|
VAERS ID: |
970618 (history) |
Form: |
Version 2.0 |
Age: |
89.0 |
Sex: |
Female |
Location: |
Arkansas |
Vaccinated: | 2021-01-22 |
Onset: | 2021-01-23 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3248 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ? Symptoms: Cerebrovascular accident,
Unresponsive to stimuli SMQs:,
Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic
malignant syndrome (broad), Ischaemic central nervous system vascular
conditions (narrow), Haemorrhagic central nervous system vascular
conditions (narrow), Embolic and thrombotic events, vessel type
unspecified and mixed arterial and venous (narrow), 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: 2021-01-25
Days after onset: 2
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: UNKNOWN Current Illness: UNKNOWN Preexisting Conditions: UNKNOWN Allergies: UNKNOWN Diagnostic Lab Data: HOSPITAL STATED PATIENT HAD A STROKE CDC Split Type:
Write-up: SON SAID PATIENT WAS FOUND UNRESPONSIVE AND CALLED 911 |
|
VAERS ID: |
970930 (history) |
Form: |
Version 2.0 |
Age: |
91.0 |
Sex: |
Male |
Location: |
North Carolina |
Vaccinated: | 2021-01-09 |
Onset: | 2021-01-14 |
Days after vaccination: | 5 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
AR / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Asthenia,
COVID-19,
Death,
Fall,
Head injury,
Respiratory disorder,
SARS-CoV-2 antibody test negative,
SARS-CoV-2 test positive SMQs:,
Acute central respiratory depression (broad), Guillain-Barre syndrome
(broad), Accidents and injuries (narrow), Respiratory failure (broad),
Infective pneumonia (broad), Opportunistic infections (broad), COVID-19
(narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-25
Days after onset: 11
Permanent Disability? No
Recovered? No Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: I-caps Current Illness: - Preexisting Conditions: AAA Allergies: Penicillins Diagnostic Lab Data: Patient had positive PCR test on 1/21. IgG to COVID was negative on 1/19. CDC Split Type:
Write-up: Pt developed COVID-19 infection,
symptoms starting 7 days after first dose was given. Patient was
admitted to hospital on 1/21 after falling (secondary to weakness) and
striking head on toilet. Patient expired due to respiratory
complications of COVID on 1/25. |
|
VAERS ID: |
970976 (history) |
Form: |
Version 2.0 |
Age: |
95.0 |
Sex: |
Female |
Location: |
Connecticut |
Vaccinated: | 2021-01-20 |
Onset: | 2021-01-20 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL8982 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Death,
Dyspnoea,
Hypotension,
Lethargy,
Oxygen saturation decreased,
Rales,
Tachycardia,
Unresponsive to stimuli SMQs:,
Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes
mellitus (broad), Neuroleptic malignant syndrome (broad),
Anticholinergic syndrome (broad), Arrhythmia related investigations,
signs and symptoms (broad), Acute central respiratory depression
(broad), Pulmonary hypertension (broad), Guillain-Barre syndrome
(broad), Noninfectious encephalitis (broad), Noninfectious
encephalopathy/delirium (broad), Noninfectious meningitis (broad),
Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad),
Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia
(broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-21
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: VEntolin inhaler, Ursodial, Protonix, MVI, Mirtazapine, Lasix, Coumadin Current Illness:
Admitted from home to hospital on 1/5 for pancreatitis, Chocystitis, GI
bleed. HAd a biliary stent placed. TEsted positive for Covid 19 on
1/7/21. Transferred from hospital to a covid recovery Short term
facility and transferred to this facility on 1/18/21 for long term care.
She was admitted on comfort measures due to prior decline Preexisting Conditions: as above. Allergies: NKA Diagnostic Lab Data: n/a CDC Split Type:
Write-up: At approximately 12:15 pm the
resident had a brief unresponsive episode that resolved quickly. Her
Vital signs were stable and her mentation was at baseline. Later that
evening approximately 10 pm she had labored respirations, shortness of
breath, lethargy with bilateral crackles, Oxygen desaturated to 76% on
room air, tachycardia and hypotension. She expired at 6:30 a.m. the
following day. |
|
VAERS ID: |
971176 (history) |
Form: |
Version 2.0 |
Age: |
84.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 2021-01-20 |
Onset: | 2021-01-21 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
029L20A / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Asthenia,
Autopsy,
Cardiac arrest,
Death,
Fatigue,
Livedo reticularis,
Malaise,
Respiratory arrest,
Vomiting SMQs:,
Torsade de pointes/QT prolongation (broad), Anaphylactic reaction
(narrow), Acute pancreatitis (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), Gastrointestinal
nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy
(broad), Hypersensitivity (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-21
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: atorvastatin
10 mg avodart 0.5 mg finasteride 5 mg colace 100 mg fish oil capsule
over the counter nabumetone 750 mg omiprazole 20 mg tamsulosin 0.4 mg
calcium plus D3 over the counter Current Illness: last doctor visit on 10/27/2020 and no illness at that time, routine follow up Preexisting Conditions: BPH reflux (Gerd) Osteoarthritis high cholesterol Allergies: none Diagnostic Lab Data: Autopsy being done. CDC Split Type:
Write-up: Pt. woke up the next morning after
vaccination and "didn''t feel well", described by wife as fatigue, no
energy. At approximately 2 PM, he vomited. His wife checked on him at
4:20 PM and he wasn''t breathing sitting in his chair. EMS squad was
called but when they arrived he was asystole and mottling present. Did
not start CPR since he was already gone too long. Pronounced by coroner
on scene. |
|
VAERS ID: |
971559 (history) |
Form: |
Version 2.0 |
Age: |
|
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 2021-01-01 |
Onset: | 2021-01-19 |
Days after vaccination: | 18 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-19
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: USPFIZER INC2021053200
Write-up: her mother passed away 7-8 days
after receiving the vaccine; This is a spontaneous report from a
contactable consumer, the daughter of the patient. A female patient of
an unspecified age received the first dose of COVID-19 mRNA VACCINE
(MANUFACTURER UNKNOWN), via an unspecified route of administration in
Jan2021 as a single dose for COVID-19 immunization. The patient''s
medical history and concomitant medications were not reported. On
19Jan2021 about 7-8 days after receiving the vaccine, the patient passed
away. The patient was fine before she received the vaccine and then
passed away 7-8 days later. The cause of death was not reported. It
was not reported if an autopsy was performed. The reporter thought her
mother''s death had everything to do with the COVID-19 vaccine. The lot
number for the vaccine was not provided and will be requested during
follow up.; Reported Cause(s) of Death: Death |
|
VAERS ID: |
971561 (history) |
Form: |
Version 2.0 |
Age: |
80.0 |
Sex: |
Male |
Location: |
Virginia |
Vaccinated: | 2021-01-20 |
Onset: | 2021-01-20 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3302 / 1 |
LA / OT |
Administered by: Military Purchased by: ? Symptoms: Death,
Dizziness,
Headache,
Nausea SMQs:,
Acute pancreatitis (broad), Anticholinergic syndrome (broad),
Gastrointestinal nonspecific symptoms and therapeutic procedures
(narrow), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-20
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: Medical History/Concurrent Conditions: Atrial fibrillation (Diagnosed about 10 years ago.) Allergies: Diagnostic Lab Data: CDC Split Type: USPFIZER INC2021058178
Write-up: Unspecified event/he passed away;
Dizziness; Nausea; Headache; This is a spontaneous report from a
contactable consumer (patient''s wife). An 80-year-old male patient
received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE)
(Lot number EL3302), intramuscular at single dose in the left arm on
20Jan2021 08:15AM for Covid-19 immunisation. Medical history included
atrial fibrillation (Diagnosed about 10 years ago). Concomitant
medications included unspecified drug for atrial fibrillation. On
20Jan2021, the patient experienced dizziness, nausea, headache with
outcome of unknown and unspecified event/he passed away. The patient
died on 20Jan2021. An autopsy was not performed. The events were
described as follows: "Her husband received the first dose of the
vaccine yesterday morning and he passed away last night. She is not sure
what time he died last night. States he was so eager to get the
vaccine. Reports he was exhibiting symptoms that were listed as possible
side effects. He was experiencing dizziness, nausea, and a headache
that started several hours after the vaccine, the side effects started
in the early afternoon. She does not know the cause of death and does
not think an autopsy was performed". The vaccine was administered at
Hospital Facility. The patient did not receive any other vaccines within
4 weeks prior to the COVID vaccine.; Reported Cause(s) of Death:
Unspecified event/he passed away |
|
VAERS ID: |
971562 (history) |
Form: |
Version 2.0 |
Age: |
|
Sex: |
Unknown |
Location: |
New York |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Death,
Immune thrombocytopenia SMQs:,
Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus
erythematosus (broad), Hypersensitivity (narrow), Drug reaction with
eosinophilia and systemic symptoms syndrome (broad),
Immune-mediated/autoimmune disorders (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: Allergies: Diagnostic Lab Data: CDC Split Type: USPFIZER INC2021058222
Write-up: died; acute immune
thrombocytopenia; This is a spontaneous report from two contactable
consumers. A patient of unspecified age and gender received BNT162B2(lot
number and expiration date not provided) via an unspecified route of
administration on unspecified date at single dose for COVID-19
immunization. The patient''s medical history and concomitant medications
were not reported. The patient died after receiving the covid vaccine
on an unknown date. The patient developed acute immune thrombocytopenia
on an unknown date. It was unknown if autopsy was performed. The cause
of death was unknown. The outcome of the event "died" was fatal and of
the event " acute immune thrombocytopenia" was unknown. The reporter
wondered if a platelets blood problem may lead to death and if who have a
blood platelets condition like essential thrombocytosis should not risk
taking the vaccine. Information on the lot/batch number has been
requested.; Reported Cause(s) of Death: Died |
|
VAERS ID: |
971676 (history) |
Form: |
Version 2.0 |
Age: |
82.0 |
Sex: |
Female |
Location: |
Iowa |
Vaccinated: | 2020-12-31 |
Onset: | 2021-01-01 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Back pain,
Myalgia SMQs:,
Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad),
Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders
(broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-19
Days after onset: 18
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: Tylenol,
aleve, aspirin, bisacodyl, calcium carb-cholecalciferol, diclofenac,
fluticasone-Salmeterol inhaler, hydromorphone, hycacyamine sulfate,
ketoconazole cream, levemir, lidocaine patch, lisinopril, mematine,
methcarbamol, metoprolol, Current Illness: HYPERLIPIDEMIA,
UNSPECIFIED(E78.5), CHRONIC OBSTRUCTIVE PULMONARY DISEASE,
UNSPECIFIED(J44.9), VASCULAR DEMENTIA WITHOUT BEHAVIORAL
DISTURBANCE(F01.50), OTHER SPECIFIED ANXIETY DISORDERS(F41.8), VENTRAL
HERNIA WITHOUT OBSTRUCTION OR GANGRENE(K43.9), NONINFECTIVE
GASTROENTERITIS AND COLITIS, UNSPECIFIED(K52.9), CHRONIC VASCULAR
DISORDERS OF INTESTINE (K55.1), SACROCOCCYGEAL DISORDERS, NOT ELSEWHERE
CLASSIFIED(M53.3), OTHER SPECIFIED DISORDERS OF BONE DENSITY AND
STRUCTURE, UNSPECIFIED SITE(M85.80), PERSONAL HISTORY OF OTHER VENOUS
THROMBOSIS AND EMBOLISM(Z86.718), PRESENCE OF INTRAOCULAR LENS(Z96.1),
ANEMIA, UNSPECIFIED(D64.9), DISORDER OF WHITE BLOOD CELLS,
UNSPECIFIED(D72.9), IRRITABLE BOWEL SYNDROME(K58), ABDOMINAL AORTIC
ANEURYSM, WITHOUT RUPTURE(I71.4), PAIN IN RIGHT ANKLE AND JOINTS OF
RIGHT FOOT(M25.571), TYPE 2 DIABETES MELLITUS WITH DIABETIC PERIPHERAL
ANGIOPATHY WITHOUT GANGRENE(E11.51), ACUTE HEMATOGENOUS OSTEOMYELITIS,
OTHER SITES(M86.08), ESSENTIAL (PRIMARY) HYPERTENSION(I10), GROSS
HEMATURIA(R31.0), MAJOR DEPRESSIVE DISORDER, RECURRENT,
UNSPECIFIED(F33.9), CHRONIC KIDNEY DISEASE, STAGE 2 (MILD)(N18.2), WEDGE
COMPRESSION FRACTURE OF T11- T12 VERTEBRA, SUBSEQUENT ENCOUNTER FOR
FRACTURE WITH ROUTINE HEALING(S22.080D), PERIPHERAL VASCULAR DISEASE,
UNSPECIFIED(I73.9), BODY MASS INDEX [BMI]40.0-44.9, ADULT(Z68.41),
HYPERMETROPIA, BILATERAL(H52.03), OTHER MYELODYSPLASTIC
SYNDROMES(D46.Z), MUSCLE WEAKNESS (GENERALIZED)(M62.81 Preexisting Conditions: see #11 Allergies: hydrocodone, metformin, niacin, Aricept, lipitor Diagnostic Lab Data: resident hospitalized on 1/6/21 CDC Split Type:
Write-up: muscle aches-increased pain to lower back |
|
VAERS ID: |
971736 (history) |
Form: |
Version 2.0 |
Age: |
88.0 |
Sex: |
Male |
Location: |
Iowa |
Vaccinated: | 2021-01-21 |
Onset: | 2021-01-21 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Neurological symptom,
Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-21
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, aspirin, atorvastatin, bicalutamide, Plavix, lisinopril,
metoprolol, multivitamin, oxycodone, Seroquel, sertraline, vanicream Current Illness:
DISPLACED INTERTROCHANTERIC FRACTURE OF LEFT FEMUR, SUBSEQUENT
ENCOUNTER FOR CLOSED FRACTURE WITH ROUTINE HEALING (S72.142D), MALIGNANT
NEOPLASM OF PROSTATE(C61), UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL
DISTURBANCE(F03.90), ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY
ARTERY WITHOUT ANGINA PECTORIS(I25.10), DISPLACED FRACTURE OF BASE OF
NECK OF RIGHT FEMUR, SUBSEQUENT ENCOUNTER FOR CLOSED FRACTURE WITH
ROUTINE HEALING(S72.041D), ESSENTIAL (PRIMARY) HYPERTENSION(I10),
ANEMIA, UNSPECIFIED(D64.9), HYPOKALEMIA(E87.6), ST ELEVATION (STEMI)
MYOCARDIAL INFARCTION OF UNSPECIFIED SITE(I21.3), MAJOR DEPRESSIVE
DISORDER, RECURRENT, UNSPECIFIED(F33.9), HYPERLIPIDEMIA,
UNSPECIFIED(E78.5), ALZHEIMER''S DISEASE WITH LATE ONSET(G30.1), OTHER
ABNORMALITIES OF GAIT AND MOBILITY(R26.89), DISORIENTATION,
UNSPECIFIED(R41.0), MUSCLE WEAKNESS (GENERALIZED)(M62.81), DYSPHAGIA,
OROPHARYNGEAL PHASE(R13.12) Preexisting Conditions: see #11 Allergies: terbinafine, ACE inhibitors, tetanus toxoids Diagnostic Lab Data: CDC Split Type:
Write-up: Vomit 30 minutes after
administration. approx. 9 hours later, resident has Stroke-like
symptoms. He was previously on Hospice before admitting to our facility
and planned to be readmitted to hospice upon discharge. |
|
VAERS ID: |
971800 (history) |
Form: |
Version 2.0 |
Age: |
58.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 2021-01-04 |
Onset: | 2021-01-04 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-25 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
RA / IM |
Administered by: Work Purchased by: ? Symptoms: Autopsy,
Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-04
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 - Smoker Preexisting Conditions: Unknown Allergies: None reported Diagnostic Lab Data: Unkown CDC Split Type:
Write-up: Patient expired - autopsy preformed - cause of death not related to COVID-19 vaccination according to coroner. |
|