|
| VAERS ID: |
967749 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2021-01-12 |
| Onset: | 2021-01-13 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL0142 / UNK |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Brain natriuretic peptide increased,
Cardiac arrest,
SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-13
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Jan 11, 2021@15:111 NASOPHARYNX COVID-19 MONT (VELA): DETECTED Jan 11, 2021@10:51 PLASMA BNP: 403 H pg/mL 0 - 100
CDC Split Type:
Write-up: Cardiac Arrest Narrative: |
|
| VAERS ID: |
950935 (history) |
| Form: |
Version 2.0 |
| Age: |
|
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2021-01-12 |
| Onset: | 2021-01-15 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL8982 / 1 |
LA / IM |
Administered by: Unknown 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Resident expired |
|
| VAERS ID: |
950979 (history) |
| Form: |
Version 2.0 |
| Age: |
81.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2021-01-14 |
| Onset: | 2021-01-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
UN / SYR |
Administered by: Public Purchased by: ?
Symptoms: Death,
Headache
SMQs:
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: allopurinol -Zyoprim 3000 mg amlodipine Norvasc 5 mg Lispro 100/unit /ml ups us to 150 unit daily per insulin scale Levemir U-100 - 100/unit/ml - (3ML) 55 units nightly Levothryoxine -Synthroid - 137 mcg - daily Simvastatin 25 mg - d
Current Illness:
Preexisting Conditions: IPF - Idoipathic Pulmonary Fibrosis Diabetic
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:
Write-up: Headache after dose was given at 10:00 a.m Died at after 7:30 pm the same night the dose was given. |
|
| VAERS ID: |
951101 (history) |
| Form: |
Version 2.0 |
| Age: |
90.0 |
| Sex: |
Male |
| Location: |
Colorado |
| Vaccinated: | 2020-12-31 |
| Onset: | 2021-01-03 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
- / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Abnormal behaviour,
Acute kidney injury,
Alanine aminotransferase increased,
Aspartate aminotransferase increased,
Blood creatinine increased,
Cerebral infarction,
Cerebrovascular accident,
Computerised tomogram head abnormal,
Computerised tomogram thorax normal,
Influenza like illness,
Liver function test abnormal,
Malaise,
Movement disorder,
Nausea,
Speech disorder,
Troponin increased,
Vomiting,
White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (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), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-05
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol tartrate, furosemide
Current Illness:
Preexisting Conditions: hypertension, dementia, osteoarthritis, diverticulosis
Allergies: tramadol
Diagnostic Lab Data: CREATININE = 4.73 AST= 410 ALT= 579 WBC= 25.95 TROPONIN = 0.174 CT SCAN OF HEAD PER THE RADIOLOGIST = ACUTE LEFT PCA DISTRIBUTION INFARCT. NO HEMORRHAGICE CONVERSION. NO MIDLINE SHIFT. BASILAR CISTERNS ARE PATENT. CT OF CHEST= NEGATIVE
CDC Split Type:
Write-up: PATIENT GOT HER FIRST COVID PFIZER VACCINE AT 12/31 IN THE AM. HAD GOTTEN FLU LIKE SYMPTOMS AND HAD BEEN SICK FOR A COUPLE OF DAYS. HAD NAUSEA AND VOMITTING DURING THIS TIME AS WELL. ON 1/3 THE CARE GIVER WENT TO CHECK ON HER PT AT HER LTC FACILITY WHERE SHE LIVES AND SHE WASN''T ACTING RIGHT. SHE WAS UNABLE TO DO A STROKE EXAM. PT HAD NO MOVEMNET IN ARMS OR LEGS AND WAS UNABLE TO SPEAK. PT WAS VITALLY STABLE AT THE TIME. EMS RECORDED THAT THEY THOUGHT DIAGNOSIS WOULD BE STROKE, PNEUMONIA OR SEPSIS. AFTER ARRIVAL AT THE HOSPITIAL DETERMED THAT SHE HAD A STORKE, ACUTE KIDNEY INJURY, ABNORMAL LFTS. |
|
| VAERS ID: |
951678 (history) |
| Form: |
Version 2.0 |
| Age: |
75.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2021-01-13 |
| Onset: | 1921-01-17 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3249 / 2 |
RA / - |
Administered by: Private 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: 2021-01-17
Days after onset: 36525
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor 20 mg, Claritin-D 24 hour, Zaria 10 mg, baby aspirin, replatha,valsart hits 160-12.5mg Fish oil, wheat germ oil, D3 1000 mg, testosterone 8% gel, CO Q 10, weirder prime , eye drops
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Heart attack death medical test
CDC Split Type:
Write-up: Heart attack death medical test |
|
| VAERS ID: |
951688 (history) |
| Form: |
Version 2.0 |
| Age: |
63.0 |
| Sex: |
Male |
| Location: |
Arkansas |
| Vaccinated: | 2021-01-02 |
| Onset: | 2021-01-17 |
| Days after vaccination: | 15 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / 1 |
- / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-17
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: Diclofenac Sodium Gel 1 %, Atorvastatin Calcium Tablet 40 MG, Acetaminophen Tablet 325 MG, Melatonin Tablet 3 MG, Vitamin D3 Tablet 25 MCG, Iron Tablet 325, Multivital-M Tablet, Eliquis Tablet 5 MG, metFORMIN HCl Tablet 500 MG, NIFEdipine
Current Illness: 11/25/20 Lower mid back abscess 11/4/20 toenail removal
Preexisting Conditions: CEREBRAL INFARCTION DUE TO UNSPECIFIED OCCLUSION OR STENOSIS OF LEFT MIDDLE CEREBRAL ARTERY, PRESENCE OF AUTOMATIC (IMPLANTABLE) CARDIAC DEFIBRILLATOR, UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE, APHASIA, DYSPHAGIA, UNSPECIFIED, WEAKNESS, COVID-19, OTHER REDUCED MOBILITY, URINARY TRACT INFECTION, SITE NOT SPECIFIED, ABNORMAL WEIGHT LOSS, TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS, VITAMIN DEFICIENCY, UNSPECIFIED, VITAMIN D DEFICIENCY, UNSPECIFIED, ANEMIA, UNSPECIFIED, CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE, CHRONIC KIDNEY DISEASE, STAGE 2 (MILD), ESSENTIAL (PRIMARY) HYPERTENSION, GOUT, UNSPECIFIED, INSOMNIA, UNSPECIFIED
Allergies: No Known Allergies
Diagnostic Lab Data: na
CDC Split Type:
Write-up: Resident expired 1/17/21 |
|
| VAERS ID: |
955256 (history) |
| Form: |
Version 2.0 |
| Age: |
88.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2021-01-16 |
| Onset: | 2021-01-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL8982 / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Cardioversion,
Immediate post-injection reaction,
Muscle contractions involuntary,
Pulse absent,
Resuscitation,
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), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
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: None listed
Current Illness: None Listed
Preexisting Conditions: None Listed
Allergies: None Listed
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient was vaccinated in right arm. Within 5 to 10 seconds after vaccination, patient started clinching his hands tightly and became unresponsive. Patient was lowered to the floor and did not exhibit a pulse. CPR was initiated and 911 was called. An AED was used and healthcare professionals onsite continued compressions until the paramedics arrived. |
|
| VAERS ID: |
952204 (history) |
| Form: |
Version 2.0 |
| Age: |
75.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
PFIZERER9201 / 1 |
LA / IM |
Administered by: Military Purchased by: ?
Symptoms: Autopsy,
Death,
Malaise
SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2020-12-01
Days after onset: 29
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin 500mg
Current Illness: None: Clean bill of health and a full cardiac exam was performed 2 months prior.
Preexisting Conditions: None.
Allergies: None
Diagnostic Lab Data: A full autopsy was done but results are pending.
CDC Split Type:
Write-up: Patient became sick 3 hours after the vaccine and was found deceased 1 day after his vaccination. He passed away in his sleep. |
|
| VAERS ID: |
952704 (history) |
| Form: |
Version 2.0 |
| Age: |
79.0 |
| Sex: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 2021-01-14 |
| Onset: | 2021-01-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Other Purchased by: ?
Symptoms: Abdominal pain upper,
Abnormal behaviour,
Agitation,
Anxiety,
Completed suicide,
Confusional state,
Dementia,
Dyspnoea,
Panic disorder,
Pyrexia,
SARS-CoV-2 test negative,
Tremor,
Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Suicide/self-injury (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-16
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: Daughter does not know all medications to list at time of reporting
Current Illness: Pneumonia 12/20 not Covid19 related
Preexisting Conditions: COPD, Curvature of Spine pressed against lung, High blood pressure, Diabetes
Allergies: N/A
Diagnostic Lab Data: Covid 19 : negative and pt lungs clear, all else unknown to reporter -- Daughter
CDC Split Type:
Write-up: Daughter call in for VAERS report to file for father whom committed suicide 1/16/2021 in the AM after reportable ae of COVID 19 vaccine administered 1/14/2021. Patient sought care twice at ER; first visit by ambulance around 5PM and Friday 1/15/2021 Medical Center: Emergency Room. 1st Discharge summary diagnosis: adverse reaction to COVID shot; 2nd Discharge summary diagnosis: adverse reaction to COVID shot, fever, Panic Disorder-- ER. Medical Center Discharge summary diagnosis: Adverse reaction to the vaccine, acute anxiety. Reportable patient symptoms at, 1st visit : fever, shaking stomach cramps, breathing issues. Medical Center -- No fever, confusion and dementia type, patient would not stay in patient bed; patient would get up and sit down again repeatedly, agitated and anxious. Attempted to urinated hospital bed. Patient committed suicide in home. |
|
| VAERS ID: |
952713 (history) |
| Form: |
Version 2.0 |
| Age: |
64.0 |
| Sex: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2020-12-30 |
| Onset: | 2021-01-12 |
| Days after vaccination: | 13 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
026L20A / UNK |
AR / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Asthenia,
Death,
Oxygen saturation decreased,
SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-16
Days after onset: 4
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: Diabetes, Parkinson Disease
Allergies: PCN, Zithromax, Flomax
Diagnostic Lab Data: PCR and antigen test
CDC Split Type:
Write-up: Weakness, Low O2, death. Positive for COVID on 1/12/21, dies on 1/16/21 |
|
