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From the 9/17/2021 release of VAERS data:

Found 15,386 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

This is page 64 out of 1,539

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VAERS ID: 1006633 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-01-20
Onset:2021-01-24
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Cardiac failure, Cardio-respiratory arrest, Chest pain, Death, Dyspnoea, Pneumonia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EARLY SUNDAY MORNING THE PATIENT BEGAN VOMITTING AND SHORT OF BREATH AND CHEST AND BACK PAIN. SHE CODED WHEN SHE GOT IN THE ER AND LATER PASSED AWAY THE MONDAY. DIAGNOSIS WAS PNEUMONIA AND HEART FAILURE PER STEP DAUGHTER.


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: 1007033 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-22
Onset:2021-02-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Death, Decompressive craniectomy, Fatigue, Glomerular filtration rate, Headache, Platelet count normal, SARS-CoV-2 test negative, Subdural haematoma, Surgery, White blood cell count increased
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   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: ? acetaminophen (TYLENOL) 500 mg tablet, Take 500 mg by mouth once daily as needed for mild pain (level 1-3)., Disp: , Rfl: ? amLODIPine (NORVASC) 10 mg tablet, Take 10 mg by mouth every evening. , Disp: , Rfl: ? ascorbic acid (VITAMI
Current Illness: History of headaches
Preexisting Conditions: Memory impairment, headaches, hypertension, prostate cancer, prior stroke
Allergies: None
Diagnostic Lab Data: 2/1/2021: WBC 11.1, PLT 229, GFR $g60, COVID Rapid PCR test was negative.
CDC Split Type:

Write-up: Patient presented to emergency room on 2/1/2021 with a chief complaint of having a chronic headache and fatigue following receipt of the Moderna vaccine 10 days prior. Following examination by the physician, the patient was diagnosed with an acute subdural hematoma. The patient subsequently underwent decompressive surgery, however demonstrated worsening neurologic status over the next several days and ultimately expired on 2/4/2021.


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: 1007371 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-19
Onset:2021-01-29
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Cough, Death, Decreased appetite, Diarrhoea, Dry mouth, Dyspnoea exertional, Gait disturbance, Influenza, Productive cough, SARS-CoV-2 test, Sputum discoloured, Weight decreased
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-04
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No current outpatient medications on file.
Current Illness: None known
Preexisting Conditions: Transplant patient.
Allergies: Not on File
Diagnostic Lab Data: COVID test at PCP 2/3/21
CDC Split Type:

Write-up: Called PCP, from the note: I got my shot on Jan 19. But last Friday I have been down with a horrible flu. I''m wearing diapers because of uncontrollable diarrhea. I can''t leave my sofa to walk over to my desk because I''ll be so out of breath. I have a cough that produces a pink or gold Phelm I have dry mouth. I have no appetite I''m so weak and have lost 15 pounds. Don''t know what to do. My next Covid is shot is feb 11 Called employer on 2/3/21 but hung up. Tried calling multiple times to follow up. In triage she stated she had a COVID test scheduled and had spoken with her PCP. COVID test through PCP: 2/4/21 She passed away the night of 2/4/21


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: 1011983 (history)  
Form: Version 1.0  
Age: 77.0  
Sex: Male  
Location: Florida  
Vaccinated:2020-12-22
Onset:2021-01-26
   Days after vaccination:35
Submitted: 2021-01-27
   Days after onset:1
Entered: 2021-02-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 3 RA / -

Administered by: Other       Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Atrial fibrillation, Bacterial test positive, Bilirubin conjugated, Blood albumin, Blood bilirubin, Blood creatinine increased, Blood culture negative, Blood urea nitrogen/creatinine ratio, Bronchoscopy abnormal, Chest X-ray abnormal, Chest tube insertion, Condition aggravated, Culture urine negative, Cystatin C increased, Death, Dyspnoea, General physical health deterioration, Hepatic enzyme increased, Hypoxia, Intensive care, Ischaemic hepatitis, Klebsiella infection, Lung infiltration, Pneumonia, Protein total, Respiratory failure, SARS-CoV-2 test negative, Serratia infection, Spinal cord injury, Stenotrophomonas infection, Tachycardia, Tracheal aspirate culture
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (narrow), COVID-19 (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: Other Medication acetaminophen, albuterol/ipratropium, amlodipine, ascorbic acid, atorvastatin, baclofen, buspirone, calcium carbonate with vitamin D, cholecalciferol, dexmedetomidine, diltiazem, docusate, esomeprazole, famotidine, fentanyl
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Collection DT Spec CoV19BF COVIDIg 01/21/2021 14:10 NASAL Not Detected 01/12/2021 04:00 SERUM 0.03 01/11/2021 12:35 NASAL Not Detected Collection DT Spec WBC BUN Creat Cystn-C 01/25/2021 04:00 BLOOD 15.28 H 01/25/2021 04:00 PLASM 64 H 1.3 2.46 H 01/24/2021 04:00 PLASM 56 H 1.1 01/24/2021 04:00 BLOOD 13.16 H 01/23/2021 04:40 BLOOD 14.02 H 01/23/2021 04:00 PLASM 52 H 0.9 01/23/2021 04:00 BLOOD 7.93 01/22/2021 04:00 BLOOD 10:58 H 01/22/2021 04:00 PLASM 49 H 0.9 01/21/2021 04:00 PLASM 47 H 1.0 01/21/2021 04:00 BLOOD 7.39 01/20/2021 04:00 PLASM 30 H 0.8 01/20/2021 04:00 BLOOD 9.10 01/19/2021 04:00 PLASM 17 0.7 L Collection DT Spec Protein Albumi TotBili DirBili AST AlkPhos 01/25/2021 04:00 PLASM 5.6 L 3.2 L 1.1 1096 H 504 H 51 01/24/2021 04:00 PLASM 6.0 L 3.2 L 0.8 1482 H 699 H 57 01/23/2021 04:00 PLASM 5.5 L 2.9 L 0.6 1778 H 1044 H 53 01/22/2021 04:00 PLASM 5.7 L 2.6 L 0.4 2135 H 1579 H 49 01/21/2021 17:00 PLEUR 1.3 01/14/2021 04:00 PLASM 6.8 3.2 L 0.4 15 21 57 01/13/2021 04:00 PLASM 6.3 L 3.0 L 0.3 14 18 53 01/12/2021 04:00 PLASM 5.8 L 2.7 L 0.3 11 17 55
CDC Split Type:

Write-up: Narrative: See "Other Relevant History" in Section 6 above Other Relevant Hx: 76yo man with a history of for C5 tetraplegia 2/2 cervical stenosis leading to neurogenic bowel/bladder (chronic suprapubic catheter) and chronic respiratory failure with tracheostomy, severe dysphagia s/p G tube placement and multiple aspiration pneumonias, COPD GOLD III, hx MRSA bacteremia (7/2018) and E coli bacteremia (12/2019). Patient transferred from Spinal Cord Injury until to ICU on 1/11/2021 due to worsneing dyspnea, hypoxia (80s) and tachycardia and was found to have acute hypoxic respiratory failure likely 2/2 multifocal pneumonia. CXR findings of "There is interval increase in patchy airspace infiltrates and consolidation in bilateral lungs concerning for pneumonia" Patient was started on vancomycin and pip/tazo on 1/11 and tracheal aspirate cultures were obtained for VAP diagnosis which ultimately grew Serratia liquifaciens and Proteus mirabilis. Infectious Diseases was consulted who recommended a switch to ertapenem therapy for a total 10 day course for VAP. UCx/BCx remained negative. On 1/20, a therapeutic bronchoscopy was completed with cultures growing Stenotrophomonas maltophilia and pan-S Klebsiella pneumoniae. The following day a chest tube was inserted and the course of ertapenem completed but vancomycin was continued. By 1/22, patient developed shock liver with ALT/AST 2135/1579 from normal range the day prior and SCr increased to 1.3 from baseline 0.7/cystatin C of 2.46 up from 1.15. Levofloxacin was added for Stenotrophomonas coverage. By 1/25, patient''s clinical status continued to decline and Cardiology was consulted for new onset Afib with RVR. Discussion was documented with patient''s family who requested DNR. Patient passed away in the early AM on 1/26. Demise does not appear to be related to COVID-19 vaccination but occurred in recent timeframe. Symptoms: ElevatedLiverEnzymes & death, pneumonia, afib


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


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