|
VAERS ID: |
1187918 (history) |
Form: |
Version 2.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
New Hampshire |
Vaccinated: |
0000-00-00 |
Onset: |
2021-04-05 |
Submitted: |
0000-00-00 |
Entered: |
2021-04-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / - |
Administered by: Private Purchased by: ? Symptoms: Cardiac arrest, Intensive care SMQs:, Torsade de pointes/QT prolongation (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), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-04-06
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: levothyroxine Current Illness: Preexisting Conditions: Trisomey 21, Atrioventricular canal s/p repair, hypothyroidism, asthma, obstructive sleep apnea, cervical spine instability, hypotonia, scoliosis, feeding difficulties, renal dysplasia, autism, chronic constipation, bronchopulmonary dysplasia, mixed conductive and sensorineural hearing loss, binocular vision disorder, gastroesophgeal reflux, Allergies: Cefdinir, Sulfa, Ex-Lax, NSAIDS Diagnostic Lab Data: CDC Split Type: Write-up: I do not know the exact date of the first or second Moderna Vaccine. I am the PICU attending who cared for the patient after her cardiac arrest which we believe was about 3-4 days after her second Moderna Vaccine |
|
VAERS ID: |
1199455 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: |
2021-04-02 |
Onset: |
2021-04-10 |
Days after vaccination: |
8 |
Submitted: |
0000-00-00 |
Entered: |
2021-04-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ? Symptoms: Cardiac arrest, Chest pain, Death, Dyspnoea SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-04-10
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: fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin Current Illness: NA Preexisting Conditions: spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation Allergies: bananas, cephalexin, kiwi, mango, pineapple, latex Diagnostic Lab Data: CDC Split Type: Write-up: Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death |
|
VAERS ID: |
1225942 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: |
2021-03-19 |
Onset: |
2021-03-28 |
Days after vaccination: |
9 |
Submitted: |
0000-00-00 |
Entered: |
2021-04-18 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
UNKNOWN / 1 |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Cardiac arrest, Death, Laboratory test, Lung assist device therapy, Oral contraception, Pulmonary embolism, Resuscitation SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-03-30
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: Reported to be on Drospirenone-Ethinyl Estradiol 3-0.02 MG per tab Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use. Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21. |
|
VAERS ID: |
1242573 (history) |
Form: |
Version 2.0 |
Age: |
15.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: |
2021-04-18 |
Onset: |
2021-04-19 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
2021-04-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Public Purchased by: ? Symptoms: Cardiac failure, Death SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Noninfectious myocarditis/pericarditis (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-04-20
Days after onset: 1 Permanent Disability? No Recovered? No Office Visit? Yes ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination Current Illness: No Preexisting Conditions: No Allergies: Nothing Diagnostic Lab Data: CDC Split Type: Write-up: Heart failure |
|
VAERS ID: |
1243487 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: |
2021-04-13 |
Onset: |
2021-04-21 |
Days after vaccination: |
8 |
Submitted: |
0000-00-00 |
Entered: |
2021-04-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW010 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ? Symptoms: Completed suicide SMQs:, Suicide/self-injury (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-04-21
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: Unknown, History of Mental Illness Current Illness: Mental Illness, Preexisting Conditions: Mental Illness Allergies: None Reported Diagnostic Lab Data: None CDC Split Type: Write-up: Patient Committed Suicide with a firearm. |
|
VAERS ID: |
1307657 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: |
2021-04-19 |
Onset: |
2021-04-23 |
Days after vaccination: |
4 |
Submitted: |
0000-00-00 |
Entered: |
2021-05-11 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0153 / 2 |
- / - |
Administered by: Other Purchased by: ? Symptoms: Completed suicide SMQs:, Suicide/self-injury (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-04-23
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: none Diagnostic Lab Data: CDC Split Type: Write-up: Death by suicide. |
|
VAERS ID: |
1382906 (history) |
Form: |
Version 2.0 |
Age: |
15.0 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
2021-05-15 |
Onset: |
2021-06-07 |
Days after vaccination: |
23 |
Submitted: |
0000-00-00 |
Entered: |
2021-06-08 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0187 / 2 |
LA / IM |
Administered by: Other Purchased by: ? Symptoms: Death SMQs: Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-06-07
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 known Current Illness: none noted Preexisting Conditions: Acne, no other conditions noted Allergies: None noted Diagnostic Lab Data: CDC Split Type: Write-up: Unexplained death within 48 hours |
|
VAERS ID: |
1386841 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: |
2021-06-03 |
Onset: |
2021-06-07 |
Days after vaccination: |
4 |
Submitted: |
0000-00-00 |
Entered: |
2021-06-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
AR / IM |
Administered by: Other Purchased by: ? Symptoms: Abdominal discomfort, Condition aggravated, Death, Headache SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-06-07
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: Adderall Current Illness: Headache, upset stomach Preexisting Conditions: ADHD Allergies: NKDA Diagnostic Lab Data: Autopsy pending CDC Split Type: Write-up: Prodrome of headache and gastric upset over 2 days following second dose. Then felt fine. Found the following day dead in bed. Autopsy pending |
|
VAERS ID: |
1388042 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: |
2021-05-23 |
Onset: |
2021-06-07 |
Days after vaccination: |
15 |
Submitted: |
0000-00-00 |
Entered: |
2021-06-10 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0168 / 2 |
UN / IM |
Administered by: Private Purchased by: ? Symptoms: Brain oedema, Cerebral infarction, Computerised tomogram head abnormal, Decompressive craniectomy, Haemorrhage intracranial, Intracranial pressure increased, Intraventricular haemorrhage, Ventricular drainage SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow) Life Threatening? Yes 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 Current Illness: Headache started around 3 weeks prior to event that delayed dose of second vaccine. Headache was very severe and she saw PCP for it twice and it lasted a week. It then resolved and she got her second vaccine. Preexisting Conditions: None except obesity with BMI 39 Allergies: None Diagnostic Lab Data: CT scans 6/7 and 6/8 CDC Split Type: Write-up: Patient had massive acute intracranial hemorrhage. Was found down in bathroom. In ED CT scan showed large intraventricular hemorrhage, EVD placed, patient progressed to massive brain swelling and infarctions, decompressive craniectomy, unable to control intracranial pressure, parents agreed to DNR status and patient is not expected to survive. |
|
VAERS ID: |
1406840 (history) |
Form: |
Version 2.0 |
Age: |
13.0 |
Sex: |
Male |
Location: |
Unknown |
Vaccinated: |
2021-06-13 |
Onset: |
2021-06-14 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
2021-06-17 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0217 / UNK |
- / - |
Administered by: Unknown Purchased by: ? Symptoms: Death, Influenza like illness SMQs: 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: Write-up: Flu like symptoms for 2 days then was found deceased |
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