|
| VAERS ID: |
944439 (history) |
| Form: |
Version 2.0 |
| Age: |
62.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-26 |
| Onset: | 2021-01-03 |
| Days after vaccination: | 8 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1685 / 1 |
- / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-03
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: Keppra, Levothyroxine, Miralax, Olanzapine, Trazadone, Risperidone, and Lorazepam
Current Illness: Receiving hospice services
Preexisting Conditions: Stage 4 kidney function
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Resident expired on 1/2/21. |
|
| VAERS ID: |
944595 (history) |
| Form: |
Version 2.0 |
| Age: |
56.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2021-01-12 |
| Onset: | 2021-01-12 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3302 / 2 |
AR / IM |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0140 / 1 |
AR / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Brain death,
Cardiac arrest,
Death,
Intensive care,
Life support,
Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (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), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-14
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan, spironolactone, carvedilol
Current Illness: No known new illnesses,
Preexisting Conditions: Cardiomyopathy
Allergies: nkda
Diagnostic Lab Data: mulitple Full ER code and then ICU support for 2 days
CDC Split Type:
Write-up: Cardiac arrest within 1 hour Patient had the second vaccine approximately 2 pm on Tuesday Jan 12th He works at the extended care community and was in good health that morning with no complaints. He waited 10-15 minutes at the vaccine admin site and then told them he felt fine and was ready to get back to work. He then was found unresponsive at 3 pm within an hour of the 2nd vaccine. EMS called immediately worked on him 30 minutes in field then 30 minutes at ER was able to put him on life support yet deemed Brain dead 1-14-21 and pronounced dead an hour or so later |
|
| VAERS ID: |
944641 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 2021-01-12 |
| Onset: | 2021-01-13 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
011L20A / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-13
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 80mg daily, biotin 2500mg daily, Calcium-Mag-Zinc tab daily, Restasis eye drop q12hr, ezetimibe 10mg qhs, gabapentin 100mg bid, lysine 1000mg daily, metoprolol tart 50mg bid, fish oil 1000mg daily, prilosec 20mg daily, ranola
Current Illness: CAD, angina, coronary bypass in 1990''s, Cardiac Cath on 12/28/2020
Preexisting Conditions: CAD
Allergies: Sulfa
Diagnostic Lab Data: NA
CDC Split Type:
Write-up: Patient died on 1/21-2021 |
|
| VAERS ID: |
944732 (history) |
| Form: |
Version 2.0 |
| Age: |
92.0 |
| Sex: |
Male |
| Location: |
Wisconsin |
| Vaccinated: | 2021-01-13 |
| Onset: | 2021-01-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
037K2OA / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Pulse absent,
Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (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: 2021-01-14
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: Cholecalciferol, furosemide, metoprolol tartrate, tamsulosin, amlodipine, finasteride
Current Illness: Covid-19 infection from 12/31-01/10/2021
Preexisting Conditions: CHF, atrial fibrilation, Dysphagia, macular degeneration, Vitamin D deficiency, impaired fasting glucose, benign prostatic hyperplasia, osteoporosis, retention of urine, anemia
Allergies: hydrocodone
Diagnostic Lab Data: None.
CDC Split Type:
Write-up: Resident found unresponsive and without pulse at 05:45am. |
|
| VAERS ID: |
944998 (history) |
| Form: |
Version 2.0 |
| Age: |
88.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2021-01-04 |
| Onset: | 2021-01-12 |
| Days after vaccination: | 8 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Headache,
Malaise,
Nausea,
Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-12
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: Resident in skilled nursing facility. Please contact facility if needing all medications.
Current Illness:
Preexisting Conditions: Asthma, hypothyroidism, essential hypertension, atherosclerotic heart disease of native coronary artery, spinal stenosis, fibromyalgia, dementia. Please contact nursing facility for further needed information.
Allergies: Phenazopyridine, Demerol, Pyridium, Penicillins
Diagnostic Lab Data:
CDC Split Type:
Write-up: On 1/11/21 noted with headache, nausea/vomiting, severe melaise. On 1/12/21 resident expired. |
|
| VAERS ID: |
945241 (history) |
| Form: |
Version 2.0 |
| Age: |
71.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2021-01-13 |
| Onset: | 2021-01-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / UNK |
- / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Exposure to SARS-CoV-2,
Resuscitation,
Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-14
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data:
CDC Split Type:
Write-up: 71yo female resident who died after receiving Pfizer BioNTech vaccine. On 1/14/2021, VS taken at 10am, B/P 99/60, O2 sats, 95% (trach w/O2). At 11:30am, Patient showed no s/sx of distress, A&Ox3. At 11:50am, a nurse went to perform a COVID test and assessment (the facility is experiencing an outbreak), and found the patient unresponsive on the bathroom floor. CPR was immediately started; no shock advised per AED; 12:15pm EMS arrived and took over. At 12:38pm, EMT called time of death. |
|
| VAERS ID: |
945247 (history) |
| Form: |
Version 2.0 |
| Age: |
96.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-29 |
| Onset: | 2021-01-05 |
| Days after vaccination: | 7 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Cerebrovascular accident,
Chest X-ray normal,
Death,
Dysphagia,
Hemiparesis,
Urinary tract infection,
Urine analysis abnormal
SMQs:, Anticholinergic 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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-13
Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: depakote, lexapro, lisinopril, multiple vitamin, senna, seroquel, tylenol
Current Illness: Nothing acute prior
Preexisting Conditions: dementia, hypertension, depression, delusions, anxiety
Allergies: aricept, namenda, penicillin, actonel, erythromycin, niacin
Diagnostic Lab Data: Urinalysis did show a UTI and CXR was negative for aspiration pneumonia. Family did not want her sent to the hospital. She died on 1/13/21
CDC Split Type:
Write-up: Has underlying dementia and often with difficulty eating. 1 week after immunization she developed a stroke with left sided weakness and difficulty swallowing. Comfort measures instituted. Not sure if this is related to the vaccine, but thought I should report |
|
| VAERS ID: |
945253 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2021-01-13 |
| Onset: | 2021-01-14 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL1284 / UNK |
- / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Feeling abnormal,
Nausea,
Pulse absent,
Respiratory arrest,
Restlessness,
Resuscitation,
Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Akathisia (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-14
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies: UNK
Diagnostic Lab Data: UNK
CDC Split Type:
Write-up: 83yo female resident who died after receiving Pfizer BioNTech vaccine. On 1/14/2021, the patient reportedly got up in the middle of the night with c/o feeling "blah", restlessness, and nausea. VS normal, no other s/sx. At 4:15am, the patient was asked to go back to bed, assisted by a nurse and GNA. At 6am, GNA was going to do morning VS and found the patient unresponsive, no pulse, no respirations. GNA notified the nurse. At 6:03am, CPR started and EMS called. At 6:15am, EMS arrived and took over. At or around 6:30am, EMT called time of death |
|
| VAERS ID: |
945578 (history) |
| Form: |
Version 2.0 |
| Age: |
72.0 |
| Sex: |
Female |
| Location: |
Kansas |
| Vaccinated: | 2021-01-02 |
| Onset: | 2021-01-10 |
| Days after vaccination: | 8 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0142 / UNK |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Decreased appetite,
Hyporesponsive to stimuli,
Livedo reticularis,
Skin discolouration
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-11
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: Aspirin 81 mg, metformin, namenda, effexor XR, donepezil, potassium chloride, Vitamin B12, Brillinta, clonzepam, flomax, ultram, oxybutynin chloride, sucralfate, ferrous sulfate, protonix, percocent, metoprolol succinate ER, senna Colace, n
Current Illness: Had a tooth extraction done on 1/6/21. Was on amoxicillin for 7 days and it caused diarrhea. Changed to Keflex.
Preexisting Conditions: Dementia, COPD, Type 2 DM, Atherosclerotic Heart Disease, Depression, Hypertensive Heart disease without heart failure GI hemorrhage, calculus of ureter, systolic CHF, Peripheral vascular disease, GERD, anxiety.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: No reactions immediately after vaccine was given. Resident has dementia, has had multiple hospitalizations related to a renal stone recently. Had a tooth that was bothering her, went to see her dentist and it was extracted on 1/6/21. On 1/10 they noted feet and ankles are dark purple with white splotches appears to be mottling. Minimally responsive to voice and touch. Not eating. Compassionate visit with family. Family did not want hospice, did not feel it was needed, said, what more could they do for her than you''re already doing? On 1/11 at 1950 was determined to be deceased. |
|
| VAERS ID: |
945603 (history) |
| Form: |
Version 2.0 |
| Age: |
94.0 |
| Sex: |
Male |
| Location: |
Kansas |
| Vaccinated: | 2021-01-02 |
| Onset: | 2021-01-08 |
| Days after vaccination: | 6 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0412 / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Cardiac pacemaker evaluation,
Cyanosis,
Metabolic function test,
Pulse absent
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-08
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: Verapamil ER, Pepcid, Norco, Vit D3, synthroid, flecainide Ace acetate, mucinex, lisinpril, amitriptyline, eliquis, atorvastatin, furosemide, acetaminophen, Coenzyme Q-10, metoprolol succinate ER
Current Illness: Hospitalized for abnormal heart rhythm 12/18/20.
Preexisting Conditions: anemia, hypothyroidism, BPH, paroxysmal atrial fib, HTN, atherosclerotic heart disease, Chronic Kidney dz stage 3, CHF
Allergies: NKA
Diagnostic Lab Data: 1/5/21 BMP drawn
CDC Split Type:
Write-up: Had no immediate issues with the vaccine. He had returned from the hospital on 12/21 and had some concerns about his weight which were shared with his physician on 1/4/21. On 1/5/21 had a visit with his cardiologist for a pacemaker check. On 1/8/21 staff were called to his room, he was on the floor, bluish skin color. No vital signs found, no heart rhythm heard at 2200. |
|
