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

Found 6,558 cases where Onset Interval is 0 or 1 or 2 and Vaccine is COVID19 and Patient Died

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Case Details

This is page 34 out of 656

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VAERS ID: 1006640 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-02-03
Onset:2021-02-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 PFIZER / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acidosis, Anaemia, Analgesic drug level decreased, Anxiety, Bacterial test negative, Basophil percentage increased, Bilirubin urine, Blood bicarbonate decreased, Blood gases, Blood magnesium decreased, Blood pH decreased, Blood smear test, Blood urine absent, Bradycardia, Brain oedema, Cardiac arrest, Cardio-respiratory arrest, Chromaturia, Computerised tomogram head abnormal, Crystal urine absent, Culture urine, Death, Drug screen negative, Endotracheal intubation, Eosinophil percentage increased, Fibrin D dimer increased, Gastrointestinal haemorrhage, Glucose urine absent, Haematocrit decreased, Haemoglobin decreased, Head discomfort, Human chorionic gonadotropin negative, Hypoxia, International normalised ratio increased, Lymphocyte percentage decreased, Mean cell haemoglobin decreased, Mean cell volume decreased, Mechanical ventilation, Monocyte percentage decreased, Musculoskeletal stiffness, Neutrophil count normal, Nitrite urine absent, PCO2 normal, PO2 normal, Platelet count decreased, Poisoning, Protein urine absent, Prothrombin time prolonged, Pulse absent, Pulseless electrical activity, Red blood cell count decreased, Red blood cell nucleated morphology, Red blood cells urine positive, Red cell distribution width normal, Resuscitation, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Seizure like phenomena, Specific gravity urine increased, Specific gravity urine normal, Sulphur dioxide test, Syncope, Troponin I increased, Urinary sediment present, Urine abnormality, Urine ketone body absent, Urine leukocyte esterase, Urobilinogen urine decreased, White blood cell count normal, White blood cells urine positive, pH urine normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Tumour lysis syndrome (broad), Proteinuria (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Naltrexone 25mg PO daily, chlordiazepoxide 25mg was 2/4 at 1:25pm for CIWA 9
Current Illness: Alcohol use disorder, facial laceration, alcohol intoxication, secondary syphillis
Preexisting Conditions: Alcohol use disorder
Allergies: NKDA
Diagnostic Lab Data: UR COLOR Yellow [3873] 02/05/21 01:16 UR CLARITY HAZY [3873] 02/05/21 01:16 UR SPECIFIC GRAVITY 1.010 1.001 - 1.035 [3873] 02/05/21 01:16 URINE PH 7.0 UNITS 5.0 - 9.0 [3873] 02/05/21 01:16 UR PROTEIN 100 mg/dL "Neg " [3873] 02/05/21 01:16 UR GLUCOSE 150 mg/dl "Neg " [3873] 02/05/21 01:16 UR KETONES NEG mg/dL "Neg " [3873] 02/05/21 01:16 UR BILIRUBIN NEG mg/dL "Neg " [3873] 02/05/21 01:16 UR BLOOD MOD mg/dl "Neg " [3873] 02/05/21 01:16 UR NITRITE NEG mg/dL "Neg " [3873] 02/05/21 01:16 UR UROBILINGEN NEG L mg/dL "<2.0" [3873] 02/05/21 01:16 UR L.ESTERASE NEG "NEG" [3873] 02/05/21 01:16 RBC/HPF 262 /HPF [3873] 02/05/21 01:16 WBC/HPF 5 /HPF [3873] 02/05/21 01:16 UR EPITHELIAL CELLS [none] /HPF [3873] 02/05/21 01:16 UR-BACTERIA [none] /HPF [3873] 02/05/21 01:16 WBC CLUMPS [none] /HPF [3873] 02/05/21 01:16 UR-TRIPLE PHOS CRYSTALS [none] [3873] 02/05/21 01:16 UR-CA+OXALATE CRYSTALS [none] [3873] 02/05/21 01:16 UR-URIC ACID CRYSTALS [none] [3873] 02/05/21 01:16 UR-AMORPHOUS SEDIMENT RARE [3873] 02/05/21 01:16 UR-BUDDING YEAST [none] [3873] 02/05/21 01:16 URINE HCG Neg [3873] 02/05/21 01:16 Internal QC Hcg PASS [3873] 02/05/21 01:16 Comment: rare MUCOUS Urine sent for culture. Res Site Test name Result Flg Units Ref. range Code Result Dt/Time Cannabinoids UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 50 ng/mL" Methadone, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 200 ng/mL" Cocaine Screen, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 150 ng/mL" Buprenorphine Screen, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 10 ng/mL" Internal QC Ur Tox Screen PASS [3873] 02/05/21 01:32 Amphetamines, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at 500 ng/dL" Barbiturates, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 200 ng/mL" Benzodiazepines, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 150 ng/mL" Methamphetamine, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 500 ng/mL" Opiates, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 100 ng/mL" Oxycodone, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 100 ng/mL" Phencyclidine Screen, UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 25 ng/mL" Tricyclic Antidepressants,UR NEG "Neg" - [3873] 02/05/21 01:32 "Positive at 300 ng/mL" Propoxyphene, UR NEG "NEG" - [3873] 02/05/21 01:32 "Positive at Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _SARS-CoV-2 NEGATIVE [3873] 02/04/21 23:49 Eval: Positive - The 2019 novel coronavirus (SARS-CoV-2) target nucleic acids are detected. Eval: Eval: Presumptive Positive - The 2019 novel coronavirus (SARS-CoV-2) target nucleic Eval: acids may be present. Sample is retested. For samples Eval: with repeated presumptive positive result, additional Eval: confirmatory testing may be conducted to differentiate Eval: between SARS-CoV-2 and SARS-CoV-1 or other Sarbecovirus Eval: currently unknown to infect humans, for epidemiological Eval: purposes or clinical management. Eval: Eval: Negative - The 2019 novel coronavirus (SARS-CoV-2) target nucleic acids are not detected. Internal QC SARSCOV2 Valid [3873] 02/04/21 23:49 Test name Result Flg Units Ref. range Code Result Dt/Time SO2 88.8 L % 90.0 - 100.0 [3873] 02/04/21 21:58 PH, BLOOD 7.16 L* 7.35 - 7.45 [3873] 02/04/21 21:58 PCO2 34.7 mmHg 30 - 40 [3873] 02/04/21 21:58 PO2 68 mmHg 58 - 70 [3873] 02/04/21 21:58 HCO3 12.6 L mmol/L 18.0 - 24.0 [3873] 02/04/21 21:58 Base Excess -16.8 L mmol/L <3.0 [3873] 02/04/21 21:58 TCO2 34.7 H mmol/L 19.0 - 25.0 [3873] 02/04/21 21:58 SAT 88.8 L % 90 - 99 [3873] 02/04/21 21:58 Oxy Hgb 87.0 % [3873] 02/04/21 21:58 Patient Temperature 92.0 Deg Far [3873] 02/04/21 21:58 COHB% 0.6 % 0.0 - 10.0 [3873] 02/04/21 21:58 METHB 1.5 H % <0.5 [3873] 02/04/21 21:58 Comment: AC RR 28 VT 400 FIO2 100 PEEP +5 Test name Result Flg Units Ref. range Code Result Dt/Time MAGNESIUM-09 0.9 L mg/dL 1.6 - 2.6 [3873] 02/04/21 22:20 Test name Result Flg Units Ref. range Code Result Dt/Time SALICYLATE-09 <1 mg/dL [3873] 02/04/21 22:20 ACETAMINOPHEN-09 <5 L mcg/mL 5 - 200 [3873] 02/04/21 22:20 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time TROPONIN I-09 2.6 H* ng/mL 0.0 - 0.3 [3873] 02/04/21 22:19 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time D-DIMER (TOP) $g5250 H ng/mL 0 - 230 [3873] 02/05/21 00:10 Eval: The HemosIL D Dimer assay is cleared by the FDA for 100% negative predictive value Eval: for results <230 ng/mL DDU, when used in conjunction with clinical pre-test Eval: assessment for the purpose of ruling out Deep Vein Trombosis (DVT) and/or Eval: Pulmonary Embolism (PE). Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _PT (TOP) 29.4 H sec 9.8 - 12.8 [3873] 02/04/21 22:20 _INR (TOP) 2.58 H 0.85 - 1.11 [3873] 02/04/21 22:20 name Result Flg Units Ref. range Code Result Dt/Time WBC-XE 5.70 10*3/uL 4.74 - 10.94 [3873] 02/05/21 00:30 RBC-XE 1.83 L M/uL 4.32 - 5.85 [3873] 02/05/21 00:30 HGB-XE 5.1 L* g/dL 12.6 - 17.3 [3873] 02/05/21 00:30 HCT-XE 18.6 L* % 38.2 - 52.4 [3873] 02/05/21 00:30 MCV-XE 101.6 H fL 81.7 - 96.6 [3873] 02/05/21 00:30 MCH-XE 27.9 pg 26.7 - 32.2 [3873] 02/05/21 00:30 MCHC-XE 27.4 L g/dL 31.4 - 34.7 [3873] 02/05/21 00:30 PLT-XE 37 L 10*3/uL 125 - 400 [3873] 02/05/21 00:30 MPV-XE 10.6 fL 8.7 - 11.8 [3873] 02/05/21 00:30 NEUT% 74.2 % 47.2 - 74.4 [3873] 02/05/21 00:30 LYMPH% 20.0 % 17.9 - 42.6 [3873] 02/05/21 00:30 MONO% 1.2 L % 3.0 - 9.0 [3873] 02/05/21 00:30 EO% 0.7 % 0.0 - 4.6 [3873] 02/05/21 00:30 BASO% 0.2 % 0.0 - 1.1 [3873] 02/05/21 00:30 NRBC 0.5 /100WBC 0.0 - 1.0 [3873] 02/05/21 00:30 IM GRAN% 3.7 H % 0.0 - 1.0 [3873] 02/05/21 00:30 RDW-XE 14.9 % 12.2 - 15.1 [3873] 02/05/21 00:30 NEUT# 4.24 10*3/uL 1.56 - 6.13 [3873] 02/05/21 00:30 LYMPH# 1.14 L 10*3/uL 1.18 - 3.74 [3873] 02/05/21 00:30 MONO# 0.07 L 10*3/uL 0.24 - 0.86 [3873] 02/05/21 00:30 EO# 0.04 10*3/uL 0.04 - 0.36 [3873] 02/05/21 00:30 BASO# 0.01 10*3/uL 0.01 - 0.08 [3873] 02/05/21 00:30 IG# 0.21 10*3/uL [3873] 02/05/21 00:30 NRBC# 0.03 H 10*3/uL 0.00 - 0.01 [3873] 02/05/21 00:30 SEGS 72 % 55 - 75 [3873] 02/05/21 00:30 BANDS 9 H % 0 - 3 [3873] 02/05/21 00:30 LYMPHS 14 L % 20 - 35 [3873] 02/05/21 00:30 MONOS 1 L % 2 - 8 [3873] 02/05/21 00:30 EOS 1.0 % 1.0 - 4.0 [3873] 02/05/21 00:30 META 3.0 H % <0.0 [3873] 02/05/21 00:30 Reactive Lymphs 3 #/100 WBC [3873] 02/05/21 00:30 NUCLEATED RBC/100WBC 1 #/100 WBC [3873] 02/05/21 00:30 MICROCYTOSIS 1+ [3873] 02/05/21 00:30 HYPOCHROMIA 1+ [3873] 02/05/21 00:30 PLT SMEAR EST Reduced [3873] 02/05/21 00:30 RBC COLOR/SIZE ABNORMAL [3873] 02/05/21 00:30 Comment: Notified/Readback Rec''d: PHARM/ED/2.4.21@2159/DD Verified by Repeat Analysis. NO Platelet Clumps Present NO Cells Resembling Immunoblasts Are Present PLATELET ESTIMATE= 36,000 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _CALCULATED OSMOLALITY 306 H mOsm/kg 275 - 295 [3873] 02/04/21 22:19 Eval: Neonatal: may be as low as 266 Eval: $g60 yrs old: 280 - 301 ALCOHOL-09 <10 L mg/dL "<10" [3873] 02/04/21 22:19 LIPASE-09 26 U/L 13 - 60 [3873] 02/04/21 22:19 T BILI-19 0.3 mg/dL 0.1 - 1.2 [3873] 02/04/21 22:19 Eval: Per manufactures instructions, intereferance substance of IgG $g28 gm/L Eval: may affect Total Bilirubin results. Clincal judgement is recommended. No Eval: significant interference was shown in the bilirubin concentration Eval: ranges $g5.9 mg/dL, medical risk for the newborn population is most Eval: unlikely. GLUCOSE-RANDOM-09 101.0 mg/dL 74.0 - 106.0 [3873] 02/04/21 22:19 Eval: NEONATES: 40 - 60 mg/dL Eval: CHILDREN: 60 - 100 mg/dL BUN-09 3.0 L mg/dl 6.0 - 20.0 [3873] 02/04/21 22:19 Eval: 18 - 60 year old = 6-20 mg/dL Eval: 60 - 90 year old = 8-23 mg/dL CREATININE <0.5 L mg/dL 0.5 - 1.5 [3873] 02/04/21 22:19 SODIUM-09 148.0 H mEQ/L 136.0 - 145.0 [3873] 02/04/21 22:19 POTASSIUM-09 1.5 L* mEQ/L 3.5 - 5.1 [3873] 02/04/21 22:19 Eval: PLASMA reference range: 3.4 - 4.5 mmol/L CHLORIDE-09 134.3 H mEQ/L 98.0 - 107.0 [3873] 02/04/21 22:19 CO2-09 5.0 L* mEQ/L 22.0 - 29.0 [3873] 02/04/21 22:19 ANION GAP-09 9.00 0.00 - 14.00 [3873] 02/04/21 22:19 CALCIUM-09 2.8 L* mg/dL 8.6 - 10.2 [3873] 02/04/21 22:19 T PROTEIN-09 1.5 L gm/dL 6.6 - 8.7 [3873] 02/04/21 22:19 ALBUMIN-09 0.7 L gm/dL 3.5 - 5.2 [3873] 02/04/21 22:19 ALK PHOS-09 43.0 IU/L 37.0 - 108.0 [3873] 02/04/21 22:19 Eval: CHILDREN: Eval: <1 day old: <260 U/L Eval: 6 days-6 months: <467 U/L Eval: 1-3 yrs: <292 U/L Eval: 1-12 years: <312 U/L Eval: 13-17 yrs(f): <195 U/L Eval: 13-17 yrs(m): <406 U/L AST-09 463.0 H IU/L 10.0 - 32.0 [3873] 02/04/21 22:19 ALT-09 89.0 H IU/L 10.0 - 33.0 [3873] 02/04/21 22:19 ESTIMATED GFR N/A mL/min [3873] 02/04/21 22:19 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time LACTATE-09 70.7 H* mg/dL 4.5 - 19.8 [3873] 02/04/21 22:02 Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _ABO Group A [3873] 02/04/21 22:39 _Rh Positive [3873] 02/04/21 22:39 Antibody Screen Negative [3873] 02/04/21 22:39
CDC Split Type:

Write-up: In discussion with Dr., medical director at Detox, she arrived night of 2/3/21 was quite intoxicated so was not going through any withdrawal. She was getting vitals and CIW checked regularly. First dose of chlordiazepoxide 25mg was 2/4 at 1:25pm for CIWA 9. She had repeat vitals at 5:50pm, CIWA 1, vitals: P 67, 118/79, 94% on RA, T 98.3. she had complained of some "pressure in her head" and feeling anxious, but otherwise denied other complaints. she was talking with others in the group, then other patients report she suddenly started having seizure like activity around 6:45pm, med techs came to help and found her stiff, gurgling. they tried to get vitals on her, called 911, noticed that at 6:54pm she had lost a pulse and they started CPR. paramedics arrived at 7:08pm and she was brought to ED. Pt BIBA in cardiac arrest. Pt was at Detox Center when she was reported to have seizure-like activity followed by collapse. She was found to be pulseless and CPR initiated by staff members. EMS arrived and performed approx 15 min of CPR and gave pt epi x 3 and bicarb. No shocks administered but they did not report a rhythm. In the emergency room the patient arrived and was found to be pulseless with PEA arrest, CPR was initiated, patient was intubated. ROSC ultimately achieved, patient remained very acidotic despite ventilator adjustment, head CT revealed cerebral edema. Pt also found to be profoundly anemic with a hemoglobin of 5 and platelets of 37, she was thought to be GI bleeding so medications for this were initiated. Patient then became more hypoxemic with bradycardia, consultation with neurosurgery and critical care medicine at tertiary care center deemed ongoing CPR futile. Patient arrested at 2:30AM on 2/5, pronounced dead at 2:48AM.


VAERS ID: 1006662 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-22
Onset:2021-01-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Endotracheal intubation, Haemoptysis, Muscle spasms
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had 2nd vaccine, went home and started having "cramping" in all of her muscles. It became bad enough that she was taken to local ED where she then started coughing up blood, required intubation and about 6 hrs later, died.


VAERS ID: 1006994 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-01-22
Onset:2021-01-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Condition aggravated, Death, Thrombotic thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, arterial (narrow), Renovascular disorders (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin Excedrin Extra Strength gabapentin lansoprazole Lantus Solostar U-100 Insulin lisinopril Ozempic phenazopyridine Prelief Vitamin B-12 vitamin D3-vitamin K2 (MK4) zolpidem
Current Illness:
Preexisting Conditions: Diabetes Hyperlipidemia
Allergies: penicillin and sulfa
Diagnostic Lab Data: CT scans plus transport to an out of state hospital. No records from that hospital to report.
CDC Split Type:

Write-up: Patient had one occurrence of thrombotic thrombocytopenic purpura in 1996 for which she had plasma exchange therapy in 1996. No other occurrence since 1996 until she received her first dose of the Pfizer covid vaccine.


VAERS ID: 1007310 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-02
Onset:2021-02-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dry skin, Dyspnoea, Failure to thrive, Hypopnoea, Lethargy, Mouth breathing, Pain, SARS-CoV-2 test negative, Skin warm, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   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: Morphine, lorazepam
Current Illness: ALTERED MENTAL STATUS, UNSPECIFIED CARDIAC ARREST, CAUSE UNSPECIFIED UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERIPHERAL VASCULAR DISEASE, UNSPECIFIED COVID-19 Resolved 1-1-21 AGE-RELATED COGNITIVE DECLINE CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY UTI
Preexisting Conditions: ALTERED MENTAL STATUS, UNSPECIFIED CARDIAC ARREST, CAUSE UNSPECIFIED UNSPECIFIED DEMENTIA WITH BEHAVIORAL DISTURBANCE ESSENTIAL (PRIMARY) HYPERTENSION HYPERLIPIDEMIA, UNSPECIFIED ANEMIA, UNSPECIFIED PERIPHERAL VASCULAR DISEASE, UNSPECIFIED COVID-19 AGE-RELATED COGNITIVE DECLINE CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY UTI
Allergies: none
Diagnostic Lab Data: Rapid Covid test on 2/3/2021 for discharge- negative
CDC Split Type:

Write-up: view 2/5/2021 09:23 e Progress Note Note Text: Patient passed away in the facility this morning. view 2/5/2021 08:39 Orders - Administration Note Note Text: Resident passed. view 2/5/2021 08:33 Nurses Note Note Text: Body released to funeral home at this time. Personal effects sent with resident include: 1 pair of glasses, 1 yellow wedding band, 1silver spoon ring, 1 ring with black and clear stones. Resident has own teeth view 2/5/2021 08:32 Nurses Note Note Text: cause of death per CRNP failure to thrive. view 2/5/2021 07:44 Orders - Administration Note Note Text: Take and document temp & PO2 every 4 hours for MONITORING Resident passed. view 2/5/2021 06:49 Nurses Note Note Text: Son returned call and was updated of resident''s passing this am view 2/5/2021 06:33 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger PRN Administration was: Unknown Resident expired @ 0604 [linked] view 2/5/2021 06:06 Nurses Note Note Text: Res found without pulse or respirations. Pronounced at 0604. Updated. N/o''s for RN to pronounce, release body to funeral home, dispose of medications per facility policy. Daughter updated. Funeral Home called to release body. view 2/5/2021 05:26 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger Pulse ox 60% on O2 @ 5L/min via mask. Resps 44 per minute. view 2/5/2021 01:57 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger PRN Administration was: Effective Follow-up Pain Scale was: 2 [linked] view 2/5/2021 00:52 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger Residents resps are 40 per minute, pulse ox 76% on O2 @ 5L/min via mask. Resps are labored, shallow and rapid. view 2/5/2021 00:48 Nurses Note Note Text: Nonresponsive to verbal and tactile stimulation. Appears comfortable. view 2/4/2021 22:01 Nurses Note Note Text: Resident resting comfortably, breathing becoming increasingly shallow, wearing O2 via mask at 5L via mask, no dyspnea noted, feet are mottled, oral and peri care provided Q2H. No s/s of pain or discomfort. view 2/4/2021 21:40 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger PRN Administration was: Effective [linked] view 2/4/2021 19:32 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 2 hours as needed for pain/air hunger medicated for air hunger, RR 28 to 32/ min view 2/4/2021 19:22 Nurses Note Note Text: Daughter updated on N/O to increase Morphine Sulfate 20mg/mL 0.25mL to Q2H prn from Q6H prn. view 2/4/2021 18:06 Nurses Note Note Text: POA Daughter and daughter aware of residents current condition. view 2/4/2021 11:58 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB PRN Administration was: Effective Follow-up Pain Scale was: 2 [linked] view 2/4/2021 11:13 Nurses Note Note Text: Pt. noted to be lethargic at this time. Does respond to verbal and tactile stimuli by opening her eyes but non verbal currently. Skin warm and dry. No mottling or apnea observed at this time. O2 sat 88% with O2 at 2 LPM via n/c. On increased to 3 LPM via mask as pt. noted to be mouth breathing. Respirations 28. F/U O2 sat 93%. HOB elevated. Pt. medicated with morphine by LPN. Daughter updated on pt.''s condition. Does not want pt. sent out to hospital and would like comfort measures to continue. Daughter also in agreement with delay in d/c d/t pt.''s condition.CRNP updated on pt.''s condition, delay in d/c and daughter''s wishes. No n/o''s at this time. view 2/4/2021 10:56 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB Resident showing s/s of discomfort. SOB at this time and high respirations. Repositioned, changed for incontinence care and mouth care provided. view 2/4/2021 10:34 Progress Note Note Text: Spoke with RN regarding change in condition. Updated Sr Living regarding change. Recommendation to cancel d/c/transfer for today, see how resident does through the weekend and re-evaluate on Monday. Daughter updated on cancellation of d/c today. view 2/4/2021 10:04 Nurses Note Note Text: Daughter aware that resident''s O2 sat was 88% on room air on 3-11 shift and that oxygen was applied via nasal cannula. view 2/4/2021 10:03 Nurses Note Note Text: N/O: Discharge 2/4/21 with scripts to Sr. Living. Daughter aware. view 2/4/2021 09:53 Nurses Note Note Text: Pt. to be d/c''d to another facility this am as per MD order. Pt. alert and responsive. Skin assessment done as per facility policy. No pressure areas noted at this time. No s/sx of pain or discomfort observed at this time. V.S. 97.0 67 20 O2 sat 95% with O2 at 2 LPM via n/c. view 2/4/2021 07:45 Nurses Note Note Text: Resident seen by Dr. for discharge. Orders pending at this time. view 2/4/2021 07:36 Nurses Note Note Text: CRNP and Dr. updated on O2 sat 88% on RA with f/u of 93% with O2 on at 2 LPM as well as rest of VS, 3-11 shift 2/3/21. No n/o''s at this time. view 2/3/2021 21:17 Nurses Note Note Text: Resident Sp02 88% on RA. Pulse 124. Respirations 40. PRN morphine given and O2 applied via NC at 2L/min. After recheck pulse ox up to 93%, pulse 100, and respirations 22. Resident appears comfortable at this time. view 2/3/2021 20:05 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB PRN Administration was: Effective [linked] view 2/3/2021 19:48 Orders - Administration Note Note Text: Morphine Sulfate (Concentrate) Solution 20 MG/ML Give 0.25 ml by mouth every 6 hours as needed for pain/SOB PRN given for SOB after elevation of HOB not effective. view 2/3/2021 11:51 Nurses Note Note Text: CRNP updated rapid COVID test done for d/c tomorrow was negative. No n/o''s at this time. view 2/3/2021 11:44 Nurses Note Note Text: Daughter notified of rapid covid swab being negative. view 2/3/2021 09:50 Orders - Administration Note Note Text: Obtain Rapid Covid test on 2/3/2021 for discharge. Please give copy of results to Social Worker every day shift for covid testing for 1 Day Completed and negative. view 2/3/2021 08:45 Skilled Nursing Note Reason for skilled service: Therapy describe skilled service: Nursing, therapy assessment: V.S. 97.8 79 18 138/84 Orientation: Oriented to self only. Oxygen: O2 sat 94% on RA Edema: Trace edema noted BLE. Pedal pulses present. Pain: Denies pain or discomfort at this time. Nursing note: Pt. alert and responsive. Skin warm and dry. Lung sounds diminished. No respiratory distress observed at this time. Abdomen soft. BS+ in all 4 quads. Continent/Incontinent of B&B. 1 assist with ambulation, transfers. 1 assist with ADL''s. Working with therapy on gait training, therapeutic exercise, therapeutic activities & neuromuscular reeducation. view 2/2/2021 14:37 Progress Note Note Text: Per health professional at Sr Living, prepared to accept patient to their Memory Care Unit 2/4. Transportation arranged for 11 AM per family request. Daughter (POA) updated on d/c time on 2/4/21. Facility requesting rapid COVID test completed prior to d/c and results sent to them. All other information sent for continuity of care.


VAERS ID: 1011771 (history)  
Form: Version 1.0  
Age: 84.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 2021-02-04
   Days after onset:1
Entered: 2021-02-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / UNK LA / -

Administered by: Other       Purchased by: Other
Symptoms: Cerebrovascular accident, Death, Dyspnoea, Hypertensive cerebrovascular disease, Loss of consciousness, Type 2 diabetes mellitus, Unresponsive to stimuli, Vascular dementia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: Narrative: Patient with history advanced vascular dementia, hypertensive cerebrovascular disease and stroke, T2DM. Received her second dose of Pfizer COVID-19 vaccine at approximately 14:00 and was reported to have expired at home at 20:55. Dr. (Medical Director) spoke with patient''s son/caregiver 2/4/21. Son reports that patient was in her usual health yesterday morning, deemed well enough by son to travel for vaccination. He reports she had no bothersome symptoms after either first or second vaccinations. Specifically denied rash, wheeze, and difficulty breathing. Son was with patient throughout the day. In the evening, when preparing for bed, he noted she became suddenly unresponsive in a similar fashion as she has done several times in past years. While in all previous such episodes she recovered within minutes, last evening she did not regain consciousness, experiences a brief period of labored breathing, and died. Patient''s son called 911 and the patient''s body was brought to the medical examiners. The medical examiner declined to proceed with autopsy. Patient''s son is not interested in autopsy. Patient''s son reports confidence that his mother''s underlying hypertensive/diabetic cardiovascular disease is the natural cause of her death. Other Relevant Hx: Symptoms: & Death Treatment:


VAERS ID: 1008041 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-01-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Disorientation, Fall, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, bisacodyl supplement, levsin (hyscyamine)
Current Illness: gout
Preexisting Conditions: congestive heart failure diagnosis, alzheimers
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: itchy skin, swelling, disorientation that led to a fall


VAERS ID: 1008758 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-16
Onset:2021-01-18
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Diarrhoea, Full blood count, Metabolic function test, Nausea, Pallor, Urine analysis
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix 10mg Aqupril Coumadin
Current Illness:
Preexisting Conditions: Thrombocytopenia, A-fib, CHF, Spinal stenosis, Renal stent
Allergies: Codine
Diagnostic Lab Data: CBC CMP uranalysis
CDC Split Type:

Write-up: Patient began feeling nauseated on 1/18/21 around 6pm, and had uncontrolled diarrhea, reported that she did not feel right. Staff reported to this writer, that her skin tone was gray in tone and she just didn''t look good. She was transferred to the HOSPITAL ER VIA AMBULANCE.


VAERS ID: 1015838 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-02
Onset:2021-02-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Aspiration, Cardiac arrest, Chills, Cough, Dyspnoea, Endotracheal intubation, Influenza virus test negative, Loss of consciousness, Pulseless electrical activity, Pyrexia, Resuscitation, SARS-CoV-2 test negative, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to hospital from home in cardiac arrest. Hx of hypertension, hyperlipidemia, type 2 diabetes (not on insulin) and bilateral carotid artery stenosis. The patient was reportedly at his baseline health on 2/2/21. He received the 2nd dose of COVID vaccine around 1000AM on 2/2/21. Reportedly started running fever of 100.1 and chills the afternoon of 2/2/21. Around 7:00PM he started having dry cough and was complaining of breathing difficulties. He subsequently vomited multiple times (was eating pizza and aspirated) then lost consciousness. His wife called 911, did CPR and EMS reported he in PEA at scene and was intubated. Transported to hospital. SARS CoV-2 and influenza negative.


VAERS ID: 1009866 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-29
Onset:2021-01-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown new pt
Preexisting Conditions: unknown
Allergies: penicillins
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: pt was given vaccine on the afternoon of 01-29-2021. Pt was administered the moderna covid-19 shot into the deltoid muscle of this pt. Pt was observed and left pharmacy. on 2-6, pts daughter calls pharmacy, and says the night of 1-29, after recieveing the vaccine, her mother had a hemmorhagic stroke and passed away


VAERS ID: 1009991 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-07
Onset:2021-02-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Circulatory collapse, Death, Endotracheal intubation, Mechanical ventilation, Pharyngeal swelling, Pulse absent, Respiration abnormal, Resuscitation, Syncope, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Believed to have chronic atrial fibrillation, believed not to be on anticoagulants
Allergies: No severe allergies reported on questionaire
Diagnostic Lab Data:
CDC Split Type:

Write-up: 73-year-old man s/p first dose of Pfizer at 10:20 AM Ambulated comfortably to exit after 20 minutes in observation but 10:45 collapsed while exiting the building 10:47 CPR initiated 10:49 medical team/EMS found no pulse, agonal respirations, ventricular fibrillation Paramedics and team performed ACLS; of note patient was intubated 7.5 ETT with bilateral breath sounds on ventilation; paramedic reported easy intubation with no apparent throat swelling; 11:02 transported to Emergency Department 11:30 Pronounced dead at Emergency Department


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