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From the 1/7/2022 release of VAERS data:

Found 21,745 cases where Vaccine targets COVID-19 (COVID19) and Patient Died

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1260474 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-03
Onset:2021-04-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042723 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiogenic shock, Death
SMQs:, Cardiac failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow)

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: FUROSEMIDE TEVA; NORVASC; NEURABEN; PANTORC; CARDURA; KAYEXALATE; ZEMPLAR; QUETIAPINA TEVA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Death; Shock cardiogenic; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 19-Apr-2021 and was forwarded to Moderna on 19-Apr-2021. This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (Death) and CARDIOGENIC SHOCK (Shock cardiogenic) in a 77-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 300042723) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included FUROSEMIDE (FUROSEMIDE TEVA) from 23-Mar-2021 to 05-Apr-2021, AMLODIPINE BESILATE (NORVASC) from 23-Mar-2021 to 05-Apr-2021, BENMETIAMINE, CYANOCOBALAMIN, PYRIDOXINE HYDROCHLORIDE (NEURABEN) from 23-Mar-2021 to 05-Apr-2021, PANTOPRAZOLE SODIUM SESQUIHYDRATE (PANTORC), DOXAZOSIN MESILATE (CARDURA) from 23-Mar-2021 to 05-Apr-2021, SODIUM POLYSTYRENE SULFONATE (KAYEXALATE) from 23-Mar-2021 to 05-Apr-2021, PARICALCITOL (ZEMPLAR) from 23-Mar-2021 to 05-Apr-2021 and QUETIAPINE FUMARATE (QUETIAPINA TEVA) from 23-Mar-2021 to 05-Apr-2021. On 03-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) .5 dosage form in total. On 05-Apr-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced DEATH (Death) (seriousness criterion death) and CARDIOGENIC SHOCK (Shock cardiogenic) (seriousness criterion medically significant). The patient died on an unknown date. It is unknown if an autopsy was performed. At the time of death, CARDIOGENIC SHOCK (Shock cardiogenic) outcome was unknown. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Treatment not provided. This is a case of death in a 77-year-old male subject with unknown medical history, who died on an unknown date after receiving the vaccine. Very limited information has been provided at this time. No follow up is possible.; Sender''s Comments: This is a case of death in a 77-year-old male subject with unknown medical history, who died on an unknown date after receiving the vaccine. Very limited information has been provided at this time. No follow up is possible.


VAERS ID: 1260490 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-12
Onset:2021-03-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Death, Delusion, Disorientation, Hallucination, auditory, Hallucination, visual, Investigation, Pain, Somnolence, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 24
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLOPURINOL; ELIQUIS; SEROQUEL; LASIX [FUROSEMIDE]; LANOXIN; MICARDIS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cardiac failure; Chronic atrial fibrillation; COPD; Dysphoria; Hypertension arterial; Hyperuricaemia
Allergies:
Diagnostic Lab Data: Test Name: Impact on quality of life; Result Unstructured Data: Test Result:10/10
CDC Split Type: ITPFIZER INC2021398768

Write-up: the patient died; speech disorder, delusions and sound and visual hallucinations;; disorientation; sleepy; pain; speech disorder, delusions and sound and visual hallucinations;; speech disorder, delusions and sound and visual hallucinations; speech disorder, delusions and sound and visual hallucinations;; This is a spontaneous report from a contactable consumer downloaded from the Agency Regulatory Authority- WEB. The regulatory authority number is IT-MINISAL02-712396. An 88-year-old female patient received her first dose of BNT162B2 (COMIRNATY, lot number and expiration date were unknown) at the age of 88-years-old, intramuscular in left arm (also reported as left shoulder) on 12Mar2021 at 19:45 at single dose COVID-19 immunisation. Medical history included hyperuricaemia, chronic atrial fibrillation, dysphoria, hypertension arterial, cardiac failure, and COPD. Concomitant medications included allopurinol tablet for hyperuricaemia, apixaban (ELIQUIS) tablet for chronic atrial fibrillation, quetiapine fumarate (SEROQUEL) tablet for dysphoria, furosemide (LASIX) tablet for hypertension arterial, digoxin (LANOXIN) tablet for cardiac failure, and telmisartan (MICARDIS) tablet for hypertension arterial. The patient experienced speech disorder on 15Mar2021; and delusions, sound and visual hallucinations on an unspecified date in 2021. The course of events was reported as follows: Following the first dose of COMIRNATY vaccine, the patient was sleepy for two days since 12Mar2021, and upon awakening on the third day, 15Mar2021, she experienced disorientation and difficulty speaking. While the disorientation subsided, the difficulties in speaking fluctuated until the disorientation worsened to the point of not recognizing her children, and visual and auditory hallucinations appeared (animals on the floor or imaginary interlocutors were visualized and talks were held with the aforementioned imaginary subjects) on an unspecified in 2021. For two days these disturbances continued day and night, continuously. Sometimes the speech was clearly understandable (during the waking state), sometimes, probably in the most sleepy stages, the words were slurred and possibly incomprehensible. The patient took quetiapine 50 mg daily as directed by the physician. In the last few days, the patient was no longer able to express herself verbally, she could only express the pain (on an unspecified date in 2021) by moaning and by facial expressions; on 06Apr2021 the patient died. Impact on quality of life was reported as 10/10 on unspecified date. Therapeutic measures were taken as a result of the events speech disorder, delusion, sound and visual hallucinations, and disorientation. The patient died on 06Apr2021. The cause of death was unknown. It was not reported if an autopsy was performed. The outcome of the event pain was unknown and not recovered for all other events. The events speech disorder, delusion and sound and visual hallucinations were reported as serious, causing disability. Reporter''s comment: atrial fibrillation, arterial hypertension, COPD. Sender''s Comment: 02Apr2021 Regulatory Authority: requests for further information from the reporter such as the lot, the clinical history, the possible resolution of the adverse reaction. Information about the lot/batch number cannot be obtained.; Reporter''s Comments: atrial fibrillation, arterial hypertension, COPD; Reported Cause(s) of Death: the patient died


VAERS ID: 1260491 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000494 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Cyanosis, Death, Deep vein thrombosis, Oedema, Pain in extremity, Pyrexia, Ultrasound Doppler, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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: FUROSEMIDE; RAMIPRIL; GLYCERYL TRINITRATE; POTASSIUM CANRENOATE; IVABRADINE; LOPRESOR [METOPROLOL FUMARATE]
Current Illness: Angina pectoris; Cardiac failure; Hyperaldosteronism; Hypertension arterial
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210405; Test Name: body temperature; Result Unstructured Data: 37.2 degree celsius; Test Name: Ultrasound Doppler; Test Result: Inconclusive ; Result Unstructured Data: not provided
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death), DEEP VEIN THROMBOSIS, PAIN IN EXTREMITY, OEDEMA , PYREXIA , CYANOSIS and VOMITING in a 93-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3000494) for COVID-19 vaccination. Concurrent medical conditions included Cardiac failure, Hypertension arterial, Angina pectoris and Hyperaldosteronism. Concomitant products included GLYCERYL TRINITRATE and IVABRADINE for Angina pectoris, FUROSEMIDE for Cardiac failure, POTASSIUM CANRENOATE for Hyperaldosteronism, RAMIPRIL and METOPROLOL FUMARATE (LOPRESOR [METOPROLOL FUMARATE]) for Hypertension arterial. On 01-Apr-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form in total. On 05-Apr-2021, the patient experienced DEEP VEIN THROMBOSIS (seriousness criterion medically significant), PAIN IN EXTREMITY (seriousness criterion medically significant), OEDEMA (seriousness criterion medically significant), PYREXIA (seriousness criterion medically significant), CYANOSIS (seriousness criterion medically significant) and VOMITING (seriousness criterion medically significant). The patient died on 06-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, DEEP VEIN THROMBOSIS, PAIN IN EXTREMITY, OEDEMA, PYREXIA , CYANOSIS and VOMITING outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 05-Apr-2021, Body temperature: 37.2 degree celcius (abnormal) 37.2 degree celsius. On an unknown date, Ultrasound Doppler: not provided (Inconclusive) not provided. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. The action taken with mRNA-1273 in response to the event was not applicable. No treatment information was provided. Company comment: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Event of death added as none of the reported events are likely to directly result in death but could have contributed to the fatal outcome. Reporter did not allow further contact; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Event of death added as none of the reported events are likely to directly result in death but could have contributed to the fatal outcome.; Reported Cause(s) of Death: Death


VAERS ID: 1260497 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042723 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: ALPRASOX; NEBIVOLOL; SIMVASTATIN; CARDIRENE; PALEXIA; COTAREG
Current Illness: Glaucoma; Hypertension arterial; IHD; Osteoporosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: 05/03/2021; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of VOMITING (05/03/2021) in a 92-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 300042723) for COVID-19 vaccination. Concurrent medical conditions included Osteoporosis, IHD, Hypertension arterial and Glaucoma. Concomitant products included ALPRASOX, NEBIVOLOL, SIMVASTATIN, ACETYLSALICYLATE LYSINE (CARDIRENE), TAPENTADOL HYDROCHLORIDE (PALEXIA) and HYDROCHLOROTHIAZIDE, VALSARTAN (COTAREG) for an unknown indication. On 04-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form in total. On 04-Mar-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced VOMITING (05/03/2021) (seriousness criterion death). The patient died on 05-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Company comment: This case of a 92-year-old female patient who experienced vomiting on the same day after the administration of mRNA-1273 and died the following day. Based on the information which shows a strong temporal association between the onset of vomiting and the fatal outcome, a causal association cannot be excluded.; Sender''s Comments: This case of a 92-year-old female patient who experienced vomiting on the same day after the administration of mRNA-1273 and died the following day. Based on the information which shows a strong temporal association between the onset of vomiting and the fatal outcome, a causal association cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1260500 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001414 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cyanosis, Hyperpyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-09
   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: ITMODERNATX, INC.MOD20210

Write-up: This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of CYANOSIS and CHILLS in an 85-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001414) for COVID-19 vaccination. No Medical History information was reported. On 08-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form(s) in total. On 08-Apr-2021, the patient experienced CYANOSIS (seriousness criterion death), HYPERPYREXIA (seriousness criterion death) and CHILLS (seriousness criterion death). The patient died on 09-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications reported by investigator. Treatment was not reported. Company Comment: Very limited information regarding these events has been provided at this time. No follow up is possible.; Sender''s Comments: Very limited information regarding these events has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1260506 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-03-25
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001442 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   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:
Current Illness: Chronic kidney disease (Chronic renal insufficiency)
Preexisting Conditions: Medical History/Concurrent Conditions: End ileostomy
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Death; Thoracic pain; This case was received via an unknown source (no reference has been entered for a health authority or Regulatory Authority) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death) and CHEST PAIN (Thoracic pain) in an 87-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001442) for COVID-19 vaccination. The patient''s past medical history included End ileostomy. Concurrent medical conditions included Chronic kidney disease (Chronic renal insufficiency). On an unknown date, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) .5 milliliter in total. On 25-Mar-2021, the patient experienced DEATH (Death) (seriousness criterion death) and CHEST PAIN (Thoracic pain) (seriousness criterion medically significant). On 06-Apr-2021, CHEST PAIN (Thoracic pain) outcome was unknown. The patient died on 06-Apr-2021. The reported cause of death was Thoracic pain. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment drug was reported. The patient underwent ileostomy (25 Mar 2021 to 06 Apr 2021). Action taken with mRNA-1273 in response to the event was not applicable. This is a case of death in a 87-year-old female subject with a medical history of chronic renal insufficiency, who died one day after receiving the vaccine. Very limited information has been provided at this time. No follow up is possible.; Sender''s Comments: This is a case of death in a 87-year-old female subject with a medical history of chronic renal insufficiency, who died one day after receiving the vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: Thoracic pain


VAERS ID: 1260508 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-31
Onset:2021-04-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001414 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   Days after onset: 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: Medical History/Concurrent Conditions: Hypertensive heart disease ; Ischemic leukoencephalopathy ; Transient ischaemic attacks
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of PYREXIA and ASTHENIA in a 93-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001414) for COVID-19 vaccination. The patient''s past medical history included Hypertensive heart disease , Ischemic leukoencephalopathy and Transient ischaemic attacks . On 31-Mar-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 01-Apr-2021, the patient experienced PYREXIA (seriousness criterion death) and ASTHENIA (seriousness criterion death). The patient died on 02-Apr-2021. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided. Treatment information was not provided. Sender''s Case Number 713706 Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, and excluding other etiologies, a causal relationship with the product use cannot be excluded.; Sender''s Comments: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, and excluding other etiologies, a causal relationship with the product use cannot be excluded.; Reported Cause(s) of Death: see case description.


VAERS ID: 1260509 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-19
Onset:2021-03-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000494 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Malaise, Oxygen saturation decreased
SMQs:, Dementia (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes mellitus; Ischaemic heart disease ("cardiopatia ischemica (pregressa PTCA)")
Preexisting Conditions: Medical History/Concurrent Conditions: Adenocarcinoma of colon ("pregresso K del colon"); Angina pectoris ("episodi anginosi in soggetto diabetico"); Percutaneous transluminal coronary angioplasty
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Oxygen saturation low; General malaise; Fuzzy head; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 21-Apr-2021 and was forwarded to Moderna on 21-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of OXYGEN SATURATION DECREASED (Oxygen saturation low), MALAISE (General malaise) and FEELING ABNORMAL (Fuzzy head) in an 81-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3000494) for COVID-19 vaccination. The patient''s past medical history included Adenocarcinoma of colon ("pregresso K del colon"), Percutaneous transluminal coronary angioplasty and Angina pectoris ("episodi anginosi in soggetto diabetico"). Concurrent medical conditions included Ischaemic heart disease ("cardiopatia ischemica (pregressa PTCA)") and Diabetes mellitus. On 19-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 21-Mar-2021, the patient experienced OXYGEN SATURATION DECREASED (Oxygen saturation low) (seriousness criterion death), MALAISE (General malaise) (seriousness criterion death) and FEELING ABNORMAL (Fuzzy head) (seriousness criterion death). The patient died on 21-Mar-2021. The reported cause of death was Oxygen saturation low, General malaise and Fuzzy head. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication was not reported. Company Comment This is a case of death of an 81-year-old female patient 2 days post mRNA-1273 vaccination. Patient experienced oxygen saturation low, general malaise and fuzzy head prior to death. Based on temporal association between the use of the product and onset of oxygen saturation lo, general malaise and fuzzy head, a causal relationship cannot be excluded. The primary cause of death was not provided and hence cannot be assessed. No further information is expected.; Sender''s Comments: This is a case of death of an 81-year-old female patient 2 days post mRNA-1273 vaccination. Patient experienced oxygen saturation low, general malaise and fuzzy head prior to death. Based on temporal association between the use of the product and onset of oxygen saturation lo, general malaise and fuzzy head, a causal relationship cannot be excluded. The primary cause of death was not provided and hence cannot be assessed. No further information is expected.; Reported Cause(s) of Death: Oxygen saturation low; general malaise; fuzzy head


VAERS ID: 1260511 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-25
Onset:2021-03-31
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001442 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pseudomonas infection, Urine output decreased
SMQs:, Acute renal failure (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-04
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Infection Pseudomonas aeruginosa; Urinary output diminished; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 23-Apr-2021 and was forwarded to Moderna on 23-Apr-2021. This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of PSEUDOMONAS INFECTION (Infection Pseudomonas aeruginosa) and URINE OUTPUT DECREASED (Urinary output diminished) in a 90-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001442) for COVID-19 vaccination. No Medical History information was reported. On 25-Mar-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) .5 milliliter in total. On 31-Mar-2021, the patient experienced PSEUDOMONAS INFECTION (Infection Pseudomonas aeruginosa) (seriousness criterion death) and URINE OUTPUT DECREASED (Urinary output diminished) (seriousness criterion death). The patient died on 04-Apr-2021. The reported cause of death was Infection Pseudomonas aeruginosa and Urinary output diminished. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Action taken with mRNA-1273 in response to the event was not applicable No relevant concomitant medications were reported No treatment information was provided. Company comment: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Awaiting translation of SD. Both events reported as resulting in death in SD and conservatively retained as serious / fatal; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Awaiting translation of SD. Both events reported as resulting in death in SD and conservatively retained as serious / fatal; Reported Cause(s) of Death: Infection Pseudomonas aeruginosa; Urinary output diminished


VAERS ID: 1260513 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-07
Onset:2021-04-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ET7205 / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LANSOPRAZOLE SANDOZ; IMBRUVICA; BACTRIM; ACICLOVIR
Current Illness: Chronic lymphatic leukemia (Chronic lymphatic leukemia patient with pulmonary infiltrates being treated with Imbruvica); Pulmonary infiltration (being treated with Imbruvica)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITPFIZER INC2021435831

Write-up: Death; This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority (RA)-WEB IT-MINISAL02-715352. A 50-years-old male patient received bnt162b2 (COMIRNATY), intramuscular at left arm on 07Apr2021 11:45 as first dose (Batch/Lot Number: ET7205; exp date 31Jul2021) as 0.3 mL, single for SARS-CoV-2 vaccination. Medical history included ongoing chronic lymphocytic leukaemia described as Chronic lymphatic leukemia patient with pulmonary infiltrates being treated with Imbruvica. Concomitant medications included lansoprazole (LANSOPRAZOLO SANDOZ GMBH); ibrutinib (IMBRUVICA) taken for pulmonary infiltrates since and unknown date and ongoing; sulfamethoxazole, trimethoprim (BACTRIM), ACICLOVIR. The patient experienced death on 11Apr2021. It was not reported if an autopsy was performed. Reporter comment: The patient administers the FIRST dose of the vaccine on 07Apr2021, 11:45 am, left arm. lot: ET7205 expiry: 31Jul2021 Patient suffering from Chronic Lymphatic Leukemia with pulmonary infiltrates. He takes Imbruvica, Bactrim, Lansoprazole and Aciclovir without reporting the Company (from the poorly understood writing he could also take Adenuric). The patient died at home and therefore the supporting clinical report is not available. No follow-up attempts possible. No further information expected. ; Reporter''s Comments: The patient administers the FIRST dose of the vaccine on 07Apr2021, 11:45 am, left arm. lot: ET7205 expiry: 31Jul2021 Patient suffering from Chronic Lymphatic Leukemia with pulmonary infiltrates. He takes Imbruvica, Bactrim, Lansoprazole and Aciclovir without reporting the Company (from the poorly understood writing he could also take Adenuric). The patient died at home and therefore the supporting clinical report is not available ; Reported Cause(s) of Death: Death


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