ABCDEFGHIJKLMNOPQRSTUVWXYZAAABACADAEAFAGAHAIAJAK
1
VAERS_IDVAXBRANDRECV DATESTATEAGE _YRSCAGE _YRCAGE_MOSEXDIEDSYMPTOM_TEXTDIEDDATEDIEDL_THREATER_VISITHOSPITALHOSPDAYSX_STAYDISABLERECOVDVAX_DATEONSET_DATENUMDAYSLAB_DATAV_ADMINBYV_FUNDBYOTHER_MEDSCUR_ILLHISTORYPRIOR_VAXSPLTTYPEFORM_VERSTODAYS_DATEBIRTH_DEFECTOFC_VISITER_ED_VISITALLERGIES
16
936805
COVID19
MODERNA
1/12/2021KY2525MYPatient 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.Y1/11/2021N12/22/20201/11/202120
None associated.
PVT
See Continuation Field
Whiplash injury to neck. Sprain of ligaments of cervical spine
Septal defect (heart), chronic sinusitis
21/11/2021
Ceftriaxone
37
943397
COVID19
PFIZER\BIONTECH
1/14/2021NJ2828MYOn 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.Y1/11/2021N12/23/20201/11/202119
No labs or tests.
PVTNoneNoneNone21/14/2021
Ceclor, Penicillin, Sulfa
38
939050
COVID19
MODERNA
1/12/2021NY3232FYPatient vaccinated on 12/28. Approximately one day later, develops cough and on azithromycin x 1 week. On 1/3, patient develops left-sided weakness and aphasia. Taken to the hospital, tested COVID+, required intubation -- acute hypoxic respiratory failure secondary to COVID - on H&P. Patient died on 1/4/21 at 7:20am.Y1/4/2021N12/28/202012/29/20201PVT
Unknown
Unknown
Morbid obesity and hypothyroidism
21/12/2021
Unknown
50
921667
COVID19
PFIZER\BIONTECH
1/5/2021OH3939FYLTCF Pfizer Vaccine clinic conducted 12/29/2020 Vaccine lead received a call indicating that a staff member deceased somewhere between 1/3/2021 and 1/4/2021. Cause of death is unknown, and an autopsy is being performed.Y1/3/2021N12/29/20201/3/20215SEN21/5/2021
201
933578
COVID19
MODERNA
1/11/2021NY4343MYPronounced dead 1/9/2021 at 12:42. Received first dose of vaccine 1/8/2021YN1/8/2021PUB
metform, atorvastin
Diabetes, Hypertension, Sleep Apnea, Obese
Hx smoking
21/11/2021NKA
203
937527
COVID19
PFIZER\BIONTECH
1/12/2021NH4444FYunsure if related to vaccine, but was notified by her next of kin that she died on 1/4/2021. No reports of side effects or hospitalization were reported to the facility prior to the notification of death.Y1/4/2021N12/23/20201/4/202112
unknown, not reported
SEN
unknown
unknown
unknown
21/12/2021
unknown
204
929764
COVID19
MODERNA
1/8/2021WA4545MYThe patient was found deceased at home about 24 hours after immunization. Date of Death:: 12/29/2020; estimated time of death 6:00pmY12/29/2020N12/28/202012/29/20201PVT
Hydrochlorthiazide (by record, not confirmed)
Hypertension, sleep apnea, obesity. based on medical record
21/8/2020
no known allergies recorded in medical record
205
939270
COVID19
PFIZER\BIONTECH
1/12/2021HI4848MYSudden cardiac deathY12/31/2020N12/22/202012/31/20209WRK21/12/2021
280
918518
COVID19
MODERNA
1/4/2021NE5050FYsyncopal episode - arrested - CPR - deathY12/31/2020N12/31/202012/31/20200
Autopsy being performed
PVT
To be determined
To be determined
To be determined
21/4/2021Y
To be determined
291
938118
COVID19
PFIZER\BIONTECH
1/12/2021MI5151FYon 1/8/2021 17:30 patient taken to ER, cerebellar hemorrhage, stroke, aneurysmY1/10/2021YY2N1/5/20211/8/20213
CT brain head; CT cervical spine; chest xray; CT chest, abdomen, pelvis; abdominal xray; CT angiogram neck & brain
PUB
multivitamin; vitamin D
none mentioned
no significant past medical history
21/12/2021Ylatex
404
946293
COVID19
MODERNA
1/15/2021VA5151MY51 year old M with h/o O2 dependent COPD, Severe pulmonary fibrosis became increasingly hypoxic around 1800hours 1/7/2021. He was transported to hospital for acute on chronic hypoxia respiratory failure. On 1/12/2021 he decompensated further, and after discussing with family and palliative care, He was changed to comfort care. He expired on 1/12/2021@2325 at medical center.Y1/12/2021Y61/7/20211/7/20210OTH
Alvesco inh, Mepron susp, Coreg, Zetia, Tricor, Umeclidinum, Cellcept, Zyprexa, Prilosec, paxil, Miralax, prednisone, trazodone, xopenex inh
Pulmonary fibrosis on O2
COPD,Severe pulmonary fibrosis,HTN,GERD
21/14/2021none
406
930910
COVID19
MODERNA
1/9/2021HI5252FYPatient received COVID vaccination around 12:15pm. Patient was monitored for the appropriate amount of time by nursing staff. Patient passed away at 2:15pm.Y1/8/2021N1/8/20211/8/20210SEN
Patient was refusing to take all medications for over a year
None
Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, major depressive disorder, aphasia following cerebral infarction, muscle weakness, dysphagia, hypothyrodism, type 2 diabetes, hyperlipidemia, hypomagnesemia, hypokalemia, hypertension, gastro esophageal reflux disease, gastritis, constipation
21/9/2021
Metformin, morphine, statins, latex
409
933739
COVID19
PFIZER\BIONTECH
1/11/2021OH5454FYStaff member checked on her at 3am and patient stated that she felt like she couldn't breathe. 911 was called and taken to the hospital. While in the ambulance, patient coded. Patient was given CPR and "brought back". Once at the hospital, patient was placed on a ventilator and efforts were made to contact the guardian for end of life decisions. Two EEGs were given to determine that patient had no brain activity. Guardian, made the decision to end all life saving measures. Patient was taken off the ventilator on 1/9/2021 and passed away at 1:30am on 1/10/2021. The initial indication from the ICU doctor was the patient had a mucus plug that she couldn't clear.Y1/10/2021Y1N1/8/20211/9/20211
COVID-19 test administered - 1/9/2021 - Negative 2 EEGs were performed on 1/9/2021 and both indicated she had not brain activity
OTH
Aspirin, Diazepam, Doxepin HCL, Duloxetine, Juven POW, Lamotri Levothyroxin, Loratadine, Melatonin, Mucus Relief, Olanzapine, Prazosin HCL, Pregabalin,
Recent g-tube placement, Several hospitalizations over the pas few months due to low Oxygen Levels.
Major depression, borderline personality disorder, Cerebral Palsy, History of dissected left carotid artery
21/11/2021YPenicillin
417
934968
COVID19
PFIZER\BIONTECH
1/11/2021CA54MYhe passed away; not responsive; mind just seemed like it was racing; body was hyper dried; Restless; not feeling well; ate a bit but not much; kind of pale; Agitated; Vomiting; trouble in breathing; This is a spontaneous report from a contactable consumer (brother of the patient). A 54-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, on 04Jan2021 (at the age of 54-years-old) as a single dose for COVID-19 immunization. Medical history included diabetes and high blood pressure. Concomitant medications included metformin (MANUFACTURER UNKNOWN) taken for diabetes, glimepiride (MANUFACTURER UNKNOWN) taken for diabetes, lisinopril (MANUFACTURER UNKNOWN), and amlodipine (MANUFACTURER UNKNOWN). The patient experienced not feeling well, ate a bit but not much, kind of pale, vomiting, trouble in breathing, and agitated on 04Jan2021; body was hyper dried and restless on 05Jan2021; mind just seemed like it was racing on 06Jan2021; and not responsive and he passed away on 06Jan2021 at 10:15 (reported as: around 10:15 AM). The clinical course was reported as follows: The patient received the vaccine on 04Jan2021, after which he started not feeling well. He went right home and went to bed. He woke up and ate a bit but not much and then was kind of pale. The patient then started to vomit, which continued throughout the night. He was having trouble in breathing. Emergency services were called, and they took his vitals and said that everything was okay, but he was very agitated; reported as not like this prior to the vaccine. The patient was taken to urgent care where they gave him an unspecified steroid shot and unspecified medication for vomiting. The patient was told he was probably having a reaction to the vaccine, but he was just dried up. The patient continued to vomit throughout the day and then he was very agitated again and would fall asleep for may be 15-20 minutes. When the patient woke up, he was very restless (reported as: his body was just amped up and could not calm down). The patient calmed down just a little bit in the evening. When the patient was awoken at 6:00 AM in the morning, he was still agitated. The patient stated that he couldn't breathe, and his mind was racing. The patient's other brother went to him and he was not responsive, and he passed away on 06Jan2021 around 10:15 AM. It was reported that none of the symptoms occurred until the patient received the vaccine. Therapeutic measures were taken as a result of vomiting as aforementioned. The clinical outcome of all of the events was unknown; not responsive was not recovered, the patient died on 06Jan2021. The cause of death was unknown (reported as: not known by reporter). An autopsy was not performed. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.; Reported Cause(s) of Death: not responsive and he passed awayY1/6/2021N1/4/20211/4/20210UNK; ; ;
Medical History/Concurrent Conditions: Blood pressure high; Diabetes
USPFIZER INC2021011383
21/11/2021
418
942106
COVID19
PFIZER\BIONTECH
1/13/2021CA5454MY54 y/o M with PMH of HTN, HLD, Alcoholic Cirrhosis, Aortic Valve Stenosis, and angina BIBA as a Medical Alert for cardiac arrest noted PTA. Per EMS, the patient called because he was having constant, diffuse abdominal pain x 1 day that radiated to his chest. On scene, the patient had a witnessed arrest with EMS starting CPR. He was given 3 rounds of epi without ROSC. Pt had no associated shockable rhythm. Of note, pt's wife, had noted pt had received covid vaccine the prior day.Y1/9/2021N1/8/20211/9/20211PVT21/13/2021
461
928933
COVID19
MODERNA
1/8/2021IA5656FYPatient had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessfulY1/8/2021N12/23/20201/8/202116UNK21/8/2021
477
935511
COVID19
MODERNA
1/11/2021SD5656FYPatient received the 1st dose of Moderna and was found deceased in her home the next day.Y1/9/2021N1/8/20211/9/20211
unknown
PVT
unknown
none known of
history of vaginal adenocarcinoma- removed with surgery in 2019
21/11/2021
latex (skin reaction)
478
941811
COVID19
MODERNA
1/13/2021LA5656FYResident began having fever on 1/11/21 @0600. VS= T-102 B/P- 100/57 P- 112 RR- 24 O2 Sat 92% on RA. MD called. Rapid COVID Test was negative. CBC,CMP, U/A were ordered as well as CXR. Resident's condition declined. At 3:00pm resident started having respiratory distress and hypoxia O2 Sat 89%. Supplemental O2/mask @ 5LPM. Neb TX, EKG, and Rocephin 1 GM ordered. Condition worsened. Resident sent to nearest ER for evaluation. Later in the evening the staff AT Medical Center called to inform staff that resident had expired @ 2230 as a result of Respiratory Failure and Sepsis.Y1/4/20211/11/20217
CXR on 1/11/21: Suspicion of minimal infrahilar infiltrates bilaterally. U/A on 1/11/21: Leuk Esterase 3+, Albumin 2+, Few Bacteria, White cells 10 CBC on 1/11/21: WBC 8.9
SEN
Haldol 2mg TWICE DAILY, DEPAKENE 750MG THREE TIMES
NONE
HUNTINGTON'S CHOREA, HTN, HLP, HYPOTHYROID, DEPRESSION, CONSTIPATION, AND DYSPHAGIA
21/13/2021
NKDA & NO FOOD ALLERGIES
480
944595
COVID19
PFIZER\BIONTECH
1/14/2021FL5656MYCardiac 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 laterY1/14/2021Y2N1/12/20211/12/20210
mulitple Full ER code and then ICU support for 2 days
SEN
losartan, spironolactone, carvedilol
No known new illnesses,
Cardiomyopathy
21/14/2021Ynkda
482
920815
COVID19
MODERNA
1/5/2021KY5858FYFound deceased in her home, unknown cause, 6 days after vaccine.Y1/4/2021N12/30/20201/4/20215PVT
unknown
unknown
Per employee health records HTN, DM, Breast CA 2016 with radiation, obesity, gastric sleeve 10 years ago, arthritis, plantar fasciitis, ankle tendonitis, DeQuarvains, carpal tunnel, anxiety
21/5/2021
Lisinpril, Codeine, Latex , environmental (hay fever)
484
921768
COVID19
PFIZER\BIONTECH
1/5/2021WA5858FYVaccine received at about 0900 on 01/04/2021 at her place of work, Medical Center, where she was employed as a housekeeper. About one hour after receiving the vaccine she experienced a hot flash, nausea, and feeling like she was going to pass out after she had bent down. Later at about 1500 hours she appeared tired and lethargic, then a short time later, at about 1600 hours, upon arrival to a friends home she complained of feeling hot and having difficulty breathing. She then collapsed, then when medics arrived, she was still breathing slowly then went into cardiac arrest and was unable to be revived.Y1/4/2021N1/4/20211/4/20210
Autopsy scheduled for 01/07/2021
PVT21/5/2021
None Known
488
930154
COVID19
MODERNA
1/8/2021OH6060MYNotified today that he passed away. No other details known at this time.Y1/8/2021N1/5/20211/8/20213PUB
unknown
unkown
unknown
VFC # 21109
21/8/2021Sulfa
501
933090
COVID19
PFIZER\BIONTECH
1/10/2021CA6060MYPatient died, I have a copy of his vaccination cardY1/9/2021N1/5/20211/5/20210
Unknown
WRK
Unknown
Unknown
Unknown
21/10/2021
Unknown
616
941743
COVID19
MODERNA
1/13/2021NY6060FYThis person was found to be deceased on routine rounds during the night, 3am. No symptoms of reaction noted post vaccine. No injection site reaction. No reports of any allergic reaction.Y1/13/2021N1/12/20211/13/20211NoneOTH
Amitiza, Anastrozole, Calcium Carbonate, Levemir, Novolog, Docusate, Fiber Lax, Fluvoxamine Maleate, Gavilax, Glucerna, Ketoconazole, levetiracetam, loratadine, Selenium sulfide lotion, vimpat, vitamin D3, Prolia AS needed medications: fle
None
Benign polycythemia, Type II DM, Anxiety, Epilepsy, Blepharitis (bilateral), cataract (not specified), Allergic rhinitis, constipation, scoliosis, osteoporosis, dyspahgia, urinary incontinence, Dermatitis, breast cancer (right breast lumpectomy), history of respiratory infection, DNR AND MOLST were in place at time of death
21/13/2021
No known drug or food allergies
621
924464
COVID19
PFIZER\BIONTECH
1/6/2021IA6161FYcoughing up blood, significant hemoptysis -- > cardiac arrest. started day after vaccine but likely related to ongoing progression of lung cancerY1/6/2021N1/5/20211/6/20211PVT
COPD, lung cancer
COPD, lung cancer
21/6/2021Y
623
932898
COVID19
PFIZER\BIONTECH
1/10/2021PA6161MYThe patient had an apparent cardiac arrest on 12/23/20 and was admitted to the ICU. He was taken off of life support on 12/30/20. He had known cardiac disease.Y12/30/2020N12/17/202012/23/20206
Unknown.
PVT
Amlodipine, Atorvastatin, Xarelto, Aspirin (These were medications listed with our office in 2019. Unknown if this patient was still taking at time of vaccination).
High blood pressure. Congenital unicuspid aortic valve s/p aortic valve replacement 2001 & 2011. Pacemaker placement 2011. Melanoma
21/10/2021
None known.
631
923993
COVID19
MODERNA
1/6/2021NC6262MYPatient was vaccinated Dec 30, 2020. Prime dose of Moderna vaccine. Observed for full 15 minutes post-injection. No complaints when asked during observation. Released. Subsequently, vaccine clinic staff learned from the patient's supervisor that on Jan 4, 2021 that the patient had expired on Jan 2, 2021. By report from the supervisor, the patient was found dead at his home. The patient's primary care provider was unaware of his death when contacted by this reporter today (Jan 6, 2021). Electronic Medical Record without any information since the vaccination.Y1/2/2021N12/30/20201/2/20213PVT
Unknown
No
History of stage II (T3N0) appendiceal carcinoma - s/p resection Dec 2014. CAD s/p stenting Diabetes Mellitus Hyperlipidemia Hypertension Glaucoma
21/6/2021
Hay fever
632
937569
COVID19
MODERNA
1/12/2021RI6262MYpatient reported expired 1/7/2021Y1/7/2021N1/2/20211/7/20215OTH
unknown
unknown
unknown
21/12/2021
unknown
638
942085
COVID19
PFIZER\BIONTECH
1/13/2021KS6262FYNo adverse effects from vaccination seen on 1/2/21. On 1/6/21 resident was seen by Dr and her baclofen pump was refilled with 20 ml Baclofen 4,000mcg/ml. ITB Rate increased by 6% to 455.5 mcg/day simple continuous rate over 3 days. On 1/8/21 at 0615 resident was shaking, lower extremities mottled, Sa02 70%, pulse 45. Oxygen started at 2 L/m per NC. At 0715 her primary physician was notified as well as her daughter. Oxygen increased to 4 L/min, sats at 83%. SOA noted, reported all over pain. At 0850 when they attempted to reposition the resident, she was not responsive. Licensed nurse assessed her and no heartbeat heard or pulse found.Y1/8/2021N1/2/20211/8/20216SEN
Ativen, Butrans Patch, Tylenol, Potassium Citrate-Citric Acid
Medical diagnosis: quadriplegia, Atherosclerotic heart disease
see #11.
21/13/2021
Amoxicillin, Clavulanic Acid, Codeine, Morphine, Pencillin
677
944439
COVID19
PFIZER\BIONTECH
1/14/2021KY6262FYResident expired on 1/2/21.Y1/3/2021N12/26/20201/3/20218N/ASEN
Keppra, Levothyroxine, Miralax, Olanzapine, Trazadone, Risperidone, and Lorazepam
Receiving hospice services
Stage 4 kidney function
21/14/2021N/A
680
935815
COVID19
PFIZER\BIONTECH
1/11/2021CA6363MYDifficulty breathing, death.Y1/5/20211/5/20211/5/20210SEN21/11/2021
681
918065
COVID19
MODERNA
1/4/2021CA6464MY1/1/2020: Residents was found unresponsive. Pronounced deceased at 6:02pmY1/1/2021N12/30/20201/1/20212N/AOTH
- Invega Trenza 546mg Q3months - Lithium 300mg BID - Oxybutynin 5mg QID - lipitor 20mg QHS - cogentin 2mg BID - Norvasc 5mg QD - Dyazide Capsule 37.5-25 MG (Triamterene-HCTZ) QD
#NAME?
- SCHIZOPHRENIA, UNSPECIFIED - ANEMIA, UNSPECIFIED - OVERWEIGHT - OVERACTIVE BLADDER - ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS - HYPOTHYROIDISM DUE TO MEDICAMENTS AND OTHER EXOGENOUS SUBSTANCES - NICOTINE DEPENDENCE, UNSPECIFIED, UNCOMPLICATED - CHRONIC VIRAL HEPATITIS C - UNSPECIFIED AGE-RELATED CATARACT - ESSENTIAL (PRIMARY) HYPERTENSION - CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED - UNSPECIFIED CONVULSIONS - INHALANT ABUSE, UNCOMPLICATED - OTHER SEIZURES
21/4/2021#NAME?
730
918388
COVID19
PFIZER\BIONTECH
1/4/2021FL6565FYResident found unresponsive without pulse, respirations at 04:30 CPR performed, expired at 04:52 by RescueY1/1/2021N12/30/20201/1/20212SEN
Albuteral Sulfate Amlodipine Carvedilol Ipratropium Levetiracetam Olanzapine Sodium Chloride Symbicort Valproic Acid
No acute illness at time of vaccination. History of: CVA SCPT Dementia Seizure Disorder HTN COPD
As noted above
NHSNfacilitynumber48433
21/4/2021NKA
733
918418
COVID19
PFIZER\BIONTECH
1/4/2021FL6565MYResident became SOB, congested and hypoxic requiring oxygen, respiratory treatments and suctioning. Stabilized after treatment and for the next 72 hours with oxygen saturations in the 90s. On 1/3/2021 was found without pulse and respirations. Resident was a DNR on Hospice.Y1/3/2021N12/30/20201/1/20212
low oxygen saturation
SEN
Mucomyst ASA Benadryl Periactin Colace Ferrous Sulfate Folic Acid Gabapentin Sennosides Albuterol Ipratropium Melatonin MVI Oxycodone Polyethylene Glycol Seroquel Rosuvastatin Valproic Acid Venlafaxine Vitamin C
Hypoxia started on 1/1/2021. History of: Osteomyelitis CVA Pain Pressure Ulcers PVD Hepatitis C COPD HTN HLD Constipation SCPT Anemia Seizure disorder Depression AKA
As noted above
NHSNfacilitynumber48433
21/4/2021NKA
735
921547
COVID19
MODERNA
1/5/2021AR6565MYDEATH ON 1/4/2021, RESIDENT RECIEVED VACCINE ON 1/2/20Y1/4/2021N1/2/20211/4/20212N/ASEN
Acetaminophen Tablet 325 MG Give 2 tablet by mouth every 6 hours as needed for Pain. elevated Temp. Phone Active 05/08/2020 05/08/2020 AmLODIPine Besylate Tablet 10 MG Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYP
CEREBRAL INFARCTION, UNSPECIFIED(I63.9), LONG TERM (CURRENT) USE OF ASPIRIN(Z79.82), VITAMIN DEFICIENCY, UNSPECIFIED(E56.9), ACUTE KIDNEY FAILURE, UNSPECIFIED(N17.9), HYPERKALEMIA(E87.5), ACUTE RESPIRATORY FAILURE, UNSPECIFIED WHETHER WITH HYPOXIA OR HYPERCAPNIA(J96.00), PURE HYPERCHOLESTEROLEMIA, UNSPECIFIED(E78.00), PAIN IN RIGHT FOOT(M79.671), ESSENTIAL (PRIMARY) HYPERTENSION(I10), ACIDOSIS(E87.2), ABNORMAL LEVELS OF OTHER SERUM ENZYMES(R74.8), HYPERLIPIDEMIA, UNSPECIFIED(E78.5), DISORDER OF THYROID, UNSPECIFIED(E07.9), GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS(K21.9), MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, UNSPECIFIED SITE(M62.50), MUSCLE WASTING AND ATROPHY, NOT ELSEWHERE CLASSIFIED, MULTIPLE SITES(M62.59), COGNITIVE COMMUNICATION DEFICIT(R41.841), UNSPECIFIED LACK OF COORDINATION(R27.9), OTHER DYSPHAGIA (R13.19), OTHER CHRONIC PAIN(G89.29), HYPOTHYROIDISM, UNSPECIFIED(E03.9), DRY EYE SYNDROME OF UNSPECIFIED LACRIMAL GLAND (H04.129), METABOLIC ENCEPHALOPATHY(G93.41), UNSPECIFIED CONVULSIONS(R56.9), POLYNEUROPATHY, UNSPECIFIED(G62.9), TYPE 1 DIABETES MELLITUS WITH UNSPECIFIED DIABETIC RETINOPATHY WITHOUT MACULAR EDEMA(E10.319), NASAL CONGESTION(R09.81), BRONCHITIS, NOT SPECIFIED AS ACUTE OR CHRONIC(J40), HYPOKALEMIA(E87.6), ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED(D72. 829), OTHER MALAISE(R53.81), CELLULITIS OF RIGHT LOWER LIMB(L03.115), CELLULITIS OF LEFT LOWER LIMB(L03.116), EDEMA, UNSPECIFIED (R60.9), IRON DEFICIENCY ANEMIA, UNSPECIFIED(D50.9), CUTANEOUS ABSCESS, UNSPECIFIED(L02.91), COVID-19(U07.1)
UNCONTROLLED DIABETES MELLITUS ON INSULIN
21/5/2021NKDA
736
926600
COVID19
MODERNA
1/7/2021MO6565MYPatient did not report any signs or symptoms of adverse reaction to vaccine. Patient suffered from several comorbidities (diabetes and renal insufficiency). Patient reported not feeling well 01/06/2021 and passed away that day.Y1/6/2021N1/4/20211/6/20212PHM
Unknown
Diabetes, renal insufficiency
Diabetes, renal insufficiency
21/7/2021
Penicillin, ibuprofen
741
944273
COVID19
PFIZER\BIONTECH
1/14/2021NC65MYdeath 2 days after vaccine; 101 fever on day of booster shot; This is a spontaneous report from a contactable consumer. A 65-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration, on 09Jan2021 (at the age of 65-years-old) as a single dose for COVID-19 immunization. Medical history included high blood pressure, high cholesterol, enlarged prostate, and lifelong digestive issues/irritable bowel syndrome (IBS). Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient had no allergies to medications, food, or other products. The patient's concomitant medications were not reported. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient experienced 101 fever on day of booster shot on 09Jan2021 and death 2 days after vaccine on 10Jan2021. The event, death 2 days after vaccine, was reported as fatal. The patient underwent lab tests and procedures, which included body temperature: 101 on 09Jan2021. The patient did not receive treatment for the events. The clinical outcome of 101 fever on day of booster shot was unknown and of death 2 days after vaccine was fatal. The patient died on 10Jan2021. The cause of death was unknown. It was unknown if an autopsy was done. It was also reported that since the vaccination, the patient had not been tested for COVID-19. The batch/lot number for the vaccine, BNT162B2, was not provided and has been requested during follow up.; Reported Cause(s) of Death: death 2 days after vaccineY1/10/2021N1/9/20211/9/20210
Test Date: 20210109; Test Name: body temperature; Result Unstructured Data: Test Result:101
PVT
Medical History/Concurrent Conditions: Blood pressure high; Enlarged prostate; Gastrointestinal disorder; High cholesterol; Irritable bowel syndrome
USPFIZER INC2021015301
21/14/2021
748
932346
COVID19
PFIZER\BIONTECH
1/10/2021NC6666MY1/7-21 - Received second dose of pfizer covid-19 vaccine 1/8/21 - Fever, dizziness, headache 1/10/21 0250 was found not breathing. EMS performed CPR and patient deceasedY1/10/2021N1/7/20211/8/20211
autopsy pending
PVT
Unknown
none known
hypertension, hyperlipidemia.
21/10/2021
Statin - muscle aches
750
940955
COVID19
PFIZER\BIONTECH
1/13/2021NY66FYCardiac Arrest; Patient was found pulseless and breathless 20 minutes following the vaccine administration.; Patient was found pulseless and breathless 20 minutes following the vaccine administration.; This is a spontaneous report from a contactable other healthcare professional (HCP). A 66-year-old female patient (pregnant at the time of vaccination: no) received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL1284) via intramuscular at left arm on 11Jan2021 12:15 PM at single dose for COVID-19 immunization. Medical history included diastolic CHF, spinal stenosis, morbid obesity, epilepsy, pulmonary hypertension and COVID-19 (Prior to vaccination, the patient was diagnosed with COVID-19). The patient received medication within 2 weeks of vaccination included amiodarone, melatonin, venlafaxine hydrochloride (EFFEXOR), ibuprofen, aripiprazole (ABILIFY), lisinopril, cranberry capsules, diltiazem, paracetamol (TYLENOL), famotidine, furosemide (LASIX [FUROSEMIDE]), ipratropium bromide, salbutamol sulfate (IPRATROPIUM/ALBUTEROL), buspirone, senna alexandrina leaf (SENNA [SENNA ALEXANDRINA LEAF]), polyethylene glycol 3350 and morphine. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient used took Penicillin, propranolol, quetiapine, topiramate, Lamictal and had allergy to them. Patient used took the first dose of BNT162B2 (lot number: EJ1685) via intramuscular at right arm on 21Dec2020 12:00 PM at single dose for COVID-19 immunization. Since the vaccination, the patient been tested for COVID-19 (Sars-cov-2 PCR) via nasal swab on 06Jan2021, covid test result was negative. Patient was found pulseless and breathless 20 minutes following the vaccine administration (11Jan2021 12:30 AM). MD found no signs of anaphylaxis. Patient died on 11Jan2021 12:30 AM because of cardiac arrest. No treatment received for the events. Outcome of pulseless and breathless was unknown. the autopsy was performed, and autopsy remarks was unknown. Autopsy-determined cause of death was unknown. It was reported as non-serious, not results in death, Life threatening, caused/prolonged hospitalization, disabling/Incapacitating nor congenital anomaly/birth defect.; Sender's Comments: Based on the available information this patient had multiple underlying medical conditions including morbid obesity, diastolic CHF, epilepsy, pulmonary hypertension and COVID-19 diagnosed prior to vaccination. All these conditions more likely contributed to patients cardiac arrest resulting in death. However, based on a close temporal association ("Patient was found pulseless and breathless 20 minutes following the second dose of BNT162B2 vaccine administration, contributory role of BNT162B2 vaccine to the onset of reported events cannot be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Cardiac arrest; Autopsy-determined Cause(s) of Death: autopsy remarks was unknown. Autopsy-determined cause of death was unknownY1/11/2021N1/11/20211/11/20210
Test Date: 20210111; Test Name: pulseless; Result Unstructured Data: Test Result:pulseless; Test Date: 20210111; Test Name: breathless; Result Unstructured Data: Test Result:breathless; Test Date: 20210106; Test Name: Covid-19 PCR; Result Unstructured Data: Test Result:Negative (Nasal Swab)
OTH
; ; EFFEXOR; ; ABILIFY; ; CRANBERRY; ; TYLENOL; ; LASIX [FUROSEMIDE]; IPRATROPIUM/ALBUTEROL; ; SENNA [SENNA ALEXANDRINA LEAF]; POLYETHYLENE GLYCOL 3350;
Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, the patient was diagnosed with COVID-19); Diastolic heart failure; Epilepsy; Morbid obesity; Pulmonary hypertension; Spinal stenosis
USPFIZER INC2021018488
21/13/2021
814
934050
COVID19
MODERNA
1/11/2021KS6868MYStaff reported that patient was found Friday morning (Jan 8) sitting at a table with his head tilted forward and unresponsive to verbal or physical stimuli. Staff lowered patient to floor and started CPR. EMS was called and continued CPR at scene, however they were not able to revive patient. Patient was pronounced dead at the scene. Staff written statements following the death of patient show that he had a fall about 1 hr. prior. It is unknown if this fall contributed to patient's death. An autopsy has been requested.Y1/8/2021N1/7/20211/8/20211NoneSEN
Patient was a resident in Group Home Current Medications Treatments/PRN Medications: Start Date: 04/02/14: Benztropine 2mg tab BID (8-8) 02/27/15: Midodrine (Proamatine) 5mg tab TID (8-12-8) 12/30/15: Cetirizine 10mg tab daily @8am 1
No Acute Illnesses
Diagnosis: - Impulse Control Disorder - Epilepsy - Tardive Dyskinesia - Ulcerative Proctitis and Colitis - Mental Retardation (mod) - Hammer toes (bilat.) - Dermatitis (scalp/torso) - Seborrheic keratosis of left armpit - Major Depression - Infantile Meningitis - History of Squamous Cell Carcinoma (L arm)
21/11/2021
Allergies: NKDA
826
934539
COVID19
MODERNA
1/11/2021KY6868FYPatient received COVID-19 (Moderna) vaccine from the Health Department on afternoon of January 8, 2021 and went to sleep approximately 2300 that night. Was found unresponsive in bed the following morning and pronounced dead at 1336 on January 9, 2021Y1/9/2021N1/8/20211/9/20211
Postmortem examination was performed at the State Medical Examiner Office on January 10, 2021 (MEC21-0019). Tissue samples were obtained for histology and red top/tiger top/purple top tubes of blood were obtained for potential further studies. Samples of blood and vitreous humor were also obtained and submitted to AXIS Laboratories for toxicologic analysis.
PUB
Singulair, Oxybutynin, Fosamax, Prednisone, Meloxicam, Eliquis, Bumetanide, Triamcinolone cream, Klor-Con, Lisinopril, Promethazine,
Cellulitis of left lower limb (12/2020)
Hypertension
21/11/2021
No known allergies
836
943442
COVID19
PFIZER\BIONTECH
1/14/2021GA6868MYSystemic: reported by staff patient expired under suspicious circumstnces after receiving vaccine. Patient was on hospice, reported not expected to pass this soon; symptoms lasted 0 daysYN12/30/202012/31/20201SEN21/14/2021nka
885
932787
COVID19
PFIZER\BIONTECH
1/10/2021GA7070FYRECIEVED VACCINE 1/8/21 EXPIRED UNEXPECTED 1/10/21, NO ADVERSE REACTIONS NOTEDY1/10/2021N1/8/20211/10/20212
NONE AT TIME OF REPORTING, TALK OF AN AUTOPSY
SEN
CRANBERRY, PROZAC, NEUROTIN PERCOCET, IMMODIUM, SYNTHROID, LINZESS, LIPITOR, MELATONIN METFORMIN, PROTONIX PLAVIX, PROAIR, ropinirole, PROAIR SYMBICORT, THIAMINE TYLENOL VIT C VOLTAREN. ZANAX, ZOFRAN
PNEUMONIA
DEPRESSION CHRONIC LUNG ANEMIA
21/10/2021Y
TRAMADOL, methocarbamol
926
937434
COVID19
MODERNA
1/12/2021MT7070MYPt expired due to possible cardiac arrest. Unsure if this was vaccine related.Y1/12/2021N1/7/20211/11/20214OTH
None known
only had 1 lung
21/12/2021
928
944282
COVID19
PFIZER\BIONTECH
1/14/2021NY70MYresident coded on 09Jan at 8am and expired; This is a spontaneous report from a contactable Other Health Professional. A 70-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Batch/lot number: EL0140), intramuscularly in left arm on 05Jan2021 15:15 at single dose for COVID-19 immunization. Medical history included DM2(Type two diabetes mellitus), CHF(congestive heart failure), open wound, wound infection, heart failure. Allergies to medications, food, or other products: none. Concomitant medications included unspecified products (List of any other medications the patient received within 2 weeks of vaccination: yes). If the patient received any other vaccines within 4 weeks prior to the COVID vaccine: Unknown. Facility where the most recent COVID-19 vaccine was administered: Nursing Home/Senior Living Facility. The resident coded on 09Jan2021 at 8 AM and expired. The patient died on 09Jan2021. An autopsy was not performed. AE resulted in: patient died. Death cause: unknown at this time. Was treatment received for the adverse event: Unknown. Prior to vaccination, was the patient diagnosed with COVID-19: No. Since the vaccination, has the patient been tested for COVID-19: No. Serious: Yes. Seriousness criteria-Results in death: Yes. Seriousness criteria-Life threatening: No. Seriousness criteria-Caused/prolonged hospitalization: No. Seriousness criteria-Disabling/Incapacitating: No. Seriousness criteria-Congenital anomaly/birth defect: No.; Sender's Comments: The old patient had diabetes mellitus, congestive heart failure, open wound complicated by infection, all these pre-existing medical conditions contribute to the patient death. More information including complete medical history, concomitant medications and event term details especially death cause and autopsy results are needed for a full assessment of the case. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate; Reported Cause(s) of Death: resident coded on 09Jan at 8am and expiredY1/9/2021N1/5/20211/9/20214OTH
Medical History/Concurrent Conditions: Congestive heart failure; Heart failure; Open wound; Type 2 diabetes mellitus; Wound infection
USPFIZER INC2021016129
21/14/2021
936
946225
COVID19
PFIZER\BIONTECH
1/15/2021PA7070FYAt approximately 10:30pm on 1/14/2021, resident was noted to have a rash on her face, hands, arms, and chest. VS:100.2, 113, 20,108/59, 84% room air. applied nasal cannula at 4-L, telephoned Physician orders 6mg Decadron one time order, a second set of Vitals , reads 99.3, 110, 20, 106/60, 90% on 4-L N/C. On coming shift advised. At approximately 2:00am on 1/15/2021, resident congested and coughing. BP 151/70, pulse 124, temp 98.1 forehead, resp 20 and pulse oc 79% on 3L. At approximately 2:30am PRN cough syrup and breathing tx. Resident's condition began to worsen with breathing tx. This LPN updated at 0248 doctor on resident's condition. Doctor gave permission for resident to go to hospital. At 4:19am the Er called to say resident passed away.Y1/15/2021YN1/14/20211/14/20210
No testes were done at the facility. Unsure what was performed in the ER.
SEN
CloZAPine 550 mg QD, Clozaril 150 mg QD, Ergocalciferol Capsule 1.25 MG (50000 UT) QD, MiraLax Powder 17 gram QD, Multivitamin QD, Remeron 45 MG QD, Sertraline HCl 200 mg QD, Simvastatin 20 MG QD, Synthroid Tablet 75 MCG QD, Tricor 14
Dx with Covid-19 on 12/11/2020, PERIPHERAL VASCULAR DISEASES, SCHIZOAFFECTIVE DISORDER, BIPOLAR DISORDER, EPILEPSY, HYPERLIPIDEMIA, SECONDARY PARKINSONISM, MAJOR DEPRESSIVE DISORDER, ANXIETY DISORDER, HYPOTHYROIDISM, HYPERTENSION, OBESITY, and UNSPECIFIED CHRONIC BRONCHITIS,
21/15/2021Lithium
940
922977
COVID19
MODERNA
1/5/2021NY7171MYFever, RespDepression & COVID positive REMDESIVIR (EUA) 200 mg x1 then 100 mg dailyY12/28/202012/21/202012/27/20206OTHOTH1
941
945241
COVID19
PFIZER\BIONTECH
1/14/2021MD7171FY71yo 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.Y1/14/2021N1/13/20211/14/20211SENUNKUNKUNK21/14/2021UNK
942
928513
COVID19
MODERNA
1/8/2021MI7272FYResident passed away in her sleepY1/6/2021N1/5/20211/6/20211N/ASEN
Amiodarone Hcl, Carvedilol, Ferrous sulfate, Eliquis (cont)
Atrial fibrillation, Anemia, 1st degree AV block, CDK stage 4,
CDK stage 4, Atrial fibrillation, 1st degree AV block, Patient was under hospice care
21/7/2021
Aldactone, contrast dye
943
945578
COVID19
PFIZER\BIONTECH
1/14/2021KS7272FYNo 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.Y1/11/2021N1/2/20211/10/20218SEN
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
Had a tooth extraction done on 1/6/21. Was on amoxicillin for 7 days and it caused diarrhea. Changed to Keflex.
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.
21/14/2021NKA
946
930912
COVID19
PFIZER\BIONTECH
1/9/2021NY7373MYDiarrhea followed by death 24 hrs after vaccinationY1/8/2001N1/7/20211/8/20211UNKNoneNoneNone21/9/2021None
952
935222
COVID19
MODERNA
1/11/2021FL7373MYPatient was reported to be deceased at home by law enforcement on 1/7/21Y1/7/2021N12/30/20201/7/20218PVT
Oxybutynin Chloride, Lasix 80mg, hydyralazine 50mg, amlodipine 10mg, amitriptyline 10mg, ASA, Klor-Con 20meq, Tylenol, allopurinol 100mg, Vit D3, turmeric 400mg, Lipitor 80mg, gabapentin 100mg, baclofen 5mg, candesartan 32mg, insulin lispro
No acute illnesses
Diabetes, CKD, CHF, HTN
21/11/2021NKA
957
943362
COVID19
MODERNA
1/14/2021MI7373FYPt collapsed at home approx 5:30 pm and diedY1/13/2021N1/13/20211/13/20210
currently undergoing preliminary autopsy
PUB
unknown none reported
none known
none21/14/2021
none reported
958
926269
COVID19
PFIZER\BIONTECH
1/7/2021MD7474MYPt last seen at 1200 by nurse for ID band check. No visible signs of distress noted. Pt states "I just want to be left alone". 1230 nurse was called to pt room. Pt was noted unresponsive, no pulse and respiration noted. CPR started immediately, at 1239 first shock given. 1245 EMT took over, at 1319 EMT called time of deathY1/5/2021N1/4/20211/5/20211SEN
Acetaminophen Tablet 325 MG, Enulose Solution 10 GM/15ML (Lactulose Encephalopathy), HYDROcodone-Acetaminophen Tablet 5-325 MG, Milk of Magnesia Suspension 400 MG/5ML (Magnesium Hydroxide, Potassium Chloride ER Tablet Extended Release 20 ME
Fracture of right superior and inferior pubic rami, fracture of the right sacral alla, and fracture of the L3 vertebral body. UNSPECIFIED PROTEIN-CALORIE MALNUTRITION
Abdominal aortic aneurysm CHRONIC OBSTRUCTIVE PULMONARY DISEASE tobacco abuse, EtOH abuse Ambulatory dysfunction, debility, high risk for falls, deconditioning, ambulatory dysfunction/debility/deconditioning/high fall risk/generalized weakness MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED PERSONAL HISTORY OF MALARIA
21/7/2021
No Known Allergies
981
927189
COVID19
PFIZER\BIONTECH
1/7/2021CA7474MYPatient was vaccinated at 11am and was found at the facility in his room deceased at approximately 3:00pm. Nurse did not have cause of deathY1/7/2021N1/7/20211/7/20210OTH
unknown
stroke
hypertension, atrial fibrillation, atherosclerosis,
21/7/2021none
993
940866
COVID19
MODERNA
1/13/2021SC7575MYPatient was found "acting abnormal" on 1/9/2021 at 1215. VS HR 20-30's. EMS activated. EMS arrived and patient was found pulseless in PEA/ asystole, CPR and ACLS initiated and then transported to the MC. Unsuccessful resuscitation and expired on 1/09/2021 at 1348. Clinical impression Cardiopulmonary arrest.Y1/9/2021N1/7/20211/9/20212OTH
Amlodipine, ASA, Atorvastatin, Baclofen, Risperidone, Levothyr
None
Hypothyroidism, Bipolar, Profound ID, HTN, Osteopenia, dysphagia, aphasia, TBI as a young adult,Muscle spasm, Hernia
21/13/2021Y
Loxapine, Thioridazine
996
943889
COVID19
MODERNA
1/14/2021VA7575MYNo adverse reactions observed after administration of medication. Patient starting complaining of shortness of breath around 0500 the following morning. SP02 checked in the 80s. Patient expired 01/09/2021;YN1/8/20211/9/20211OTH
Alvesco, Amiodarone, Lipitor, Atrovent, Coreg, Cymbalta, Guaifenesin, Keppra, Levothroid, Megace, Protonix, Potassium, Prednisone, Rifampin, Carafate, Bactrim, Flomax
Rigth femur fracture, GI bleed
Hypertension, seizure, hypothyroidism, CHF
21/13/2021
No known allergies
999
929359
COVID19
PFIZER\BIONTECH
1/8/2021FL7676MY3:07 pm lung sounds diminished oxygen sats 68%, oxygen applied Oxygen sats remained low for next 36 hours ( patient on Hospice care ) expired 6:22 am 1-8-21Y1/8/2021N1/6/20211/6/20210noneSENnone
Cerebral Atherosclerosis, malnutrition, thrombocytopenia, cva, hypothyroidism
Cerebral Atherosclerosis, malnutrition, thrombocytopenia, cva, hypothyroidism
21/8/2021none
1032
944365
COVID19
PFIZER\BIONTECH
1/14/2021KY7676MYResident expired on 12/30/20, dx cardiac arrest.Y12/30/2020N12/26/202012/30/20204N/ASEN
Diazepam, Levothyroxine, Magnesium Oxide, Olanzapine, Omeprazole, Sertraline, and Vitamin D3
None
Schziophrenia
21/14/2021N/A
1033
921175
COVID19
PFIZER\BIONTECH
1/5/2021NJ7777FYResident received Covid Vaccine, noted after 30 mins with labored breathing BP 161/77, HR 116, R 38, T 101.4,Y1/5/2021YN1/3/20211/3/20210
Epi pen 0.3mg given, sent to ER
SEN
CHF, COPD, DM, heart failure, anemia, sleep apnea
CHF, COPD, DM, heart failure, anemia, sleep apnea
21/5/2021NKA
1038
925264
COVID19
MODERNA
1/7/2021OK77MYPT was found deceased in his home on 1/5/2021Y1/7/2021N12/31/2020NoneOTH
Norco 5/325 1 tablet every 6 hours as needed. Warfarin 4mg , 2 tablets orally Monday and Friday Torsemide 100mg, 1/2 tablet orally once a day Sabcubitril-Valsartan 24/26mg 1/4 tablet orally twice a day Gabapentin 300mg, tablet once daily Ca
CHF HTN DM 2 CKD Obesity DDD
CHF HTN DM 2 CKD Obesity DDD
21/7/2021NKDA
1043
926568
COVID19
PFIZER\BIONTECH
1/7/20217777MYpatient declined 12/30/2020 and was transferred to hospital where he did not respond to treatment and passed away 1/4/2020Y1/4/2021Y12/28/202012/30/20202UNK
alprazolam, amlodipine, ASA, cilostazol, advair, lamotrigine, ,losartan, metoprolol,omprazole,simvastatin
chronic medical problems as noted below
dementia, peripheral vascular disease, COPD, hypertension, GERD, S/P CVA with stent of left carotid ,right common iliac and right external iliac arteries, CDK,diabetes
21/7/2021
clopidigrel, sulfa, vicodin
1044
930418
COVID19
PFIZER\BIONTECH
1/8/2021RI7777MYPatient received first dose of vaccine on 12/28, developed COVID-19 infection shortly thereafter and expired on 1/4/2021Y1/4/202112/28/20201/4/20217SEN21/8/2021
1048
917793
COVID19
MODERNA
1/3/2021AR7878FYPrior to the administration of the COVID 19 vaccine, the nursing home had an outbreak of COVID-19. Patient was vaccinated and about a week later she tested positive for COVID-19. She had underlying thyroid and diabetes disease. She died as a result of COVID-19 and her underlying health conditions and not as a result of the vaccine.Y1/2/2021N12/22/202012/29/20207
Unknown
SEN
Metoprolol-Tartrate, Latanoprost, Glipizide, Pravastatin, Metformin, Benaprezil, Potassium-Chloride, Levothyroxine
Diabetes, Thyroid disease
Diabetes, Thyroid Disease
21/3/2021None
1049
942040
COVID19
PFIZER\BIONTECH
1/13/2021IA7878MYlittle bit of a reaction light headed after 5 minutes. vitals were low, so observed for 30 minutes after being light headed. Patient was found unresponsive and pronounced dead later that day.Y1/13/2021N1/13/20211/13/20210SEN
unknown
noneyes21/13/2021
unknown
1053
940855
COVID19
MODERNA
1/13/2021AR7979FYPatient received her vaccination on 1/12/21 administered by pharmacy*+. She expired on 1/12/21 an approximately 7:30pm. Resident did not have any adverse reactions and was a hospice patient.Y1/12/2021U1/12/20211/12/20210N/ASEN
LORazepam Solution 2 MG/ML
Resident was a hospice patient but POA requested that she get the vaccination. Resident was already near end of life and the vaccine may not have had anything to do with her death.
Resident on hospice care due to end of life.
21/13/2021YNone
1054
925556
COVID19
PFIZER\BIONTECH
1/7/20218181MYExpired 1/05/2021Y1/6/202112/30/20201/6/20217SEN
Acute on chronic heart failure, sepsis
CAD, CKD, DM type 2, CHF, Hx TIA, Atrial fibrillation
21/7/2021
1111
935350
COVID19
MODERNA
1/11/2021TX8181MYPatient was found unresponsive at home with SpO2 20% 1/2/2021Y1/6/2021Y4N12/31/20201/2/20212PVT
Symbicort 160/4.5 mcg/act inhaler Dilitiazem ER 360mg PO daily Eliquis 5mg PO twice a day Furosemide 20mg PO daily Losartan 100mg PO daily KCL 10mEq ER PO daily Ranitidine 150mg PO Ventolin HFA 0.09mg/1ACT 2 puffs every 4 hours as needed Me
Dyspnea, Shortness of breath
Paroxysmal atrial fibrillation Hypertension Chronic iron deficiency anemia Congestive heart failure with chronic diastolic
21/11/2021Y
No known allergies
1113
940822
COVID19
PFIZER\BIONTECH
1/13/2021GA81MYpatient passed away after receiving the Covid vaccine; This is a spontaneous report from a contactable nurse. An 81-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), intramuscular into the right arm on 07Jan2021 at 0.3 mL, single for covid-19 immunization. There was no medical history and no concomitant medications. On 08Jan2021, the patient passed away after receiving the COVID vaccine. The patient died on 08Jan2021. An autopsy was not performed. Investigations indicate that unspecified labs were done, but nothing two weeks prior; no further details were provided. The patient received the first dose the day prior. The reporting nurse discussed it with the medical director, and he thought that he potentially passed away from the COVID vaccine. The relatedness of the event to the suspect vaccine was reported as related by the reporting nurse per The Agency. The batch/lot number for the vaccine, BNT162B2, was not provided and will be requested during follow-up .; Sender's Comments: Based on the limited information available, it is medically not possible to make meaningful causality assessment, it is unlikely the vaccine could have contributed to the death of the patient based on the known safety profile. However case will be reevaluated when additional information is received during the follow-up The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Stated that the patient passed away after receiving the Covid vaccineY1/8/2021N1/7/20211/8/20211UNK
Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
USPFIZER INC2021015752
21/12/2021
1114
917117
COVID19
MODERNA
1/1/2021AR8282MYAfter vaccination, patient tested positive for COVID-19. Patient was very ill and had numerous chronic health issues prior to vaccination. Facility had a number of patients who had already tested positive for COVID-19. Vaccination continued in an effort to prevent this patient from contracting the virus or to mitigate his risk. This was unsuccessful and patient died.Y1/1/2021N12/22/202012/28/20206
COVID-19 positive test approximately one week after vaccination. There is no evidence to support that the vaccine caused his death in any way.
SEN
Quietapine, Mertazipine, Hydrocodone, Fentanyl
YesYes21/1/2021None
1119
930466
COVID19
PFIZER\BIONTECH
1/8/2021LA8282FYFever, shortness of breath and chest pain that resulted in a heart attack a few hours after vaccinationY1/5/2021N1/5/20211/5/20210PVT21/8/2021None
1123
934373
COVID19
PFIZER\BIONTECH
1/11/2021WV8282FYPatient went to bed around 11pm on Saturday PM and sometime between then and 1:30am on Sunday morning got up and went into the living room without waking up her husband (which is normal). At 1:30am, the husband got up to use the restroom and she was out of bed then, but the husband did not know if she was having any problems at this time. When he got up at 7:45am, she was in the recliner and did not move or anything, which is normal for her. At 8:45am, the husband went back into the living room and tried to wake his wife and that is when he noticed there was no pulse and he called 9-1-1 at this time. EMS got on scene and did CPR for 30 mins and she was pronounced dead at 9:21am.Y1/10/2021N1/9/20211/10/20211PUB
Husband only knew that she took several medications.
Newly diagnosed heart murmur the week prior by PCP. Was referred to her cardiologist.
She did have open heart surgery in 2013. She last saw her cardiologist 4 months ago, and she did a phone consult with him a week or so ago.
21/11/2021
PCN & Sulfa drugs
1124
940954
COVID19
PFIZER\BIONTECH
1/13/2021LA82FYHeart attack; This is a spontaneous report from a contactable consumer. An 82-year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE; Lot Number: and Expiration Date: Unknown), via an unspecified route of administration in the left arm on 05Jan2021 at 13:00 at a single dose for COVID-19 immunization; administered in doctor's office/urgent care. The patient's medical history and concomitant medications were not reported. It was unknown if the patient received any other vaccines within four weeks prior to the COVID vaccine. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. On 05Jan2021, the patient experienced heart attack; which resulted in death and was assessed as medically significant. The patient also experienced the associated symptoms of cold sweats, chest pain, shortness of breath. Therapeutic measures were taken as a result of heart attack, which included "life saving measures" by the paramedics performed upon arrival with no success. The clinical outcome of the event, heart attack, was fatal. The patient died on 05Jan2021 due to heart attack; as ruled by the paramedics. It was unknown if an autopsy was performed. The batch/lot numbers for the vaccine, PFIZER-BIONTECH COVID-19 MRNA VACCINE, were not provided and will be requested during follow up.; Reported Cause(s) of Death: Heart attackY1/5/2021N1/5/20211/5/20210PVT
USPFIZER INC2021015421
21/12/2021
1127
940602
COVID19
MODERNA
1/13/2021TX8383MYPatient received vaccine on 1/8/2021. On 1/9/2021 I checked on patient via phone for symptoms or problems and he reported none but mild soreness at injection site. On 1/10/2021 family friend called me to tell me that patient had expired at about 8:00 pm. Patient reportedly complained of "pain" unspecific and collapsed at home. Hospital reportedly told family that it appeared to be a "heart attack".Y1/8/20211/10/20212PVT
see attached
None reported
HTN, Type II DM, High cholesterol
21/11/2021None
1130
941607
COVID19
MODERNA
1/13/2021IN8383FYThe patient passed away today, 1/13/2021. She was a hospice patient. She showed no adverse effects after receiving the vaccine on 1/12/2021. This morning she woke up as normal and during her morning shower she had a bowel movement, went limp and was non-responsive. The patient passed away at 7:45 am.Y1/13/2021N1/12/20211/13/20211N/ASEN
Tylenol 325mg, Lasix 20mg, Senna 8.6mg, Aspirin 81mg, Levothyroxine 75mcg
N/A
End stage dementia, cerebro vascular disease, Hx left vertebral artery aneurysm
21/13/2021NKA
1132
944641
COVID19
MODERNA
1/14/2021FL8383FYPatient died on 1/21-2021Y1/13/2021N1/12/20211/13/20211NAOTH
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
CAD, angina, coronary bypass in 1990's, Cardiac Cath on 12/28/2020
CAD21/14/2021Sulfa
1139
944659
COVID19
MODERNA
1/14/2021FL8383FYPatient died. A friend called to let us know.Y1/13/2021N1/12/20211/13/20211naOTH
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
CAD, angina, coronary bypass in 1990's, Cardiac Cath on 12/28/2020
CAD21/14/2021Sulfa
1225
945253
COVID19
PFIZER\BIONTECH
1/14/2021MD8383FY83yo 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 deathY1/14/2021N1/13/20211/14/20211UNKSENUNKUNKUNK21/14/2021UNK
1227
924126
COVID19
MODERNA
1/6/2021MI8484FYresident expired 1/1/2021Y1/1/2021N12/30/20201/1/20212N/ASEN
Singulair, lopressor, pepcid, omeprazole, lasix, albuterol, azelastine eye gtts, calcium, eliquis, prozac, terazosin, magnesium oxide, potassium
Low blood pressure requiring medication changes. Sent to ER on 1/1 with low b/p sent back same day, heart failure. Family requests comfort measures only.
CHF, Heart Failure, hypertension, Atrial-fibrillation, Crohns disease.
21/6/2021
Asa, Cardizem, delsyn, doxycycline, levaquin, motrin, prevacid, vicodin
1232
925154
COVID19
MODERNA
1/7/2021FL8484FYDeceasedY1/4/2021N1/3/20211/4/20211HospitalPUB
Avorstatin Aspirin Oxycodone
NONECOPD21/7/2021YNone
1233
924456
COVID19
PFIZER\BIONTECH
1/6/2021CA8585FYPatient did not display any obvious signs or symptoms; the vaccination was administered at approximately 10:00 AM and the patient continued throughout her day without any complaints or signs of adverse reaction. Patient was helped to bed by the nursing assistant estimated at around 9:00 PM. The facility received notification from the lab around 11:00 PM that the patient's COVID-19 specimen collection from Sunday, 1/3/21, detected COVID-19. When the nursing staff went to the room to check on the resident and prepare her to move to a COVID-19 care area the patient was found unresponsive, no movement, no chest rises, noted regurgitated small amount of food to mouth left side, lying on left side. Pupils non reactive.Y1/5/2021N1/5/20211/5/20210
OVID-19 specimen collection from Sunday, 1/3/21, detected COVID-19
SEN
Lexapro, famotidine, Namenda, Seroquel, simvastatin, Trazodone; Tamsulosin; Docusate sodium; Polyethylene glycol; Celebrex; Acetaminophen
COVID-19 detected after vaccination; asymptomatic
Hyperlipidemia; Alzheimer's disease; Atherosclerotic heart disease of native coronary artery w/o angina pectoris; Osteoarthritis; Major depressive disorder, single episode, unspecified; unspecified severe protein-calorie malnutrition
21/6/2021
No known allergies
1234
928062
COVID19
PFIZER\BIONTECH
1/8/2021MA8585MYvomiting later on 01/05/21. Lethargy and hypoxia in pm of 01/06/21. Hypotension am of 01/07/21. Hospitalized, intubated, cardiac arrest, died 01/07/21.Y1/7/2021Y1N1/5/20211/5/20210
Pancytopenia, elevated lactate, troponin, LFTs. Left mid lung infiltrate and pulmonary vascular congestion.
SEN
ACETAMINOPHEN CARBIDOPA-LEVODOPA CARBIDOPA-LEVODOPA ER CITALOPRAM HBR DONEPEZIL HCL EUCERIN FINASTERIDE FLOMAX LATANOPROST OMEPRAZOLE QUETIAPINE FUMARATE QUETIAPINE FUMARATE SENNA LAX
Parkinson's Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
Parkinson's Disease with advanced dementia, dysphagia. Alcoholism in remission. HTN. BPH. GERD
21/8/2021Y
angioedema due to ACE and ARB meds
1238
935767
COVID19
PFIZER\BIONTECH
1/11/2021CA8585FYMy mother was given Pfizer vaccine on Thursday and she died 3 days later yesterday on Sunday!!!Y1/10/2021N1/7/20211/10/20213
She had tested NEGATIVE for Covid per Doc Win he told us on Sunday.
SENIDK
Pneumomia
Dementia
21/11/2021IDK
1239
937773
COVID19
PFIZER\BIONTECH
1/12/2021KS8585MYPatient was sent to the ED due to significant hematuria. He was afebrile.Y1/3/20211/2/20211/2/20210SEN
COVID-19 positive on 11/30/2020
Parkinson's Disease, Diabetes, Heart disease, A-fib, Hypothyroidism
2Y
Baclofen, PCN, Ambien, Singulair
1243
946097
COVID19
PFIZER\BIONTECH
1/15/2021CA85FYdied 3 days after receiving the vaccine/Death cause: Pneumonia per doctor; This is a spontaneous report from a contactable consumer. An 85-year-old non-pregnant female patient (reporter's mother) received the first dose bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration on 07Jan2021 at single dose for covid-19 immunization. Medical history included dementia from an unknown date. The patient's concomitant medications were not reported. The patient died 3 days after receiving the vaccine on 10Jan2021 11:00, death cause was pneumonia per doctor. The event was reported as serious as resulted in death. It was unknown if the patient received treatment for the event. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination, and it was unknow if the patient has been tested for COVID-19 since the vaccination. The patient died on 10Jan2021. It was not reported if an autopsy was performed. Information about lot/batch number has been requested.; Reported Cause(s) of Death: PneumoniaY1/10/2021N1/7/20211/10/20213OTH
Medical History/Concurrent Conditions: Dementia (other medical history: Dementia)
USPFIZER INC2021021568
21/14/2021
1244
929997
COVID19
MODERNA
1/8/2021WI8686MYPatient received vaccine on 1/4/2021. He was in Hospice for CHF and renal failure, but was able to get up in his wheelchair and eat and take medications and talk. On 1/5/2021 am, he was noted to be very lethargic an could only mumble, could not swallow. No localizing neurologic findings. He was too lethargic to get up in chair.Y1/7/2021N1/4/20211/5/20211
He did not have testing at that point because he was on Hospice.
SEN
Amlodipine 5 mg daily, Dexamethasone 4 mg daily (for itching related to renal failure), Isosorbide dinitrate 30 mg daily, Levothyroxine 0.075 mg daily, Bisoprolol 5 mg BID, Furosemide 80 mg BID, saline nasal spray, Tylenol 1000 mg PO TID
none acute
He was on hospice for about the last 1 month for CHF (EF 20-25%) and renal failure (creat 3-4). He was on hospice but was up and around and able to eat and take pills. The day after he had his injection, he was very lethargic and only mumbled. Was not able to take meds or eat. He was on hospice, so did not want work-up or treatment. He passed away on 1/7 am. We don't know if it was a coincidence that he died or if the vaccine caused him to deteriorate more quickly.
21/8/2021
Losartan, lisinopril, metoprolol
1249
930487
COVID19
MODERNA
1/8/2021NC8686MYMedical docter state patient has a acute cardiac attackY1/8/2021N1/8/20211/8/20210naSEN
calcium-D tablet, cholecalciferol, fish oil, melatonin, tylenol,
na
bph, apraxia, , dysphagia, muscle weakness, alzheimers disease
21/8/2021
cephalexin
1289
937444
COVID19
PFIZER\BIONTECH
1/12/2021IL8686FYResident was found deceased at approximately 6pm in her apartmentY1/11/2021N1/11/20211/11/20210
The county coroner declared her death was related to a heart attack
SEN
Brain bleed, sleep apnea, htn
Brain bleed, sleep apnea, htn
21/12/2021
1292
921572
COVID19
MODERNA
1/5/2021WI8787MYResident had body aches, a low O2 sat and had chills starting on 12/30/20. He had stated that they had slightly improved. On 1/1/21 he sustained a fall with a diagnosis of a displaced hip fracture. On 1/2/21 during the NOC shift his O2 sat dropped again. He later went unresponsive and passed away.Y1/2/2021N12/29/202012/30/20201SEN
Fluticasone, Lasix, Omeprazole, Sucarafate, Ropinrole HCl
Heart Failure
Chronic Kidney Disease, Atherosclerotic Heart Disease
21/5/2021Y
Lisinopril, Losartan
1314
927260
COVID19
MODERNA
1/7/2021WI8787FYNo adverse effects noted after vaccination. Patient with cardiac history was found unresponsive at 16:45 on 1/6/21. Abnormal breathing patterns, eyes partially closed SPO2 was 41%, pulseless with no cardiac sounds upon auscultation. CPR and pulse was regained and patient was breathing. Patient sent to Hospital ER were she remained in an unstable condition had multiple cardiac arrest and severe bradycardia and in the end the hospital was unable to bring her back.Y1/6/2021Y1N12/28/20201/6/20219
Brain CT negative WBC and lactic acid increased. COVID 19 on 1/4/21 negative
SEN
Vit D3, Miralax, Spironolactone, Tramadol, Metoprolol Succinate, MOM, Ferrous Gluconate, Ondansetron, Nitroglycerin Sublingual PRN, PreserVision AREDS, Fluticasone Propionate Suspension, Lisinopril, Clopidogrel Bisulfate, Campor-Methol-Met
Digestive Surgery for bowel obstruction
HTN, AAA, Chronic Diastolic Heart Failure, Diabetes Type 2, Paroxysmal atrial fibrillation, bradycardia, Hx of STEMI, Hx of CVA, HX of uterine cancer,
21/7/2021
Codeine, Meperidine, Morphine, Estrogens, Penicillins, Tetanus Toxoids
1316
937186
COVID19
MODERNA
1/12/2021AR8787FYThe facility had a number of positive COVID 19 cases prior to patients vaccination. Due to her advanced age, chronic condition, and exposure, patient did not have the time to build immunity after exposure before becoming positive.Y1/10/2021N12/22/202012/24/20202SEN
Hydrocodone-Acetamenaphin, Lidocaine, Cefritriaxone, Citalopram
Chronic pain
Pain21/12/2021None
1321
942072
COVID19
PFIZER\BIONTECH
1/13/2021VT8787FYDeath occurred 3 days after vaccine receipt; attributed to complications of her chronic advanced dementia with aspiration at age 87. No evidence of acute vaccine reaction.Y1/5/2021N1/2/20211/5/20213
COVID-19 PCR neg on 12/31/20 and 1/3/21
SEN
Tramadol, risperidone, fluoxetine, cyanocobalamin, colchicine, torsemide, levothyroxine
aspiration pneumonia- completed treatment prior to vaccination.
Advanced dementia with severe violent behavioral symptoms. Progressive decline and frailty due to late stage dementia with likely terminal aspiration after completion of treatment for previous aspiration pneumonia. Death attributed to complications of her advanced dementia. No evidence of acute reaction to vaccine (rash, dyspnea, swelling, redness). Chronic kidney disease, hypothyroidism, type 2 diabetes, gout, B12 deficiency
21/13/2021
No known allergies
1345
921481
COVID19
PFIZER\BIONTECH
1/5/2021OH8888MYVaccine given on 12/29/20 by Pharmacy. On 1/1/21, resident became lethargic and sluggish and developed a rash on forearms. He was a Hospice recipient and doctor and Hospice ordered no treatment, just to continue to monitor. When no improvement of codition reported, doctor and Hospice ordered comfort meds (Morphine, Ativan, Levsin). Resident expired on 1/4/2021Y1/4/2021N12/29/20201/1/20213n/aSEN
Vitamin D3 5000 units qd Furosemide 20mg qd Olanzapine 2.5mg bid
Dementia Chronic PVD
Dementia PVD
21/5/2021
No known allergies
1354
930876
COVID19
MODERNA
1/8/2021TX8888MYDeathY1/8/2021N1/7/20211/8/20211
Had IV dye imaging procedure after he received the COVID-19 vaccine (the same day in the afternoon) and passed away overnight.
PHM
Prostate Cancer
21/8/2021
1367
938974
COVID19
PFIZER\BIONTECH
1/12/2021OH8888MYHospice Resident received first Covid 19 vaccine dose on 1/6/21. 1/7/21 resident had decreased appetite noted in am but ate 100% of meal at dinner. 1/9/21 resident had decreased appetite with emesis x 2, loose BM x 2. Call placed to hospice. 1/10/21 5:44 am resident able to take HS meds, ingest 2 cups of shake. No emesis or loose stool noted. 12PM nurse noted resident not eating meals but ingesting milkshake and medications without any problems. Hospice contacted for change in condition. 1:00 pm hospice ordered Phenergan 12.5 mg Q 6 hrs PRN. Labs to be drawn 1/11/21. Hospice notified POA. 1/11/21 12:24am Resident had blood in stool. Resident denies any pain, on 2L of O2 for comfort.Y1/11/2021N1/6/20211/11/20215
Labs contacted facility with critical lab, Hemoglobin 4.8, at 9:45am after resident passed
SENHospice21/12/2021NKDA
1368
939845
COVID19
PFIZER\BIONTECH
1/13/2021IL8888MYThree hours after receiving COVID 19 vaccination, Patient oxygen level decreased to a critical level and went into cardiac arrest. Staff performed full code but was unable to bring back patient from cardiac arrest.Y1/11/2021N1/11/20211/11/20210PHMCHF21/13/2021
1369
943266
COVID19
PFIZER\BIONTECH
1/14/2021AZ8888FYInitial pain in back of head and extreme headache. Some vomiting. At emergency, went into coma and was intubated. Hole drilled in skull to relieve pressure. MRI taken. Lot of bleeding in brain - anuerism lead to death approximately 14 hours after initial symptoms.Y1/13/2021Y1N1/12/20211/12/20210OTH
Losartan, Levothyroxine, Carvedilol
Arthritis, high blood pressure
21/14/2021Y
Penicillin, Sulfa, Gluten
1370
944998
COVID19
PFIZER\BIONTECH
1/14/2021KY8888FYOn 1/11/21 noted with headache, nausea/vomiting, severe melaise. On 1/12/21 resident expired.Y1/12/2021N1/4/20211/12/20218SEN
Resident in skilled nursing facility. Please contact facility if needing all medications.
Asthma, hypothyroidism, essential hypertension, atherosclerotic heart disease of native coronary artery, spinal stenosis, fibromyalgia, dementia. Please contact nursing facility for further needed information.
21/14/2021
Phenazopyridine, Demerol, Pyridium, Penicillins
1372
920326
COVID19
MODERNA
1/5/2021IN8989FYRedness and warmth with edema to right side of neck and under chin. Resident was on Hospice services and expired on 1.1.21Y1/1/2021N12/29/202012/30/20201NASEN
Cetirizine, Lactaid
G30.1 Alzheimer's disease with late onset (Primary) M19.90 Unspecified osteoarthritis, unspecified site J44.9 Chronic obstructive pulmonary disease, unspecified I95.1 Orthostatic hypotension J45.909 Unspecified asthma, uncomplicated R13.12 Dysphagia, oropharyngeal phase M15.0 Primary generalized (osteo)arthritis M85.80 Other specified disorders of bone density and structure, unspecified site Note: Osteopenia J30.9 Allergic rhinitis, unspecified F41.1 Generalized anxiety disorder M24.511 Contracture, right shoulder M24.512 Contracture, left shoulder M24.521 Contracture, right elbow R29.3 Abnormal posture M17.4 Other bilateral secondary osteoarthritis of knee M25.561 Pain in right knee R26.89 Other abnormalities of gait and mobility Z74.1 Need for assistance with personal care Z91.81 History of falling M62.81 Muscle weakness (generalized) R29.6 Repeated falls R27.8 Other lack of coordination R63.3 Feeding difficulties E73.8 Other lactose intolerance R53.1 Weakness I95.89 Other hypotension
G30.1 Alzheimer's disease with late onset (Primary) M19.90 Unspecified osteoarthritis, unspecified site J44.9 Chronic obstructive pulmonary disease, unspecified I95.1 Orthostatic hypotension J45.909 Unspecified asthma, uncomplicated R13.12 Dysphagia, oropharyngeal phase M15.0 Primary generalized (osteo)arthritis M85.80 Other specified disorders of bone density and structure, unspecified site Note: Osteopenia J30.9 Allergic rhinitis, unspecified F41.1 Generalized anxiety disorder M24.511 Contracture, right shoulder M24.512 Contracture, left shoulder M24.521 Contracture, right elbow R29.3 Abnormal posture M17.4 Other bilateral secondary osteoarthritis of knee M25.561 Pain in right knee R26.89 Other abnormalities of gait and mobility Z74.1 Need for assistance with personal care Z91.81 History of falling M62.81 Muscle weakness (generalized) R29.6 Repeated falls R27.8 Other lack of coordination R63.3 Feeding difficulties E73.8 Other lactose intolerance R53.1 Weakness I95.89 Other hypotension
21/5/2021Lactose