|
VAERS ID: |
1002229 (history) |
Form: |
Version 2.0 |
Age: |
77.0 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 2021-01-22 |
Onset: | 2021-02-03 |
Days after vaccination: | 12 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Death,
Unresponsive to stimuli SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-03
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: unknown Current Illness: none known Preexisting Conditions: CAD with stent placement 2000 Allergies: NKA Diagnostic Lab Data: CDC Split Type:
Write-up: spontaneous death, found unresponsive in cell after normal morning activities |
|
VAERS ID: |
1002255 (history) |
Form: |
Version 2.0 |
Age: |
76.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 2021-01-27 |
Onset: | 2021-01-28 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL9263 / 1 |
RA / IM |
Administered by: Public Purchased by: ? Symptoms: Death SMQs:
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? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Death |
|
VAERS ID: |
1002418 (history) |
Form: |
Version 2.0 |
Age: |
50.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 2021-01-15 |
Onset: | 2021-02-04 |
Days after vaccination: | 20 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3246 / 2 |
LA / IM |
Administered by: Work Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-04
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Unknown Current Illness: Unknown Preexisting Conditions: Unknown Allergies: Unknown Diagnostic Lab Data: CDC Split Type:
Write-up: Patient death |
|
VAERS ID: |
1002453 (history) |
Form: |
Version 2.0 |
Age: |
71.0 |
Sex: |
Female |
Location: |
Indiana |
Vaccinated: | 2021-01-26 |
Onset: | 2021-01-29 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
549616 / 1 |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-29
Days after onset: 0
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: unknown Current Illness: none Preexisting Conditions: coronary artery disease Allergies: none Diagnostic Lab Data: CDC Split Type:
Write-up: No reaction at time of vaccination. Reported by family that pt. died on 1/29/2021. Coroner does not believe this was related to vaccine, but requested to report to VAERs |
|
VAERS ID: |
1002535 (history) |
Form: |
Version 2.0 |
Age: |
97.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2021-01-28 |
Onset: | 2021-01-29 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 2 |
- / - |
Administered by: Senior Living Purchased by: ? Symptoms: Confusional state,
Death,
Herpes zoster,
Malaise,
Neuralgia,
Pain,
Rash SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-03
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: On 1/29/21 patient began not feeling well and saw her provider. The doctor gave her fluids and tramadol for pain. They noticed increased confusion, but thought that could have been due to the tramadol. They also increased her gabapentin as she was experiencing nerve pain. Patient also developed a rash and was diagnosed with shingles on 2/1/21. Patient died on 2/3/21 |
|
VAERS ID: |
1002636 (history) |
Form: |
Version 2.0 |
Age: |
90.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 2020-12-28 |
Onset: | 2021-01-17 |
Days after vaccination: | 20 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
025J20A / 1 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Angiogram,
Angiogram cerebral abnormal,
Aphasia,
Cerebral artery occlusion,
Computerised tomogram abnormal,
Computerised tomogram head,
Death,
Fall,
Movement disorder,
NIH stroke scale score increased,
Nervous system disorder,
Thrombectomy SMQs:, Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-01-23
Days after onset: 6
Permanent Disability? Yes
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: ASA 81 mg, allopurinol, potassium chloride, furosemide, diltiazem, metoprolol, tiotropium, albuterol, diclofenac gel topical Current Illness: None - had exposure to COVID19 + case on 12/18/2020 but tested negative. Preexisting Conditions: CHF, HTN, hyperlipidemia, atrial fibrillation, COPD (O2 dependent) , CKD Stage 4, type 2 diabetes (diet controlled). Allergies: Oxycodone, Percodan, atenolol, PCN VK Diagnostic Lab Data: CT 1/17/21 (no acute hemorrhage but mild hypodensity of greater than 1/3 of the MCA territory) and CT Angiogram on 1/17/21 ( distal L M1/M2 occulsion). CDC Split Type:
Write-up: On 1/17/2021 patient woke and began her day as usual, was found down by family member 1 hour later conscious but unable to speak and unable to move her R side. She was admitted to the hospital - Initial NIHSS was 26 and CT imaging showed no acute hemorrhage but mild hypodensity of greater than 1/3 of the MCA territory (TPA not recommended). CTA did show distal L M1/M2 occulsion and she was transferred to larger facility for thrombectomy. Unfortunately the patient had persistent severe neurological deficits after thrombectomy. Was discharged home on hospice care and expired on 1/23/21. |
|
VAERS ID: |
1002808 (history) |
Form: |
Version 2.0 |
Age: |
90.0 |
Sex: |
Female |
Location: |
West Virginia |
Vaccinated: | 2021-01-09 |
Onset: | 2021-02-03 |
Days after vaccination: | 25 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / UNK |
UN / IM |
Administered by: Other Purchased by: ? Symptoms: Acute respiratory failure,
Ageusia,
Anosmia,
Asthenia,
COVID-19 pneumonia,
Death,
Decreased appetite,
Dyspnoea,
Nausea,
Respiratory failure SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)
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? Yes
Hospitalized? Yes, 20 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Current Illness: Diabetes, hypertension Preexisting Conditions: IBS, GERD, overweight, scoliosis, Macular degeneration, sciatica, umbilical hernia, RBBB, Others listed Allergies: Diagnostic Lab Data: unknown CDC Split Type:
Write-up: According to medical report, Pt presented to the ED on 1/14/21 w/ cc of SOB for 1 day. She received her COVID-19 vaccine on 1/9/21. Pt stated that she developed a dry hacking cough 2 days prior to the vaccine on 1/7/21. Over the last few days prior to admission, she developed generalized weakness, SOB, loss of sense of taste and smell w/ associated decreased appetite and nausea ultimately SOB in the24 hours prior to admission. Final Diagnosis- acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Pt died on 2/3/21. See Medical report for more information. |
|
VAERS ID: |
1002813 (history) |
Form: |
Version 2.0 |
Age: |
91.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 2021-02-03 |
Onset: | 2021-02-04 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
062G20A / 2 |
LA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Blood pressure increased,
Cardiac arrest,
Death,
Heart rate increased,
Respiratory arrest,
Unresponsive to stimuli SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-04
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Alphagan gtts, aricept, colace, D3-50, Depakote, levetiracetam, metoprolol,senna, tylenol Current Illness: None Preexisting Conditions: medical diagnosis chronic conditions Epilepsy, alzehimer''s disease, acute resp. failure, non-st MI,encephalopathy, ETOH use, claucoma, anxiety/depression, HTN, macular degeneration, extropia, presbyopia, hearing loss, Allergies: no allergies Diagnostic Lab Data: none CDC Split Type:
Write-up: Patient was seen at 0710 he was sleeping but at normal cognitive behavior Patient was again assessed at 0720 where he was noted to be unresponsive, BP 180/100s, HR 230s, he was a DNR therefore not CPR was administered. EMS arrived at facility patient was noted to be in full cardiac and respiratory arrest. Time of death 0735 |
|
VAERS ID: |
1002840 (history) |
Form: |
Version 2.0 |
Age: |
85.0 |
Sex: |
Male |
Location: |
Indiana |
Vaccinated: | 2021-01-26 |
Onset: | 2021-01-27 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
ZTC540693 / 1 |
UN / IM |
Administered by: Public Purchased by: ? Symptoms: Death,
Malaise SMQs:
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: Tamulosin HCL, HCTZ, Oxybutynin CL ER, Lisinopril, Zetia, Lexapro, Trulicity, Current Illness: none Preexisting Conditions: DM II, HTN, Hyperlipidemia Allergies: None Diagnostic Lab Data: none CDC Split Type:
Write-up: Client lives alone and had dinner at his home with family members after the 4:40 appointment. Client stated that in general he did not feel well but did not give any specific symptom. Family states they asked the client to go to the ER and the client refused. Family states they helped the client to his chair in the living room and then left to go home. Family states that the client was found in his bedroom the next morning at 7:54 a.m. deceased. |
|
VAERS ID: |
1003106 (history) |
Form: |
Version 2.0 |
Age: |
92.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2021-02-04 |
Onset: | 2021-02-04 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3302 / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death,
Pupil fixed,
Unresponsive to stimuli SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-04
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Enteric Coated Aspirin 81 mg tablet,delayed release 1 Time Daily Eliquis 2.5 mg tablet 2 Times Daily Dulcolax (bisacodyl) 10 mg rectal suppository PRN Fleet Enema 19 gram-7 gram/118 mL PRN acetaminophen 500 mg ta Current Illness: CARDIOMEGALY; LOW BACK PAIN; MUSCLE WEAKNESS (GENERALIZED); NEED FOR ASSISTANCE WITH PERSONAL CARE; - OTHER ABNORMALITIES OF GAIT AND MOBILITY; LUMBAGO WITH SCIATICA, UNSPECIFIED SIDE; R26.81 - UNSTEADINESS ON FEET; REPEATED FALLS; CERVICAL SPONDYLOSIS; Other Diagnoses PRESENCE OF CARDIAC PACEMAKER; DYSPHAGIA, OROPHARYNGEAL PHASE; HYPERLIPIDEMIA, UNSPECIFIED; CHRONIC ATRIAL FIBRILLATION, UNSPECIFIED ; ATHSCL HEART DISEASE OF NATIVE CORONARY ARTERY W/O ANG PCTRS; ESSENTIAL (PRIMARY) HYPERTENSION; INSOMNIA, UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL DISTURBANCE; Preexisting Conditions: On hospice Allergies: Diltiazem Diagnostic Lab Data: N/A CDC Split Type:
Write-up: Resident received vaccination at 9:12 am, she was monitored and checked at the 15 minute interval 9:27 am, reassessed, vitals were fine. Within 20 (9:32 am) minutes of receiving the vaccine she was unresponsive, pupils were fixed at 9:45 am, no vital signs noted; hospice came out and reported her time of death 10:21 am. This person was on hospice. |
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