|
VAERS ID: |
936805 (history) |
Form: |
Version 2.0 |
Age: |
25.0 |
Sex: |
Male |
Location: |
Kentucky |
Vaccinated: | 2020-12-22 |
Onset: | 2021-01-11 |
Days after vaccination: | 20 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
039K20A / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Death,
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)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-11
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: See Continuation Field Current Illness: Whiplash injury to neck. Sprain of ligaments of cervical spine Preexisting Conditions: Septal defect (heart), chronic sinusitis Allergies: Ceftriaxone Diagnostic Lab Data: None associated. CDC Split Type:
Write-up: Patient received the vaccine on 12/22/20 without complication. It was reported today that the patient was found unresponsive and subsequently expired at home on 1/11/21. |
|
VAERS ID: |
943397 (history) |
Form: |
Version 2.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
New Jersey |
Vaccinated: | 2020-12-23 |
Onset: | 2021-01-11 |
Days after vaccination: | 19 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EJ1862 / UNK |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Cardiac arrest,
Cardioversion,
Endotracheal intubation,
Pupil fixed,
Unresponsive to stimuli SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (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: 2021-01-11
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: None Current Illness: None Preexisting Conditions: None Allergies: Ceclor, Penicillin, Sulfa Diagnostic Lab Data: No labs or tests. CDC Split Type:
Write-up: On day due for 2nd dose, Patient was found unresponsive at work in the hospital. Patient pupils were fixed and dilated. Full ACLS was initiated for 55 minutes with multiple rounds of bicarb, calcium chloride, magnesium, and epinephrine. Patient was intubated. Patient continued into V. Fib arrest and was shocked multiple times. |
|
VAERS ID: |
960841 (history) |
Form: |
Version 2.0 |
Age: |
23.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 2021-01-17 |
Onset: | 2021-01-19 |
Days after vaccination: | 2 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
UN / IM |
Administered by: Senior Living Purchased by: ? Symptoms: Cardiac arrest,
Chest X-ray abnormal,
Death,
Lung infiltration,
Pyrexia SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic 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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-21
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: Amantadine, clonazepam, clobazam, lovenox, dextroamphetamine-amphetamine , famotidine, gabapentin, keppra, robinul, polyethylene glycol, propanolol, sertaline, senna, valproic acid, vimpat, cefepime Current Illness: none Preexisting Conditions: ventilator dependent, anoxic encephalopathy, seizure disorder Allergies: none Diagnostic Lab Data: CDC Split Type:
Write-up: Patient developed 104.4 temp approximately 48 hours after being given the vaccine. I treated him with antibiotics, IV fluids, cooling methods. CXR does show a new right perihilar infiltrate. However, his fever came down within the next 24-48 hours. Unfortunately, he suffered a cardiac arrest on 1/21/21 in the early morning and expired. |
|
VAERS ID: |
1033873 (history) |
Form: |
Version 2.0 |
Age: |
25.0 |
Sex: |
Female |
Location: |
Illinois |
Vaccinated: | 2021-01-20 |
Onset: | 2021-02-01 |
Days after vaccination: | 12 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3246 / 2 |
LA / IM |
Administered by: Pharmacy Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-01
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: VENLAFAXINE, LOSARTAN, TRAZODONE. THERE MAY BE OTHERS. SHE WAS PARTICIPATING IN A CLINICAL TRIAL Current Illness: Preexisting Conditions: CHRONIC KIDNEY DISEASE Allergies: UNKNOWN Diagnostic Lab Data: UNKNOWN CDC Split Type:
Write-up: PATIENT PASSED AWAY ON 2-1-2021 |
|
VAERS ID: |
1034146 (history) |
Form: |
Version 2.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 2021-02-13 |
Onset: | 2021-02-14 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-02-16 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
01620A / 1 |
RA / IM |
Administered by: Private Purchased by: ? Symptoms: Unevaluable event SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-01
Days after onset: 13
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: N/A Current Illness: WAS NOT REPORTED AT TIME OF VACCINATION Preexisting Conditions: Allergies: UNKNOWN Diagnostic Lab Data: CDC Split Type:
Write-up: ARRIVED AT EVENT, CONSENT FORM COMPLETED, DID NOT REPORT HE HAD BEEN ILL, DID NOT REPORT THAT HE TOOK ANY FEVER REDUCING MEDICATIONS |
|
VAERS ID: |
1071935 (history) |
Form: |
Version 2.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
Iowa |
Vaccinated: | 2021-03-03 |
Onset: | 2021-03-03 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2021-03-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN6204 / 1 |
- / IM |
Administered by: Public Purchased by: ? Symptoms: Cardio-respiratory arrest,
Death,
Dizziness,
Fall,
Headache,
Malaise,
Weight increased SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic 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), Accidents and injuries (narrow), Vestibular disorders (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-03
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: Metoprolol ER 50 mg qHS, Trazodone 50 mg qHS, Lisinopril 40 mg daily, HCTZ 25 mg daily, Topiramate 25 mg qHS, Melatonin 1 tab qHS, Bupropion 300 mg daily Current Illness: HTN, sleep apnea Preexisting Conditions: HTN, sleep apnea, hx of MRSA wound infection in groin Allergies: Penicillin Diagnostic Lab Data: Wt = 201 kg (443 lbs), No specific labs were drawn when he presented to ED coding. CDC Split Type:
Write-up: Patient received the vaccine around 11 am. He hadn''t been feeling well (headache, dizziness) per report and initially called in to work. He then decided to come to work and was found down in a patient bathroom during his shift on our Facility while taking care of a patient (he was a nurse aid). Patient was coded and the team and was transferred to our Facility ED. He expired 3/3 2112 |
|
VAERS ID: |
1074788 (history) |
Form: |
Version 2.0 |
Age: |
24.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2021-02-01 |
Onset: | 2021-03-04 |
Days after vaccination: | 31 |
Submitted: |
0000-00-00 |
Entered: |
2021-03-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Exposure during pregnancy,
Foetal death,
Foetal heart rate abnormal,
Placental disorder,
Ultrasound antenatal screen abnormal SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (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: no Current Illness: no Preexisting Conditions: no Allergies: no Diagnostic Lab Data: CDC Split Type:
Write-up: At 8 weeks pregnancy (2 weeks after first shot) started bleeding and had a subchorionic hematoma. By 10 week subchorionic hematoma resolved. Received second shot and of Feb. 1 week later, at 12 weeks pregnancy , fetus had no heart beat! It measured normal size (as expected) and limited normal first trimester anatomy by ultrasound. But NO heart beat. Something insulted this placenta to lead to fetal demise. |
|
VAERS ID: |
1076949 (history) |
Form: |
Version 2.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Oregon |
Vaccinated: | 2021-01-29 |
Onset: | 2021-02-22 |
Days after vaccination: | 24 |
Submitted: |
0000-00-00 |
Entered: |
2021-03-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EN5318 / 2 |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Death SMQs:
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-22
Days after onset: 0
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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient admitted on 2/21/21 and died in hospital on 2/22/2021. Patient had a significant, lifelong underlying medical condition. |
|
VAERS ID: |
1078352 (history) |
Form: |
Version 2.0 |
Age: |
18.0 |
Sex: |
Male |
Location: |
Illinois |
Vaccinated: | 2021-03-02 |
Onset: | 2021-03-05 |
Days after vaccination: | 3 |
Submitted: |
0000-00-00 |
Entered: |
2021-03-06 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
010A21A / 1 |
LA / IM |
Administered by: Private Purchased by: ? Symptoms: Chest pain,
Death,
Fatigue,
Headache,
Pain,
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-05
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: Medical examiner report is pending. CDC Split Type:
Write-up: Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home. |
|
VAERS ID: |
1082804 (history) |
Form: |
Version 2.0 |
Age: |
28.0 |
Sex: |
Male |
Location: |
Arizona |
Vaccinated: | 2021-02-18 |
Onset: | 2021-03-02 |
Days after vaccination: | 12 |
Submitted: |
0000-00-00 |
Entered: |
2021-03-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / IM |
Administered by: Private Purchased by: ? Symptoms: Completed suicide SMQs:, Suicide/self-injury (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-03-02
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: not known Current Illness: anxiety/depression Preexisting Conditions: none known Allergies: not known Diagnostic Lab Data: CDC Split Type:
Write-up: Patient committed suicide the morning of March 2, 2021. He stepped in front of a truck on a highway. I consulted with pharmacy and they said that I should report even if the 2 most likely have nothing to do with each other. |
|