? No Birth Defect? No Died? Yes Date died: 2021-01-09 Days after onset: 0 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:Write-up: 54 y/o M with PMH of HTN, HLD, Alcoholic Cirrhosis, Aortic Valve Stenosis, and angina BIBA as a Medical Alert for cardiac arrest noted PTA. Per EMS, the patient called because he was having constant, diffuse abdominal pain x 1 day that radiated to his chest. On scene, the patient had a witnessed arrest with EMS starting CPR. He was given 3 rounds of epi without ROSC. Pt had no associated shockable rhythm. Of note, pt”s wife, had noted pt had received covid vaccine the prior day. |