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From the 6/4/2021 release of VAERS data:

Found 5,888 cases where Vaccine targets COVID-19 (COVID19) and Patient Died



Case Details

This is page 69 out of 589

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VAERS ID: 1014628 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-03
Onset:2021-02-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20R / 1 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

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: a long list
Current Illness: none
Preexisting Conditions: melanoma, skin cancer
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death within 8 hours.


VAERS ID: 1014659 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-14
Onset:2021-01-18
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / UN

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-26
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypothyroidism
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Four days after being vaccinated, she developed pneumonia and died 8 days later.


VAERS ID: 1014740 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-04
Onset:2021-02-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Agonal rhythm, Cardiac arrest, Death, Fall, Heart rate irregular, Loss of consciousness, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-06
   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: Lisinopri, Sertraline, pravastatin, alendronate, Cetirizine, Vitamin D3,
Current Illness: no acute illnesses
Preexisting Conditions: HTN, Cavernous hemangioma of liver, RBBB, hx of bilateral carotid bruits, hx of squamous cell carcinoma of right hand, arthralgia of both knees, spondylolisthesis at L3-L4, DDD thoracic, ovarian cyst, hx of pneumonia, cholelithiasis w/o obstruction, liver lesion, depression, hyperlipidemia, hypercalcemia, vitamin d deficiency, osteoporosis, former smoker, depression
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found down at home with agonal respirations and per EMS asystole, received 2 rounds of epi at her house with return of spontaneous pulses, lost pulse again in route to ER and another round of epi was given, CPR in progress when arrived at hospital. Prior to this patient''s husband states he heard her fall in the bathroom but did not immediately check on her as he states that this has happened before. He checked on her 10 min later and that''s when he found her unconscious. Daughter called 911 and she began CPR. No previous complaints of headache, chest pain, back pain, fever or chills. Husband states patient was drinking that evening which is not unusual for her. Patient died at hospital.


VAERS ID: 1014774 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-01-13
Onset:2021-01-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-15
   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: None Reported
Allergies: None Reported
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: We were informed the patient passed away 2 days after receiving the vaccine. We do not have any details about what happened, we were informed by one of his employees. We have no knowledge that this had anything to do with the vaccination in any way.


VAERS ID: 1014865 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-23
Onset:2021-02-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac arrest, Death, Malaise, Pneumonia, Renal failure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), 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 (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-03
   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: n/a
Current Illness: Tested positive for Covid in November
Preexisting Conditions: Muscular dystrophy
Allergies: n/a
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: He had not been feeling well after his second Covid vaccination (on 01/23/2021) and was found unresponsive in his room at the nursing home (late evening on 02/02/2021). He was taken to a hospital where they did tests and he had pneumonia and kidney failure, but he was being transferred to a larger hospital when he arrested and died (02/03/2021)


VAERS ID: 1015465 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-21
Onset:2021-02-07
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ELO140 / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL1283 / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Heart rate abnormal, Pulse absent, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), 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), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen [OTC] tablet; 500 mg; amt: 500 MG; oral Special Instructions: 1 TABLET BY MOUTH EVERY 4 HOURS AS NEEDED As Needed PRN 1, PRN 2, PRN 3, PRN 4, PRN 5, PRN 6, PRN 7, PRN 8, PRN 9, PRN 10 03/14/2020- Open Ended Prescription Artifi
Current Illness: U07.1 2019-nCoV acute respiratory disease (Primary) N39.0 Urinary tract infection, site not specified (Admission) K21.9 Gastro-esophageal reflux disease without esophagitis G89.4 Chronic pain syndrome E66.01 Morbid (severe) obesity due to excess calories M54.2 Cervicalgia F41.9 Anxiety disorder, unspecified (History of) G47.00 Insomnia, unspecified E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E03.9 Hypothyroidism, unspecified F06.30 Mood disorder due to known physiological condition, unspecified I50.22 Chronic systolic (congestive) heart failure I10 Essential (primary) hypertension M81.0 Age-related osteoporosis without current pathological fracture Z95.0 Presence of cardiac pacemaker F39 Unspecified mood [affective] disorder C85.84 Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb F31.62 Bipolar disorder, current episode mixed, moderate K59.09 Other constipation Z45.2 Encounter for adjustment and management of vascular access device D64.9 Anemia, unspecified Z79.01 Long term (current) use of anticoagulants Z51.81 Encounter for therapeutic drug level monitoring M17.9 Osteoarthritis of knee, unspecified M15.0 Primary generalized (osteo)arthritis I87.2 Venous insufficiency (chronic) (peripheral) F31.9 Bipolar disorder, unspecified C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites I73.9 Peripheral vascular disease, unspecified F32.9 Major depressive disorder, single episode, unspecified I89.0 Lymphedema, not elsewhere classified Q24.5 Malformation of coronary vessels I42.8 Other cardiomyopathies E03.9 Hypothyroidism, unspecified J30.9 Allergic rhinitis, unspecified Z86.718 Personal history of other venous thrombosis and embolism R33.9 Retention of urine, unspecified K42.9 Umbilical hernia without obstruction or gangrene Z90.89 Acquired absence of other organs R20.8 Other disturbances of skin sensation L03.111 Cellulitis of right axilla I87.2 Venous insufficiency (chronic) (peripheral) Z87.81 Personal history of (healed) traumatic fracture H04.121 Dry eye syndrome of right lacrimal gland R42 Dizziness and giddiness R53.81 Other malaise F48.2 Pseudobulbar affect R06.02 Shortness of breath H26.9 Unspecified cataract C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site H53.2 Diplopia E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene G89.4 Chronic pain syndrome E78.5 Hyperlipidemia, unspecified G47.33 Obstructive sleep apnea (adult) (pediatric) G60.8 Other hereditary and idiopathic neuropathies K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding I48.91 Unspecified atrial fibrillation J02.9 Acute pharyngitis, unspecified (Preliminary) F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features Z46.89 Encounter for fitting and adjustment of other specified devices R09.81 Nasal congestion Z46.89 Encounter for fitting and adjustment of other specified devices M25.562 Pain in left knee L53.9 Erythematous condition, unspecified R29.3 Abnormal posture F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified T81.30XA Disruption of wound, unspecified, initial encounter R05 Cough (Preliminary) F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features S28.222A Partial traumatic amputation of left breast, initial encounter Z48.3 Aftercare following surgery for neoplasm F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features R41.841 Cognitive communication deficit N63.0 Unspecified lump in unspecified breast H25.012 Cortical age-related cataract, left eye (Preliminary) H25.011 Cortical age-related cataract, right eye (History of) H25.091 Other age-related incipient cataract, right eye Z23 Encounter for immunization Z74.1 Need for assistance with personal care M62.81 Muscle weakness (generalized) K59.00 Constipation, unspecified I49.9 Cardiac arrhythmia, unspecified E55.9 Vitamin D deficiency, unspecified (History of) L23.9 Allergic contact dermatitis, unspecified cause (History of) F33.8 Other recurrent depressive disorders (History of) Z11.1 Encounter for screening for respiratory tuberculosis D51.9 Vitamin B12 deficiency anemia, unspecified (History of) R13.11 Dysphagia, oral phase N18.31 Chronic kidney disease, stage 3a G44.021 Chronic cluster headache, intractable (Preliminary) C50.912 Malignant neoplasm of unspecified site of left female breast
Preexisting Conditions: U07.1 2019-nCoV acute respiratory disease (Primary) N39.0 Urinary tract infection, site not specified (Admission) K21.9 Gastro-esophageal reflux disease without esophagitis G89.4 Chronic pain syndrome E66.01 Morbid (severe) obesity due to excess calories M54.2 Cervicalgia F41.9 Anxiety disorder, unspecified (History of) G47.00 Insomnia, unspecified E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E03.9 Hypothyroidism, unspecified F06.30 Mood disorder due to known physiological condition, unspecified I50.22 Chronic systolic (congestive) heart failure I10 Essential (primary) hypertension M81.0 Age-related osteoporosis without current pathological fracture Z95.0 Presence of cardiac pacemaker F39 Unspecified mood [affective] disorder C85.84 Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb F31.62 Bipolar disorder, current episode mixed, moderate K59.09 Other constipation Z45.2 Encounter for adjustment and management of vascular access device D64.9 Anemia, unspecified Z79.01 Long term (current) use of anticoagulants Z51.81 Encounter for therapeutic drug level monitoring M17.9 Osteoarthritis of knee, unspecified M15.0 Primary generalized (osteo)arthritis I87.2 Venous insufficiency (chronic) (peripheral) F31.9 Bipolar disorder, unspecified C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites I73.9 Peripheral vascular disease, unspecified F32.9 Major depressive disorder, single episode, unspecified I89.0 Lymphedema, not elsewhere classified Q24.5 Malformation of coronary vessels I42.8 Other cardiomyopathies E03.9 Hypothyroidism, unspecified J30.9 Allergic rhinitis, unspecified Z86.718 Personal history of other venous thrombosis and embolism R33.9 Retention of urine, unspecified K42.9 Umbilical hernia without obstruction or gangrene Z90.89 Acquired absence of other organs R20.8 Other disturbances of skin sensation L03.111 Cellulitis of right axilla I87.2 Venous insufficiency (chronic) (peripheral) Z87.81 Personal history of (healed) traumatic fracture H04.121 Dry eye syndrome of right lacrimal gland R42 Dizziness and giddiness R53.81 Other malaise F48.2 Pseudobulbar affect R06.02 Shortness of breath H26.9 Unspecified cataract C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site H53.2 Diplopia E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene G89.4 Chronic pain syndrome E78.5 Hyperlipidemia, unspecified G47.33 Obstructive sleep apnea (adult) (pediatric) G60.8 Other hereditary and idiopathic neuropathies K57.92 Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding I48.91 Unspecified atrial fibrillation J02.9 Acute pharyngitis, unspecified (Preliminary) F31.63 Bipolar disorder, current episode mixed, severe, without psychotic features Z46.89 Encounter for fitting and adjustment of other specified devices R09.81 Nasal congestion Z46.89 Encounter for fitting and adjustment of other specified devices M25.562 Pain in left knee L53.9 Erythematous condition, unspecified R29.3 Abnormal posture F31.30 Bipolar disorder, current episode depressed, mild or moderate severity, unspecified T81.30XA Disruption of wound, unspecified, initial encounter R05 Cough (Preliminary) F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features S28.222A Partial traumatic amputation of left breast, initial encounter Z48.3 Aftercare following surgery for neoplasm F31.64 Bipolar disorder, current episode mixed, severe, with psychotic features R41.841 Cognitive communication deficit N63.0 Unspecified lump in unspecified breast H25.012 Cortical age-related cataract, left eye (Preliminary) H25.011 Cortical age-related cataract, right eye (History of) H25.091 Other age-related incipient cataract, right eye Z23 Encounter for immunization Z74.1 Need for assistance with personal care M62.81 Muscle weakness (generalized) K59.00 Constipation, unspecified I49.9 Cardiac arrhythmia, unspecified E55.9 Vitamin D deficiency, unspecified (History of) L23.9 Allergic contact dermatitis, unspecified cause (History of) F33.8 Other recurrent depressive disorders (History of) Z11.1 Encounter for screening for respiratory tuberculosis D51.9 Vitamin B12 deficiency anemia, unspecified (History of) R13.11 Dysphagia, oral phase N18.31 Chronic kidney disease, stage 3a G44.021 Chronic cluster headache, intractable (Preliminary) C50.912 Malignant neoplasm of unspecified site of left female breast
Allergies: Iodinated Contrast- Oral and IV Dye, Penicillins (PCN)
Diagnostic Lab Data:
CDC Split Type:

Write-up: DISCOVERED UNRESPONSIVE WITHOUT PULSE, RESPIRATIONS, HEART BEAT ON 2/7/21 AT 0435 A.M. RESIDENT WAS DNR STATUS.


VAERS ID: 1015630 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Died of a heart attack; A spontaneous report was received from a consumer concerning a 56-year-old male patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and died due to a heart attack. The patient''s medical history was not provided. Products known to have been used by the patient, within two weeks prior to the event, included additional medications. On an unknown date, the patient received their first of two planned doses of mRNA-1273 intramuscularly for prophylaxis of COVID-19 infection. - On an unknown date, the reporter stated the patient received Moderna''s COVID-19 vaccine and sometime after he was found dead by his bedside around 02:30 am. The patient died on an unknown date. The cause of death was due to a heart attack. Plans for autopsy were not provided.; Reporter''s Comments: This case concerns a 56 year old, male patient, who experienced fatal unexpected event of myocardial infarction. The event occurred on an unspecified date after mRNA-1273 (Lot# Unknown). Treatment details not provided. Very limited information regarding this event has been provided at this time. Based on temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Additional information has been requested.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1015670 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-29
Onset:2021-01-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Death, SARS-CoV-2 test positive, 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-18
   Days after onset: 16
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
Allergies:
Diagnostic Lab Data: Test Date: 20210102; Test Name: Covid test; Result Unstructured Data: Test Result:Positive; Test Date: 20210115; Test Name: Xrays; Result Unstructured Data: Test Result:covid Poss pockets all in her lungs
CDC Split Type: USPFIZER INC2021104685

Write-up: Xrays showed covid Poss pockets all in her lungs on 15Jan; Xrays showed covid Poss pockets all in her lungs on 15Jan; This is a spontaneous report from a contactable consumer. An 85-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 29Dec2020 at single dose for covid-19 immunisation. Medical history included dementia. Concomitant medications were not reported. Patient popped hot 02Jan2021 along with 4 others on the hall she lived. Within 9 days 50+ patients were positive. All had the vaccine the same day. Patient was test positive on 02Jan2021. She was on day 12 of her quarantine when she started to get worse. She was unresponsive by 16Jan2021 and passed 18Jan2021. We were with her from 14Jan2021 to 18Jan2021. But had not been allowed to visit with her since Mar2020. And what post treatment pairs well with it? Publicly we hear Remdesivir and Bamlanivimab but these patients only received a general antibiotic and some vitamins. Death cause was Xrays showed covid Poss pockets all in her lungs on 15Jan2021. No autopsy was performed. Information on the lot/batch number has been requested.; Sender''s Comments: Based on the information available, a possible contributory role of the suspect products cannot be excluded for the reported event of positive for corona virus infection for the lack of efficacy of the vaccine. However, based on the mechanism of action of the vaccine, it is unlikely the patient would have fully developed immunity for the vaccine to be effective, due to the number of days passed since the vaccine is given. Case will be reevaluated based on follow-up information; Reported Cause(s) of Death: Xrays showed covid Poss pockets all in her lungs on 15Jan


VAERS ID: 1015671 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-13
Onset:2021-01-18
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain upper, Apparent life threatening event, Computerised tomogram abnormal, Computerised tomogram intestine, Death, Intestinal perforation
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Neonatal disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-01-20
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MEMANTINE; DICLOFENAC; CARBIDOPA/LEVODOPA; QUETIAPINE; LEXAPRO; TYLENOL; GLUCOSAMINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis; Dementia
Allergies:
Diagnostic Lab Data: Test Date: 202101; Test Name: CT; Result Unstructured Data: Test Result:bowel perforation; Comments: CT showed a bowel perforation in the small bowel
CDC Split Type: USPFIZER INC2021107105

Write-up: bowel perforation; pain in her upper abdomen; This is a spontaneous report from a contactable consumer. An 86-year-old female patient received the 2nd dose of bnt162b2 (BNT162B2) at single dose on 13Jan2021 for Covid-19 immunisation, administerd at nursing home/senior living facility Medical history included dementia, arthritis. No known allergies. Patient was not pregnant. Patient had not COVID prior vaccination. Concomitant medication in 2 weeks included: memantine (manufacturer unknown) 10 mg BID, diclofenac (manufacturer unknown) BID, carbidopa, levodopa (manufacturer unknown) 25-100 mg TID, quetiapine (manufacturer unknown) 12.5 mg q HS, escitalopram oxalate (LEXAPRO) 10 mg q HS, paracetamol (TYLENOL) 650 mg BID, glucosamine (manufacturer unknown) drink. The patient received the 1st dose of bnt162b2 (BNT162B2) at single dose on 24Dec2020 for Covid-19 immunisation. No other vaccine received in 4 weeks. The patient experienced bowel perforation and pain in her upper abdomen on 18Jan2021 07:30. The events resulted in Emergency room/department or urgent care, Life threatening illness (immediate risk of death from the event), and death. On 18Jan2021 07:30 AM, less than a week after the second shot, she had pain in her upper abdomen and was taken to the ER on 18Jan2021. CT showed a bowel perforation in the small bowel. She had never had bowel surgery or diverticulitis. She had been healthy other than her dementia and arthritis. Patient received treatment for the events: hospice and pain management. COVID-19 was not tested post vaccination. The cause of death was bowel perforation. An autopsy was not performed. Information about lot/batch number has been requested.; Reported Cause(s) of Death: bowel perforation


VAERS ID: 1015687 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-02-08
Onset:2021-02-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Cardiac arrest, Cough, Death, Dyspnoea, Headache, Intraosseous access placement, Laryngeal mask airway insertion, Oxygen saturation decreased, Pulse absent, Pulseless electrical activity, Pyrexia, Respiratory arrest, Resuscitation, Unresponsive to stimuli, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-09
   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: lipitor, pepcid, uloric, prozac, synthroid, lisinopril, troprol xl, multivitamin, niacin, nifedical xl, ranexa, demadex, xarelto
Current Illness: none
Preexisting Conditions: a fib, HTN, CAD, PTSD, CHF, anxiety, gout, reflux, high cholesterol, obese, hypothyroidism.
Allergies: nknda or food allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Almost immediate headache per wife. Developed fever around 4 pm. Headache all day. Took Tylenol at 4 and 10 pm. Gradual development of SOB and cough. Temp of 101.4 at 10 pm. pulse ox 92% at 10 pm. Went to sleep, woke up at 0050 with increasing SOB. Pulse ox 82%. Used albuterol inhaler, wife called emergency services at 0113. EMS arrived around 0130 to patient''s home. pulse ox 86%, coughing, sob, hard time breathing. Walked to stretcher. Became unresponsive. Found to have no pulse, stopped breathing. CPR initiated at about 0140. King airway placed in field, I/O in left tibia. Patient from PEA to asystole, to vfib, to asystole. ACLS followed. Unrecoverable asystole and patient time of death 0213.


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