|
VAERS ID: |
985004 (history) |
Form: |
Version 2.0 |
Age: |
58.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: | 2021-01-08 |
Onset: | 2021-01-27 |
Days after vaccination: | 19 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
012L20A / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Abdominal pain,
Constipation,
Death,
Fatigue,
Hyperhidrosis,
Impaired work ability,
Resuscitation,
Unresponsive to stimuli SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-27
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: none Preexisting Conditions: Cardiac Issues. Hx of cardiac Stent but unknown in-depth. Allergies: Codeine Penicillin V Diagnostic Lab Data: CDC Split Type:
Write-up: The week of 1/18/2021 The patient complained of Abdominal pain and called off work (we are also her employer) She was seen for constipation on 1/20/2021. Employee returned to work on 1/25/2021 Had occasional episodes during work where she would sweat and become tired but would rest until she felt better. On the Night of 1/27/2021 she was feeling fine no issues, later in the shift a co worker found her unresponsive, CPR was initiated but unsuccessful. |
|
VAERS ID: |
985205 (history) |
Form: |
Version 2.0 |
Age: |
75.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 2021-01-25 |
Onset: | 2021-01-26 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
029L20A / 1 |
UN / IM |
Administered by: Unknown Purchased by: ? Symptoms: Death,
Dizziness,
Malaise SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-26
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Yes, but caller does not know what they are. Current Illness: No Preexisting Conditions: None Allergies: No Diagnostic Lab Data: None CDC Split Type:
Write-up: Patient was feeling dizzy and under the weather after the vaccination. The following day he died in his sleep during a nap. |
|
VAERS ID: |
985367 (history) |
Form: |
Version 2.0 |
Age: |
83.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 2021-01-06 |
Onset: | 2021-01-18 |
Days after vaccination: | 12 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3249 / 1 |
UN / IM |
Administered by: Senior Living Purchased by: ? Symptoms: COVID-19,
Death,
SARS-CoV-2 test positive SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-25
Days after onset: 7
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Mucinex Tablet Extended Release 12 Hour 600 MG (guaiFENesin ER) Acetaminophen Tablet 500 MG cloZAPine Tablet 25 MG Remeron Tablet (Mirtazapine) Aspercreme Lidocaine Patch 4 % (Lidocaine) Cyanocobalamin Tablet 500 MCG Cholecalciferol Current Illness: COVID-19 + DAY AFTER THE FIRST DOSE OF THE VACCINE Preexisting Conditions: PARKINSON''S DISEASE HTN BPH CROHN''S DEMENTIA ANXIETY OA DDD ALLERGIC RHINITIS VITAMIN D DEFICIENCY Allergies: ATIVAN GEODON Diagnostic Lab Data: CDC Split Type:
Write-up: TESTED POSITIVE FOR COVID-19 1-7-2021, TRANFERRED TO HOSPITAL ON 1-18-2021. HE READMITTED TO THE FACILITY ON 1-21-2021 WITH HOSPICE SERVICES AND EXPIRED ON 1-25-2021. |
|
VAERS ID: |
985449 (history) |
Form: |
Version 2.0 |
Age: |
87.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2021-01-27 |
Onset: | 2021-01-28 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3249 / 2 |
- / - |
Administered by: Private Purchased by: ? Symptoms: Cardiac arrest,
Cardio-respiratory arrest,
Computerised tomogram abdomen abnormal,
Death,
Intestinal dilatation,
Large intestinal obstruction,
Pupil fixed,
Septic shock,
Unresponsive to stimuli SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Toxic-septic shock conditions (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-28
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: colonic obstruction with dilatation of large and small bowel Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient was an 87 y/o female admitted for septic shock. She was started on and eventually maxed on 3 pressors. CT abd showed colonic obstruction with dilatation of large and small bowel. Patient was made DNR in the ED. Palliative care consulted on case. Family opted for comfort care. Patient was asystole on monitor. No spontaneous breath/cardiac sounds ausculted. Patient did not withdraw to pain. Pupils fixed and dilated. She was pronounced and 1230 on 1/28/21 |
|
VAERS ID: |
985451 (history) |
Form: |
Version 2.0 |
Age: |
101.0 |
Sex: |
Female |
Location: |
Kentucky |
Vaccinated: | 2021-01-06 |
Onset: | 2021-01-24 |
Days after vaccination: | 18 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3249 / 1 |
UN / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death,
SARS-CoV-2 test positive SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-24
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: predniSONE Tablet 20 MG Mucinex Tablet Extended Release 12 Hour 600 MG (guaiFENesin ER) Acetaminophen Tablet 500 MG RisaQuad Capsule (Probiotic Product) BISACODYL 10MG SUPPOSITORY Morphine Sulfate (Concentrate) Solution 100 MG/5ML H Current Illness: Preexisting Conditions: VASCULAR DEMENTIA HEART FAILURE BULLOUS PEMPHIGOID Allergies: NKA Diagnostic Lab Data: CDC Split Type:
Write-up: COVID-19 + 1/11/2021, EXPIRED ON 1-24-2021 |
|
VAERS ID: |
985501 (history) |
Form: |
Version 2.0 |
Age: |
89.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 2021-01-18 |
Onset: | 2021-01-22 |
Days after vaccination: | 4 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3302 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ? Symptoms: Death,
Dyspnoea,
Fatigue,
Nausea,
Respiratory arrest,
Resuscitation,
Sluggishness SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-27
Days after onset: 5
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Fish oil Aspirin Calcium + D Lisinopryl 10 mg methimazole 5 mg colase 100 mg Hydrochlorathiazide 25 mg amlodipine 5 mg atenolol 25 mg trazadone 50 mg Current Illness: none Preexisting Conditions: hypertension, hyperlipidemia, hyperthyroidism, thyroid nodules, constipation, osteopenia, insomnia, incontinence Allergies: none Diagnostic Lab Data: none, no autopsy CDC Split Type:
Write-up: family states seemed short of breath since after the covid vaccine. Staff said beginning on 1/22/21 the patient seemed sluggish, more tired, and nausea noted. She stayed in her room more after the vaccine because worried about giving/getting COVID to others. was talking on the phone at 11:30 PM on 1/26/21 to staff person about temperature of room. at 12:15 AM on 1/27/21 staff noted not breathing, started CPR and called EMS. When EMS arrived they stopped the code because she was too long deceased. |
|
VAERS ID: |
985715 (history) |
Form: |
Version 2.0 |
Age: |
80.0 |
Sex: |
Male |
Location: |
Florida |
Vaccinated: | 2020-12-29 |
Onset: | 2021-01-02 |
Days after vaccination: | 4 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025J20A / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Death,
General physical health deterioration,
Malaise 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: metoprolol 25mg vitamin D3 1000IU furosemide 80mg Norvasc 5mg aspirin 81mg Renvela 800mg atorvastatin 20mg vitamin B12 1000mcg Current Illness: high blood pressure dialysis GI bleed/ symptomatic anemia Preexisting Conditions: Allergies: no known allergies Diagnostic Lab Data: CDC Split Type:
Write-up: Patient received the vaccine on 12/29/20 and presented at the ER at the Hospital on 12/30/20 stating that he wasn''t feeling well. It is stated that his health had declined over the past few weeks and currently on hospice. Visit was unremarkable. Patient stated that wanted to stop dialysis. Patient passed away on 01/02/2021. |
|
VAERS ID: |
985814 (history) |
Form: |
Version 2.0 |
Age: |
94.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 2021-01-20 |
Onset: | 2021-01-21 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
029L20A / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Aspiration,
Asthenia,
Blood creatinine increased,
Blood glucose normal,
Blood potassium increased,
Blood urea increased,
Chest X-ray abnormal,
Computerised tomogram thorax abnormal,
Cough,
Dyspnoea,
Echocardiogram abnormal,
Ejection fraction decreased,
Emphysema,
Endotracheal intubation,
Fatigue,
Haematocrit decreased,
Haemoglobin decreased,
Left atrial dilatation,
Lung consolidation,
Lung opacity,
Nausea,
Oropharyngeal pain,
Pulmonary granuloma,
Pulmonary hilum mass,
Pulmonary mass,
Red blood cell count decreased,
Respiratory tract congestion,
SARS-CoV-2 test negative,
Vomiting,
White blood cell count decreased SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-26
Days after onset: 5
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: acetaminophen 500 mg amoxicillin 1 gm aspirin furosemids 40 mg glucosamine-chondroitin 1 tab cozaar 25 mg multivitamin potassium chloride 20 meq tamsulosin 0.4 mg furosemide 40 mg zofran 4 mg Current Illness: started with a sore throat the day before vaccination Preexisting Conditions: anemia, BPH with obstruction, cervical neuritis, cervical spondylosis, cervicalgia, enlarged prostate, HLD, HTN, left sciatic nerve pain, low back pain, lumbar spinal stenosis, osteoarthritis, pacemaker, pancytopenia Allergies: morphine, oxycodone, hydrocodone, hydromorphone, coumadin Diagnostic Lab Data: 1/25/21 had CBC which showed WBC at 0.1, RBC 2.52, Hgb 8.8, Hct 27.2, Chem profile done showed high potassium, high glucose of 129, elevated BUN and Creatinine. Was negative for SARS-CoV 2 on 1/25/21. CXR showed right perihilar masslike opacity which may reflect infiltrate or neoplasm. Did CT of the chest which showed bilateral upper lobe chronic emphysematous lung changes, dense right upper lobe airspace disease, left lower lobe bronchial filling defects suggesting aspiration, scattered bilateral upper lobe nodular densities, scattered left lower lobe calcified granulomas, and left hilar calcified granuloma CDC Split Type:
Write-up: started having generalized weakness on 1/21/21, fatigued., nausea/vomiting. went to doctor on 1/25/21 with complaint of sore throat, cough, and felt congested. Went to ER on 1/25/21 with complaints of increased shortness of breath, worsening nausea and vomiting. started on oxygen for sats of 87%. admitted on 1/25/21. On 1/26/21 needed intubated, CXR showed worsening consolidative change right lung at right hilar level. Echocardiogram showed ejection fraction 35-40%, left atrium is moderately dilated. |
|
VAERS ID: |
985933 (history) |
Form: |
Version 2.0 |
Age: |
|
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2020-12-29 |
Onset: | 2020-12-30 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
- / OT |
Administered by: Unknown Purchased by: ? Symptoms: Blood creatinine increased,
Blood urea increased,
Chest X-ray abnormal,
Death,
Dyspnoea,
Erythema,
Influenza virus test negative,
Leukocytosis,
Lung infiltration,
Pulmonary congestion,
Pyrexia,
Respiratory rate increased,
White blood cell count increased SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-01
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: Dementia; Walking disability Allergies: Diagnostic Lab Data: Test Date: 20201231; Test Name: creatinine; Test Result: Inconclusive ; Test Date: 20201231; Test Name: BUN; Test Date: 20201231; Test Name: Temperature; Result Unstructured Data: ?F; Test Date: 20201231; Test Name: CXR; Test Result: Inconclusive ; Result Unstructured Data: mild left lower lung infiltrate; Test Date: 20201231; Test Name: Pulse; Test Result: Inconclusive ; Result Unstructured Data: Heart beats per minute; Test Date: 20201231; Test Name: Flu swab; Test Result: Negative ; Result Unstructured Data: negative; Test Date: 20201231; Test Name: O2; Test Result: Inconclusive ; Result Unstructured Data: Percent Room air; Test Date: 20201231; Test Name: WBC CDC Split Type: USMODERNATX, INC.MOD20210
Write-up: Died; Increased respirations (22 and labored at times); Pulse 105; 94% O2 on RA; Labored breathing at times; leukocytosis; elevated BUN; left lower lung congestion; elevated creatinine; Temperature of 102.0F; Redness on face; A spontaneous report was received from a nurse concerning a 92-year-old, female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced redness on face, increased respirations, labored breathing at times, temperature of 102F, pulse of 105, 94 percent O2, leukocytosis, elevated BUN, left lower lung congestion, elevated creatinine, and death. The patient''s medical history, as provided by the reporter, included dementia and reduced mobility. No relevant concomitant medications were reported. On 29 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. On 30 Dec 2020, the patient began to experience redness on her face, increased respirations (reported as 22 and labored at times), pulse of 105, and 94 percent oxygen saturation on room air. The patient had a fever of 102 degrees Fahrenheit. Laboratory tests revealed a negative influenza swab, elevated white blood cell count of 14.1, elevated BUN at 113, and creatinine 2.7. Chest x-ray showed mild, left lower lung infiltrate. On 31 Dec 2020, the patient went under hospice care per her family request.. Action taken with mRNA-1273 in response to the events was not applicable. The patient died on 01 Jan 2021, the cause of death was unknown.; Reporter''s Comments: This case concerns a 92-year-old, female subject with medical history of dementia and reduced mobility, who experienced the serious unexpected events of death, respiratory rate increased, heart rate increased, oxygen saturation decreased, elevated BUN, elevated creatinine, left lung congestion and dyspnoea and the non-serious events of erythema and pyrexia. The events of respiratory rate increased, heart rate increased, oxygen saturation decreased, dyspnoea, erythema and pyrexia occurred 2 days after the first dose of the study medication administration, and the event of death occurred 4 days after the first dose of the study medication administration. Very limited information regarding the events is available at this time and no definite diagnosis or autopsy report have been provided. Additional information has been requested.; Reported Cause(s) of Death: Died |
|
VAERS ID: |
986063 (history) |
Form: |
Version 2.0 |
Age: |
83.0 |
Sex: |
Female |
Location: |
Utah |
Vaccinated: | 2021-01-12 |
Onset: | 2021-01-16 |
Days after vaccination: | 4 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-29 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-16
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: Cholestyramine, Duloxetine, Fiber, Haloperidol, Hyoscyamine, Lisinopril, Lorazepam, Metoprolol, Morphine, Nystatin powder, Pepto Bismol, Seroquel, Spiriva, Symbicort, Tramadol, Tylenol, Vistaril, Zolpidem Current Illness: COPD, CHF, Major Depressive Disorder, Anxiety, Respiratory Failure, Insomnia, OsteoArthritis, Hypertension, Irritable Bowel Syndrome, Atrial Fibrillation, COVID recovered Preexisting Conditions: Resident was a Hospice Patient as of: 11/17/2020 Allergies: No Known Allergies Diagnostic Lab Data: No tests/results pertaining to this incident. CDC Split Type:
Write-up: Resident was vaccinated on 1/13/21. Resident passed away on 1/16/21 |
|