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Search Results

From the 4/26/2024 release of VAERS data:

Found 309,085 cases where Vaccine is COVID19 and Serious

Government Disclaimer on use of this data

Table

   
AgeCountPercent
< 6 Months430.01%
6-11 Months340.01%
1-2 Years850.03%
3-5 Years2010.07%
6-17 Years5,5901.81%
18-29 Years17,1105.54%
30-39 Years22,3307.22%
40-49 Years24,6627.98%
50-59 Years29,7879.64%
60-64 Years15,8765.14%
65-79 Years49,45616%
80+ Years29,7859.64%
Unknown114,12636.92%
TOTAL309,085100%



Case Details

This is page 17 out of 30,909

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VAERS ID: 914473 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Cognitive disorder, Computerised tomogram head, Decreased appetite, Depressed level of consciousness, Facial paralysis, Fatigue, Hypertension, Laboratory test, Livedo reticularis, Mental status changes, Pyrexia, Rash, Rash macular, Speech disorder, Tremor
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Eliquis, carbidopa-levidopa, Cardizem, Comtan, gabapentin, metoprolol, omeprazole, potassium citrate
Current Illness: COVID-19 positive
Preexisting Conditions: hypertension, hypokalemia, malignant neoplasm, tremor,
Allergies: Cipro, Levaquin, topiramate
Diagnostic Lab Data: Lab, Chest x-ray, Head CT, IVF
CDC Split Type:

Write-up: Weakness, fatigue, decreased appetite, upper extremity shaking, sternal red blotchy rash, decreased mental status, non-verbal, decreased level of conscious, mottling, left side facial droop, hypertensive, fever, unable to follow commands


VAERS ID: 914474 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2020-12-29
Onset:2020-12-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Dyspnoea, Headache, Oropharyngeal pain, Peripheral swelling, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 Q8, Vit C, lactobacillus 20 billions daily, metaxalone 800 mg 3 times daily
Current Illness: Asthma
Preexisting Conditions: Asthma
Allergies: Benzonatate, iodine, guaifaresin
Diagnostic Lab Data: Benadryl 50 mg then 50 IV Q8 hours, epinephrine, Pepcid,
CDC Split Type:

Write-up: headache 15 minutes after receiving vaccine, 3 to 4 hours later broke out in rash on upper extremities, ABD pain, itchy, and arm swelling, throat hurts. SOB


VAERS ID: 914479 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2020-12-24
Onset:2020-12-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Hemiparesis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xyzal 5mg tab. Take 1 tab BID Amlodipine 10mg 1 tab PO QAM Kariva (Mircette) 1 tab PO QHS Mucinex (Guaifenesin) 600 mg 1tab PO BID Omega 3 Fatty acid 1cap PO QD Calcium + Vitamin D 600 mg 2 tabs PO Qhs Ocean spray BID to nostrils Nas
Current Illness: none
Preexisting Conditions: Mild to moderate Intellectual Disabilities Organic Anxiety Disorder Atypical Manic Disorder Frontal Lobe Disorder Chronic Bronchiectasis Hypothyroidism Mild sleep apnea CPAP at 6 cm Hyperlipidemia Hypertension Nasal Allergies Facial Acne Obesity , Short Stature Chronic Sinusitis Seizure Disorder
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left sided weakness, fatigue for 3 days post immunization. Patient was seen by health care provider on 12/30/2020. Provider transferred patient to Hospital ER for further evaluation.


VAERS ID: 914496 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Injection site pain, Mobility decreased, Pruritus
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: At about 6am after receiving the shot I felt very tender at the injection site almost as if it was bruised. Then over the course of the day I started to feel very itchy all over my body but mainly on my right side. 10pm I got up for work, and could barely move, I''m feeling intense back pain on my lower back on the right side. I can walk but its all very limited motion, I can really only manage by putting all my weight on my left side.


VAERS ID: 914521 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Idaho  
Vaccinated:2020-12-28
Onset:2020-12-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Amphetamines positive, Anterograde amnesia, Antidepressant drug level, Atelectasis, Back pain, Bacterial test positive, Barbiturates positive, Blood culture, Blood lactic acid normal, Blood urine present, Chills, Cholelithiasis, Chromaturia, Coma scale abnormal, Computerised tomogram abdomen normal, Computerised tomogram head normal, Computerised tomogram pelvis, Computerised tomogram thorax normal, Condition aggravated, Cough, Culture urine, Drug screen, Dysarthria, Dysuria, Eye movement disorder, Flank pain, Gaze palsy, Glucose urine absent, Headache, Hypertonia, Hypopnoea, Incoherent, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Intervertebral disc degeneration, Lethargy, Leukocytosis, Mental status changes, Migraine, Moaning, Myalgia, Nasal congestion, Nasal septum deviation, Nausea, Nitrite urine absent, Opiates negative, Oropharyngeal pain, Paranasal cyst, Pelvic pain, Protein urine absent, Pyrexia, Red blood cells urine negative, SARS-CoV-2 test positive, Scan with contrast normal, Seizure, Sinus disorder, Specific gravity urine normal, Unresponsive to stimuli, Urine abnormality, Urine analysis, Urine bilirubin decreased, Urine ketone body present, Urine leukocyte esterase, Urobilinogen urine, Vomiting, White blood cells urine negative, pH urine normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Drug abuse and dependence (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Proteinuria (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: none on file
Current Illness: COVID- 19 diagnosis 12/11/2020 asymptomatic
Preexisting Conditions: DIAGNOSIS 1. COVID-19 virus infection ? 2. Urinary tract infection with hematuria, site unspecified ? ? Microscopic hematuria. 3. Seizure (HCC) ? 4. Nonintractable headache, unspecified chronicity pattern, unspecified headache type ? 5. Cough ? 6. Neutrophilic leukocytosis ? 7. Amphetamine or stimulant drug abuse (HCC) ? 8. Intracranial aneurysm ? ? Reportedly identified on MRI/MRA of brain in 2020. Unknown location, size, and characteristics. ? HX: seizures
Allergies: NKDA
Diagnostic Lab Data: Results as of 12/30/2020 14:32 12/30/2020 00:23 Color Urine: Yellow Clarity Urine: Slightly Cloudy (A) Specific Gravity: 1.010 Glucose Urine: Negative Bilirubin Urine: Negative Ketones Urine: 5 mg/dL Blood Urine: Moderate (2+) (A) pH Urine: 6.5 Protein Urine: Negative Nitrite: Negative Leukocyte Esterase Urine: Negative Urobilinogen: < 2 mg/dL WBC Urine: Negative RBC Urine: 0-2 /hpf Squamous Epithelial: Occ (0-10) /lpf Bacteria: Many ($g50) /hpf (A) 12/30/2020 00:26 Amphetamines: Positive (A) Barbiturates: Positive (A) Benzodiazepine: Negative Buprenorphine: Negative Cocaine: Negative Marijuana (THC): Negative Methadone: Negative Methamphetamines: Negative Opiates: Negative Oxycodone: Negative Phencyclidine: Negative Tricyclics Antidepressant TCA: Negative Propoxyphene: Negative 12/30/2020 00:36 Influenza B: Not Detected Influenza A: Not Detected SARS-CoV-2: Detected (A) 12/30/2020 00:58 CULTURE, BLOOD: Rpt pending 12/30/2020 01:04 CULTURE, BLOOD: Rpt pending ?Procedure: CT HEAD WITHOUT CONTRAST ?Date of Service: 12/29/2020 CT OF THE HEAD WITHOUT IV CONTRAST: ? INDICATION: Altered level of consciousness. ? COMPARISON: No prior exams are available for comparison. ? FINDINGS: No acute intracranial hemorrhage, mass effect, or obvious infarcts. ?Normal ventricular size. ?Rightward nasal septal deviation. ?Mildly prominent mucous retention cyst in the left maxillary sinus. ?Mild additional scattered paranasal sinus disease. ? The preliminary report was reviewed without significant discrepancy. ? IMPRESSION: No acute intracranial abnormalities. ?Scattered paranasal sinus disease, as discussed above. ? If clinical concern persists, MRI could be considered for further evaluation. ? ?Procedure: CT CHEST ABDOMEN PELVIS WITH CONTRAST ?Date of Service: 12/29/2020 CT OF THE CHEST, ABDOMEN, AND PELVIS WITH IV CONTRAST. ?ADDITIONAL MIP REFORMATTED IMAGES WERE REVIEWED. ? INDICATION: Leukocytosis, diffuse pain. ? COMPARISON: No prior exams are available for comparison. ? FINDINGS: CHEST: Shallow inspiration. ?Mild bibasilar dependent atelectasis. ?No focal consolidation, pleural effusion, or pneumothorax. ?Normal heart size. ?No definite pathologic lymphadenopathy. ?Benign-appearing bone island in T12 on the right. ?Mild degenerative change of the spine. ? ABDOMEN/PELVIS: Large probable noncalcified gallstone in the gallbladder neck measuring up to 1.9 x 3.0 cm with mildly prominent sludge throughout the remainder of the gallbladder lumen. ?No significant surrounding inflammatory change is identified at this time. ?Correlation with ultrasound is recommended for further evaluation. ? Liver, spleen, pancreas, adrenal glands, and kidneys appear grossly unremarkable. ?No hydronephrosis. ?No evidence for bowel obstruction or appendicitis. ?No definite pathologic lymphadenopathy. ?Degenerative changes of the spine. ? The preliminary report was reviewed with discrepancy as the large probable noncalcified stone and sludge in the gallbladder lumen was not mentioned on the preliminary interpretation. ? IMPRESSION: 1. ?Large probable noncalcified gallstone in the gallbladder neck with mildly prominent sludge, as discussed above. ?Correlation with ultrasound is recommended for further evaluation. 2. ?Additional nonacute/chronic findings, as detailed above. ?
CDC Split Type:

Write-up: Patient presents with ? Altered Mental Status ? Headache ? ? HPI Patient presents to ER by EMS ambulance after family called 911 as patient was incomprehensible with slurred speech and moaning on the phone this evening. On arrival of EMS patient was asleep in bed and reportedly unresponsive other that to localize to pain. EMS transferred patient to ER. On arrival to ER patient had GCS 7. Reportedly patient is locum nurse who works in a Nursing Home and patient reportedly received COVID vaccination 2 days ago and that night reportedly began complaining to family on the phone of headache, nasal congestion, sore throat, cough, fever, chills, nausea, emesis, myalgias, and lethargy. Per the medical record patient has history of seizures, migraines, and sciatica. No other information is known on patient arrival to ER. 1. Peripheral IV right dorsal hand placed by EMS in route to ER. 2. On arrival to ER GCS 7 (E1M5V1) and roving eye movements with episodic lateral conjugate and at times disconjugate gaze concerning for seizure activity. Arms and legs with moderately increased tone but no clonic movements and patient able to localize bilaterally. 3. Ativan 1 mg IVP for seizure, then further 2 mg IVP for persistent seizure. 4. Fosphenytoin 1,000 mg IVPB in ER for loading dose of antiseizure medication. 5. Patient had significant improvement following completion of Ativan 3 mg IVP and GCS improved to 14 (E3M6V5) from GCS of 7 (E1M5V1). 6. Patient able to communicate after improvement as above and reports she has had headache or migraine for past several days as well as dysuria with bilateral CVA pain and has significant pain on percussion of bilateral CVA and moderate pain on palpation of bilateral flanks. No nuchal rigidity or pain with ROM of neck. Additionally, she complains of severe headache and diffuse pain of back and abdomen/pelvis. She reports a history of seizures in the past and reports she had one last month and was treated at a hospital in her home state. She denies antiseizure medications. Additionally, patient reports nonproductive cough, sore throat, nasal congestion, fever, chills, myalgias, lethargy, nausea, and episodic emesis over the past 2 days. She has anterograde amnesia following seizure and does not recall events. 7. Normal saline 1,000 mL IV bolus, then 100 mL/hour in ER. 8. CT of head with and without contrast performed and negative for intracranial hemorrhage, lesions, stroke, or other acute pathology. 9. CT of chest/abdomen/pelvis with IV contrast shows no acute pathology or notable abnormalities. 10. Lactic acid drawn and normal. 11. UA and urine microscopy collected by straight catheterization and culture collected and pending. 12. Blood cultures x 2 collected and pending. 12. Rocephin 2 mg IVPB in ER after blood cultures collected. 13. Vancomycin 20 mg/kg (1,500 mg) IVPB following Rocephin. 14. Dexamethasone 10 mg IVP in ER. 15. Duoneb nebulizer in ER. 16. Called to discuss with patient''s daughter and the family''s preferred contact who is 23 years old. She reports patient had COVID vaccination 2 days ago and beginning that night patient has complained of headache, fever, chills, nonproductive cough, sore throat, nasal congestion, myalgias, and lethargy. Additionally, she reports patient has history of seizures on at least 1 occasion in the past a few months ago but is not on antiseizure medications. She reports patient had MRI and MRA of her brain at that time and reportedly and intracranial aneurysm was identified at that time. 17. Called to request transfer to another facility and spoke with hospitalist who states there is no neurologist there and suggests transfer to larger tertiary care facility with neurology. 18. Called to request transfer and accepted by ER provider. 19. Transfer by ALS ground ambulance with telemetry, pulse oximetry, O2 to keep $g 02%, vitals every 30 minutes, normal saline at 100 mL/hour, Rocephin 2 grams IVPB, vancomycin 20 mg/kg (1,500 mg) IVPB in ER. ? DISPOSITION Patient Stabilized and Transferred Data Unavailable Wed Dec 30, 2020 2:12 AM CST


VAERS ID: 914596 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-30
Onset:2020-12-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / UNK RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Stridor
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
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: orange and red dye
Diagnostic Lab Data: In ER and at Medical Center
CDC Split Type:

Write-up: Anaphalaxis reaction, stridor an unable to breathe. Happened in 30 seconds


VAERS ID: 914604 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2020-12-16
Onset:2020-12-20
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-20
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spouse awoke 12/20 and found spouse dead. Client was not transferred to hospital.


VAERS ID: 914621 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Iowa  
Vaccinated:2020-12-22
Onset:2020-12-27
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J02A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dementia, Fatigue
SMQs:, Dementia (narrow), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-27
   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: None
Preexisting Conditions: Resident in long term care facility for 9+ years Coronary Artery Disease Dementia Hypothyroidism Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident in our long term care facility who received first dose of Moderna COVID-19 Vaccine on 12/22/2020, only documented side effect was mild fatigue after receiving. She passed away on 12/27/2020 of natural causes per report. Has previously been in & out of hospice care, resided in nursing home for 9+ years, elderly with dementia. Due to proximity of vaccination we felt we should report the death, even though it is not believed to be related.


VAERS ID: 914690 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-23
Onset:2020-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Death, Pyrexia, Respiratory distress, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-26
   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: Contact facility for medical records. We think levothyroxine daily and ativan prn.
Current Illness: none known
Preexisting Conditions: COPD
Allergies: none known
Diagnostic Lab Data: We were told her last COVID test was negative
CDC Split Type:

Write-up: Within 24 hours of receiving the vaccine, fever and respiratory distress, and anxiety developed requiring oxygen, morphine and ativan. My Mom passed away on the evening of 12/26/2020.


VAERS ID: 914730 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram coronary artery normal, Dizziness, Electrocardiogram T wave inversion, Full blood count normal, Hyperhidrosis, Metabolic function test normal, Myocardial necrosis marker increased, Nausea, Presyncope, Troponin normal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bupropion HCl XL 300mg tablet QDay Bupropion HCl SR 100mg tablet QDay Escitalopram 20mg tablet QDay Buspirone HCL 7.5mg tablet TID
Current Illness: None
Preexisting Conditions: Scoliosis Depression
Allergies: None
Diagnostic Lab Data: EKG 12/17/2020, inverted T waves CBC, BMP, within normal limits Cardiac enzymes x 3, troponin was zero Coronary CT with contrast, WNL
CDC Split Type:

Write-up: Near syncopal episode approximately 2.5 hours after vaccination. Sudden onset of dizziness, nausea, and diaphoresis. Was admitted to ED and observed overnight. Full cardiac work up was done and shown to be within normal limits. I have no pre-existing conditions and considered to be a healthy adult.


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