Found 677 cases where Patient Died and Vaccination Date from '2023-01-01' to '2023-12-31'

Administered by: Private       Purchased by: ?
Symptoms: Death, Resuscitation, 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: 2023-01-06
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was found unresponsive in crib, EMS was called, CPR started. Pt received 20 doses of epinephrine and 90 minutes of CPR before calling time of death.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Dyspnoea, Laboratory test normal, Lethargy, Nausea, Pallor, Unresponsive to stimuli, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol sulfate, vitamin C, Bisacodyl, cranberry extract, Cymbalta, ferrous sulfate, furosemide, geri-tussin, loperamide, metoprolol succinate ER, ondansetron, ranolazine, simvastatin, Tamsulosin, Thera-M Plus, calcium carb
Current Illness: nausea and vomiting
Preexisting Conditions: Hyperlipidemia, osteoarthritis, sciatic, history of embolism and thrombosis, atherosclerotic heart disease, pain. constipation, major depressive disorder, weakness, COVID positive on 1/28/2022, anemia, essential hypertension, diarrhea, rash and other skin irruptions, idiopathic gout, diverticulitis of intestines, dry eye syndrome, nausea with vomiting, morbid obesity, vitamin deficiency, gastrointestinal hemorrhage, benign prostatic hyperplasia, long term use of anticoagulants, acquired buried penis, angina pectoris.
Allergies: Adhesives, penicillin
Diagnostic Lab Data: Resident quickly transferred to ER, no diagnostic test completed at facility
CDC Split Type:

Write-up: Resident visited ER on 1/4/2023 for nausea and vomiting at approximately 10 pm. Labs were drawn at the ER with no abnormal results reported by ER nurse. Resident returned to facility approximately 3 hours later. On 1/6/2023, resident stated he was "feeling fine" on two separate instances before vaccine administration, nausea and vomiting had subsided and vital signs were within normal limits. Vaccine was administered approximately 9:45 am. At approximately 2 pm, resident again stated he was feeling fine. At 3 pm, resident was seen by facility nurse practitioner, who noted resident was having bilateral audible wheezing. Resident refused transfer to ER at that time. Approximately, 3:20 pm, staff assisted resident from the bed to his wheel chair and resident suddenly become short of breath and pallor was noted by staff, resident was alert and oriented at this time. Pulse oximetry was 81%. Oxygen was applied at 4L /min. EMS was contacted for transport to ER. At 3:25 pm, resident became lethargic and unresponsive to stimuli, oxygen increased to 5L/min. EMS arrived shortly after and patient was transported to stretcher and taken by ambulance to ER where he passed.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-12
   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: apixaban, brimonidine tartrate ophthalmic drops, carboxymethylcellulose ophthalmic drops, dorzolamide HCL ophthalmic drops, furosemide, latanoprost ophthalmic drops, biotin, gelatin capsule, multivitamin/mineral/antioxidant tab, oxycodone a
Current Illness: Unknown
Preexisting Conditions: Glaucoma, IBS, Chronic Congestive Heart failure, Atrial fibrillation, prostate carcinoma, malignant melanoma, pulmonary hypertension
Allergies: felodipine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was reported to be deceased the morning after vaccination on 1/12/23. Unknown exact time of death during the night.

Administered by: Senior Living       Purchased by: ?
Symptoms: Chills, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-12
   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: Atorvastatin 10 mg; Furosemide 40 mg; Benadryl 25 mg; Ciloxan 0.3% eye ointment; Colace 100 mg; Gabapentin 100 mg; Glimepiride 4 mg; Insulin Lispro; Isosorbide Dinitrate 5 mg; Metalozone 2.5 mg; Omperazole; Os-Cal; Ozempic; Potassium Chlori
Current Illness: None
Preexisting Conditions: Diabetes; Hyperlipidemia; Cellulitis; COPD; Congestive Heart Failure; Emphysema; Chronic Pulmonary Edema; Acute and Chronic Heart Failure; Sleep Apnea; Dependence on Supplemental Oxygen; Morbid Obesity
Allergies: Aspirin; Adhesives
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 1/10/23, Patient reported to the nurse that she started having chills, muscle aches, and nausea. These symptoms subsided about 24 hours after reporting.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Full blood count, Hypotension, Metabolic function test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-07
   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: Lasix, Aspirin, Senna, Donepezil, Rosuvastin, Olanzapine, Tamsulosin
Current Illness: COPD, PVD, HTN, Pulmonary Fibrosis, Anemia, Dementia
Preexisting Conditions: COPD, PVD, HTN, Pulmonary Fibrosis, Anemia, Dementia
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP on 1/2/2023
CDC Split Type:

Write-up: Patient received the COVID-19 Bivalent Booster vaccine on 1/5/2023. On 1/7/2023 patient was sent to the hospital due to hypotension and later expired.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-12
   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: According to our record, pt was taking amlodipine 10mg, Janumet XR 50/1000, and clotrimazole/betamethasone. No report of OTC/dietary supplements
Current Illness: No data
Preexisting Conditions: Pt listed Type 2 DM
Allergies: no known allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: We got a report from patient''s husband that the patient passed away from heart attack approximately 20 hours after receiving the vaccine.

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-13
   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: Acetaminophen, Atorvastatin, bumex, Eliquis, Fish oil capsule, Dulcolax, Humalog insulin, Ipratropium-Albuterol aerosal, Lisinopril, Metolazone, milk of magnesia, Pancrelipase, Paxil, Percocet, Toujeo Insulin.
Current Illness: cellulitis of groin with MRSA and cutaneous abscess of groin, localized edema
Preexisting Conditions: Type 2 diabetes, Obesity, Hyperlipidemia, chronic pain syndrome, Essential hypertension, muscle weakness, urinary retention, hx of amputation of right great toe, noncompliance with medical treatment.
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident was found unresponsive with absence of vital signs. Resident was a full code and code was initiated, but resident did not recover and expired. No prior signs nor symptoms of adverse reactions to vaccine were present between the time of vaccine being given and this event.

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary normal, Cardiac arrest, Chest pain, Computerised tomogram coronary artery normal, Death, Dyspnoea, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Myocardial infarction (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: 2023-01-16
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, bupropion, atorvastatin
Current Illness: None
Preexisting Conditions: Diabetes, tobacco dependence
Allergies: Seafood
Diagnostic Lab Data: Will need to request records from hospital
CDC Split Type:

Write-up: On day of adverse event patient presented to ER with acute dyspnea and chest pain. Cardiac arrest in waiting room. Deceased. CT PE negative. Troponin elevated. Did not have cardiac cath as he died. Previously had normal coronary Calcium score 1/4/23, so shocked if this was acute coronary syndrome from Pre existing heart disease. While has risk factors, we had just done this reassuring calcium score of zero (low risk). No autopsy done. Ultimate cause of cardiac arrest not determined.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death

Administered by: Senior Living       Purchased by: ?
Symptoms: Communication disorder, Death, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-23
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: 12/29 COVID at the hospital
Preexisting Conditions: Dementia
Allergies: NKA
Diagnostic Lab Data: Unsure
CDC Split Type:

Write-up: Resident sent to hospital on 01/20/2023 for change in mental status, unable to communicate at baseline, yelling out Received a call today from hospital that he expired there this am 01/23/2023

Administered by: Other       Purchased by: ?
Symptoms: Death, Myocardial infarction, Resuscitation
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (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: .5 mg avorstatin, vitamin c,
Current Illness: none
Preexisting Conditions: Rheumatic fever at age 13. Leg varicosities. Heart murmur. Atypical migraines.
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: He had a heart attack and was not able to be resusitated

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NIFEDIPINE,FENOFIBRATE,LOVASTATIN,LISINOPRIL,GLIPIZIDE,ZOLPIDEM, TRIUMEQ, METOPROLOL, CLONIDINE.
Current Illness:
Preexisting Conditions: DIABETES MELLITUS TYPE 2, HYPERTENSION, HIV DISEASE, CHRONIC KIDNEY DISEASE, HYPERLIPIDEMIA, LIPODYSTROPHY
Allergies: AMOXICILLIN, SULFA PRODUCTS
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found at home dead.

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Death, Lethargy, Malaise, Pyrexia, Respiratory tract congestion, Respiratory viral panel, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-25
   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: Nystatin, tylenol, Keppra, Remeron, Coreg
Current Illness: wheezing and cough on 12/30/2022
Preexisting Conditions: Epilepsy, essential hypertension, repeated falls, depression, dementia
Allergies: codeine, depakote
Diagnostic Lab Data: physician ordered chest xray, respiratory panel, urinalysis 1/24/23
CDC Split Type:

Write-up: Death. Pt became ill with fever, congestion, lethargy on 1/24/23.

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Infant irritability, Respiration abnormal, Sudden infant death syndrome, Viral test
SMQs:, Acute central respiratory depression (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-25
   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 known at this time
Preexisting Conditions: none known at this time
Allergies: none known
Diagnostic Lab Data: Results of autopsy and viral testing not yet available
CDC Split Type:

Write-up: Sudden infant death several days after receiving 4 month vaccine series Became fussy and developed raspy breathing in the days following the vaccine administration

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-31
   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: D-Vi-Sol (10mcg/mL-400units/mL)
Current Illness: No known
Preexisting Conditions: no known
Allergies: NKDA
Diagnostic Lab Data: Sent for autopsy 01/31/2023
CDC Split Type:

Write-up: Death

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-12
   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: Amlodipine, Aplxaban, Doxazosin, Hydrocodone, I-Vite, Insulin Lispro, Linezolid, Melatonin, Metoprolol, Metronidazole, Mirtazipine, Ondansetron, Pantoprazole, Phenergen transdermal, Sertraline
Current Illness:
Preexisting Conditions: CHRONIC KIDNEY DISEASE, STAGE 3; TRANSIENT CEREBRAL ISCHEMIC ATTACK; TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA; URINARY TRACT INFECTION; PSOAS MUSCLE ABSCESS
Allergies: Amoxicillin, ceFAZolin, Cephalexin, Sulfamethoxazole/Trimethoprim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident became hypoxic and possibly aspiration transported to the ER. Resident passed away on the 1/16/2023

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-30
   Days after onset: 0
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine Sulfate, Aspirin, Anoro Elipta Aerosol, Hyoscyamine SL
Current Illness: COPD,, Dementia, Chronic Subdural Hemorrhage Malnutrition
Preexisting Conditions: COPD and Malignant Neoplasm of Bronchus and Lungs
Allergies: Keppra
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has been under the services of hospice care since4-7-22. He tested positive COVID positive on 1-23-23 and expired in house 1-30-23

Administered by: Other       Purchased by: ?
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-03
   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: Biktarvy
Current Illness: HIV positive History of syphilis-Treated Anxiety Methamphetamine abuse Tobacco abuse
Preexisting Conditions: HIV positive Methamphetamine abuse IV drug use Tobacco abuse Anxiety
Allergies: No known allergies
Diagnostic Lab Data: Unknown. Body in the care of Coroner''s Office. Autopsy pending to the best of my knowledge.
CDC Split Type:

Write-up: Sudden death

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None reported
Allergies: KNDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per pt spouse, pt suffered blood clot and died.

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiac arrest, Chest pain, Death, Electrocardiogram ST segment elevation, Pulseless electrical activity, Troponin, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-03
   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: metformin, losartan 100 mg qd, cholecalciferol 25mcg qd
Current Illness: none
Preexisting Conditions: Type II DM, HTN
Allergies: nkda
Diagnostic Lab Data: EKG with ST elevated 2,3,f, V2-6 troponin 222
CDC Split Type:

Write-up: Pt presented at 16:35 to clinic on 2/3/23 c/o chest pain. Clinic was closed. Nurse talked to pt - pt assessed, no acute distress, speaking full sentences, advised to drive to ER pov. Pt presented to ER at 16:46 with chest pain ,EKG showed inferior ST elevation MI with elevation in leads 2, 3,F, V2-V6. Given thrombolytics. At approx 18:30 pt became unresponsive, suffered cardiac arrest with PEA, unable to be resuscitated. Time of death 18:50

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyanosis, Death, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (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: 2023-02-06
   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: Acetaminophen, Amlodipine, Artificial tears eye drops, Aspirin, Atorvastatin, Senna Plus
Current Illness: Left frontoparietal CVA on 12/27/22 with right sided hemiplegia
Preexisting Conditions: Dementia, Depression, Hypertension, Hyperlipidemia, Coronary artery disease, chronic kidney disease, Anxiety, Macular degeneration
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Received vaccine on 2/3/23 and then on 2/6/23 in am when up for breakfast was noted to cyanotic and unresponsive, was assisted into bed and passed away. There is no evidence that her death is related to vaccine other than timing.

Administered by: Public       Purchased by: ?
Symptoms: Death, Neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-09
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown, was being treated for recurrent brain and breast cancer.
Current Illness: Cancer
Preexisting Conditions: Cancer
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient died on 2/7/23 from cancer

Administered by: Public       Purchased by: ?
Symptoms: Cardiac arrest, Dyspnoea, Pulseless electrical activity
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), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-18
   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: citalopram 40mg take 1 tab daily. levothyroxine 50mcg take 1 tab daily. SUMAtriptam 25mg 1 tab as needed, may repeat 1 dose after 2 hours. zofran 4 mg take 1 tab as needed. Folic acid, Xeljanz, fexofenadine
Current Illness: Hypothyroidism, Depression, Migraines, Dyslipidemia, RA, Hx colitis, Dog Bite in Jan 2023,
Preexisting Conditions: Hyperlipidemia, Hypothyroidism
Allergies: Latex, Sulfamethoxazole-trimethoprim, Banana, Iodine, Shellfish, Opium
Diagnostic Lab Data: PEA at rhythm checks 2/18/23
CDC Split Type:

Write-up: Pulseless electrical activity, Cardiac arrest, possible PE event, pt spouse reported shortness of breath 3-4 days prior to incident with no recent illness per hospital report.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-19
   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: Olanzapine 5mg 1 daily Levothyroxine .075mg 1 daily Ferrous gluconate ergocalciferol
Current Illness: Dementia with auditory hallucinations
Preexisting Conditions: Hx breast cancer Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found down 2/19/23 in her bathroom, pronounced dead.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-16
   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: Namenda, Tylenol, Cepacol, Sertraline hydrochloride, Januvia, Dulcolax
Current Illness: Generalized decline
Preexisting Conditions: Dementia, diabetes
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident expired within 14days of receiving Bivalent dose.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Latanoprost Solution 0.005 %, Cholecalciferol Tablet 1000 UNIT, Cefuroxime Axetil Tablet 500 MG, Atorvastatin Calcium Tablet 20 MG, MiraLax Powder 17 GM/SCOOP,
Current Illness: CHRONIC KIDNEY DISEASE, STAGE 3, BENIGN PROSTATIC HYPERPLASIA,
Preexisting Conditions: HYPERTENSION, NEOPLASM
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardioversion, Death, Incorrect product formulation administered, Pulse absent, Respiratory arrest, Resuscitation
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has 2 Immunization Information System profiles. The profile checked prior to vaccine administration had 1 moderna vaccine listed. The other profile (discovered when looking up this dose) had the primary series listed. Vaccinator thought the patient needed a second dose and administered that dose. However, patient should have received a bivalent booster because the patient had a primary series documented on another profile in Immunization Information System. On February 24th, nurse was called to resident''s room at 1440 with reports from the CNA that he "wasn''t breathing." Upon approach, resident found to be pulseless and without respirations. At 1345, resident was awake and alert, as CNA stated that he gave him fresh water at that time. At 1442 CPR and AED initiated as well as oxygen via ambu bag with manual resuscitator. 911 called, as resident was a full code. Dr. present in room at 1450. Family called at 1452 (this RN spoke with sister) and informed her that resident was found pulseless and without respirations and that CPR had been initiated, and continued despite no return of spontaneous circulation. Sister was tearful during call, but agreed to stop CPR. TOD: 1454, resident was pronounced by Dr.

Administered by: Private       Purchased by: ?
Symptoms: Death, Fatigue, Hypersomnia, Illness, Immediate post-injection reaction, Infant irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-03-03
   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: multivitamins with iro
Current Illness: mild cold
Preexisting Conditions: severe reflux
Allergies: none known of
Diagnostic Lab Data: none available yet
CDC Split Type:

Write-up: Immediately following the vaccination pt. was VERY tired. He slept much more than unusual. He was very cranky and, in the evening, began to run a fever which lasted 3 days. He continued to have what appeared to be illness until his death. Death occurred 03/03/2023

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hypervolaemia
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INCPV20230004419

Write-up: fluid overloaded; passed away; This is a spontaneous report received from contactable reporter (Nurse) from a sales representative. A male patient received pneumococcal 20-val conj vac (dipht CRM197 protein) (PREVNAR 20), on 16Feb2023 as dose number unknown, single (Batch/Lot number: unknown) for immunisation. The patient''s relevant medical history and concomitant medications were not reported. The following information was reported: DEATH (death) with onset 24Feb2023, outcome "fatal", described as "passed away"; HYPERVOLAEMIA (hospitalization, medically significant), outcome "unknown", described as "fluid overloaded". The patient date of death was 24Feb2023. The reported cause of death was unknown. It was not reported if an autopsy was performed. Additional information: Nurse administered PCV20 on 16Feb2023 to patient. On 17Feb2023, patient went to the hospital and on 24Feb2023 the patient passed away. They didn''t report because based on doctor it didn''t feel it was related to Prevnar 20 and instead on fluid overloaded however the nurse felt suspicion that it was due to her giving PCV20 which is why she asked me what the mortality rate of PCV20 is. The information on the batch/lot number for pneumococcal 20-val conj vac (dipht CRM197 protein) has been requested and will be submitted if and when received.; Sender''s Comments: The limited information in this report precludes a full assessment of the case. The patient''s death on fluid overloaded which occurred one day after the vaccination more likely is associated with underlying medical condition. However, follow-up information such medical history, concurrent diseases, concomitant medications and event term details especially death cause and autopsy results are needed for meaningful evaluation. 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: passed away

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-03-10
   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: 1. Albuterol Sulfate HFA Inhalation Aerosol Solution 108 (90 Base) MCG/ACT (Albuterol Sulfate) 2 puff inhale orally every 4 hours as needed for WHEEZING 2. Cholecalciferol Tablet 1000 UNIT Give 1 tablet by mouth one time a day for VITAMIN
Current Illness: RESIDENT BECAME UNDER HOSPICE CARE ON 03/05/2023. NEWLY DIAGNOSISED NEOPLASM OF CONNECTIVE TISSUE TO THE HEAD.
Preexisting Conditions: CONGESTIVE HEART FAILURE PULMONARY MYCOBACTERIAL INFECTION EXOPHTHALMOS DEMENTIA DEPRESSION ATHEROSCLEROTIC HEART DISEASE NONRHEUMATIC AORTIC STENOSIS AFTRIAL FIBRILLATION BENIGH PROSTATIC HYPERPLASTIA BRADYCARDIA CARIDIAC PACEMAKER
Allergies: TUBERCULIN TEST
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: RESIDENT PASSED ON 03/10/2023. RESDIENT WAS UNDER HOSPICE CARE BUT HAD EXPRESSED THAT HE WANTED THE VACCINE BECAUSE HE WAS IN A LONG TERM FACILITY.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Epistaxis, Mouth haemorrhage, Pulse absent, Respiratory arrest, Resuscitation, Skin laceration
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-03-13
   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: NONE
Current Illness: NONE
Preexisting Conditions: PAROXYSMAL ATRIAL FIBRILLATION UNSPECIFIED ATRIAL FIBRILLATION ESSENTIAL (PRIMARY) HYPERTENSION CHRONIC KIDNEY DISEASE (CKD) SEPSIS, UNSPECIFIED ORGANISM URINARY TRACT INFECTION, SITE NOT SPECIFIED PAIN IN JOINT
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Resident was found on the floor by housekeeping. He was not breathing and had no pulse. He had a laceration to his nose and blood was coming out of his nose and mouth. Nurses did CPR on him and sent him to Regional Health Center ER. He was pronounced dead at the ER. He was last seen sitting up on the side of his bed by the CMA when she took him his medications. He was stable with normal vital signs.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-03-10
   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: penicillin V potassium 250 mg/5 mL recon soln (penicillin v potassium) Take 2.5 ml by mouth twice a day
Current Illness: Well visit with abnormal findings 03/06/23 Sickle Cell Disease
Preexisting Conditions: Sickle Cell Disease
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: notified at approximately 3pm on Friday, March 6, 2023 infant passed away that day

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood sodium decreased, Blood urea increased, Confusional state, Death, Dyspnoea, Hypotension, Laboratory test abnormal, Oxygen saturation decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-03-10
   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: Buspar,Carvedilol,Doxazosin,Duloxetine,Ferrous Sulfate,Finasteride,Guaifenisin,Insulin Glarginre, Isosorbide,Acetominophen,Albuterol Sulfate HFA Inhaler,Bupropion,Empaglifiozin,Levothyroxine,Magnesium,Pantoprazole,Sacubitri-Valsartan,Spiron
Current Illness:
Preexisting Conditions:
Allergies: Atorvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3/9/2023- Resident had increased confusion, SOB, low 02% and was hypotensive. Labs done on 3/7/2023 indicate low sodium levels with elevated BUN. Sub Q fluids initiated on 3/9/2023. Symptoms worsening throughout the day. Sent to ED on 3/9/2023 at 23:00. Notified by Hospital on 3/10/2023 that patient passed away.

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Expired product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-02-24
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20237

Write-up: She states that 5 patients were given expired doses. One elderly patient passed away the next day 24Feb2023.; Moderna lot 015B22A that expired 2/12/23. If a dose was given 2/23/23, She states that 5 patients were given expired doses; The vial was expired on 12-Feb-2023 and initially stored in the refrigerator on 23-Feb-2023; This spontaneous case was reported by a pharmacist and describes the occurrence of DEATH (She states that 5 patients were given expired doses. One elderly patient passed away the next day 24Feb2023.) in an elderly male patient who received mRNA-1273 (Spikevax) (batch no. 015B22A) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 23-Feb-2023, the patient received dose of mRNA-1273 (Spikevax) (unknown route) .5 milliliter. On 23-Feb-2023, the patient experienced EXPIRED PRODUCT ADMINISTERED (Moderna lot 015B22A that expired 2/12/23. If a dose was given 2/23/23, She states that 5 patients were given expired doses) and PRODUCT STORAGE ERROR (The vial was expired on 12-Feb-2023 and initially stored in the refrigerator on 23-Feb-2023). The patient died on 24-Feb-2023. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, EXPIRED PRODUCT ADMINISTERED (Moderna lot 015B22A that expired 2/12/23. If a dose was given 2/23/23, She states that 5 patients were given expired doses) and PRODUCT STORAGE ERROR (The vial was expired on 12-Feb-2023 and initially stored in the refrigerator on 23-Feb-2023) outcome was unknown. For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments. The concomitant medication was not reported. The treatment medication was not reported. No information provided about individual vials or unbroken cartons. The vial size was 2.5 ml but the information was unknown. The vial was initially stored on 23-Feb-2023. The vial had undergone no temperature excursions. Company comment: This spontaneous case concerns an elderly male patient of unspecified age with no medical history reported, who experienced the fatal unexpected serious (medically significant) event of death that occurred one day after receiving a dose of mRNA-1273 vaccine in COVID-19 vaccination series. It was reported that, an expired product was administered which was initially stored in refrigerator. Cause of death was unknown. It is unknown if an autopsy was performed. No further details on risk factors, circumstances leading to death, patient''s past medical history and additional vaccination details were reported.The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report. This case was linked to US-MODERNATX, INC.-MOD-2023-715165 (E2B Linked Report).; Sender''s Comments: US-MODERNATX, INC.-MOD-2023-715165:Same reporter (4 patient''s case); Reported Cause(s) of Death: Unknown cause of death

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
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: Patient was found deceased as reported via phone call by a member of the police department. No details were provided by the individual.

Administered by: Private       Purchased by: ?
Symptoms: Bed sharing, Infant irritability, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-04-04
   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: none
Current Illness: reflux, infant acne
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom put the baby in bed with her at midnight because he was fussy, Mom woke up in the morning and found the baby under the covers looking lethargic. She then called 911 and baby was taken to the emergency room.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide 2omg, Calcium Carbonate-Vitamin D 500-5MG-MCG, Ondansetron HCL 4mg, Docusate Sodium 100mg, Trazadone 50mg, Aluminum-Magnesium-Simethicone 200-200-20 MG/5ML, Tylenol Extra Strength 500mg, Senna Plus 8.6-50mg, Glycolax, Metoprolol
Current Illness: Other diagnosis: Hyperkalemia, Anemia, Dementia, UTI, Sepsis, Pneumonia, Hypo-osmolality and Hyponatremia, COPD, Old myocardia infarction
Preexisting Conditions: Heart Failure, Type 2 Diabetes Mellitus, Moderate Protien Calorie Malnutrition, Chronic Kidney Disease, Acquired abscence of Left Leg above the knee, major depressive disorder, Thrombocytopenia, Hypoxemia, Hperlipidemia, PVD, Generalized anxiety disorder.
Allergies: No Known Allegies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident expired

Administered by: Private       Purchased by: ?
Symptoms: Crying, Death, Foaming at mouth, Infant irritability, Resuscitation, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-15
   Days after onset: 14
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: He received his 2 month immunizations at 4:30 pm, he was extremely fussy and inconsolable. I was assured that this was normal due to vaccines. By Sunday morning, I found him unresponsive laying down. I called 911, administered CPR until paramedics arrived. Dark foam began coming out of his mouth. They pronounced him dead at the scene, stating that he had only been gone 10 to 30 minutes before I started CPR compressions. My son was born 8lbs 11oz. He was extremely healthy and full of smiles. Such a happy baby with absolutely no medical conditions.

Administered by: Senior Living       Purchased by: ?
Symptoms: Cardiac disorder, Cardio-respiratory arrest, Death
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), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-04-22
   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: Apixaban, Atorvastatin, Famotidine, Benzonatate, Docusate sodium, Flecainide Humulin R Sliding scale, Lactulose, Lantus solostar, Metoprolol, Pregabalin, Reglan, Renvela, Zofran, Plavix
Current Illness: ESRD, DM, Morbid Obesity ,Bradycardia, A-Fib, PVD, Cardiomegaly, Anxiety disorder, Right BKA, Hyperlipidemia
Preexisting Conditions: ESRD, DM, Morbid Obesity ,Bradycardia, A-Fib, PVD, Cardiomegaly, Anxiety disorder, Right BKA, Hyperlipidemia
Allergies: Bactrim, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac Event- Coded-Expired

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-04-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: Autism
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child passed away

Administered by: Senior Living       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac arrest, Cardio-respiratory arrest, Intensive care, Laboratory test, Respiratory arrest, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-04-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby aspirin, atorvastatin, Coreg, lisinopril, Ativan, prednisolone ophthalmic, Aldactone one time dose of IM Rocephin on 04/05 for leukocytosis and completed 7 day course of doxycycline on 4/3/2023 fir bronchopneumonia. Also completed QID
Current Illness: elevated wbc of 14.7 on 4/3/2023 with no evidence to support why.
Preexisting Conditions: Heart failure, Peripheral Vascular Disease, Hypertension
Allergies: None known
Diagnostic Lab Data: none available. All testing would have been done at hospital
CDC Split Type:

Write-up: Approximately 10 minutes post vaccination administration found with no heart beat or respiration. CPR initiated. EMS arrived. received 3 doses of epi. Approximately 20 after EMS arrived ER Dr. called to stop CPR. CPR was stopped. Suddenly heart rhythm noted. CPR restarted and taken to ER. Per hospital report coded again and was admitted to ICU in AFIB. While in ICU coded again but was not resuscitated.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2023-04-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Torsemide; Tylenol; Vicks VapoRub; FeroSul; Vitamin B12; Melatonin; Geri-Tussin; Omega-3; Sodium Phosphates Enema; Milk of Magnesia; Bisacodyl Suppository; Ensure; Zoloft; Metoprolol Tartrate; Bisacodyl Tablet; Polyethylene Glycol; Vitamin
Current Illness: Heart failure, COPD, Tachycardia; Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing; Unspecified fracture of right femur, sequela; Other lack of coordination; Dry eye syndrome of bilateral lacrimal glands; Open angle with borderline findings, low risk, bilateral; Vitreous degeneration, bilateral; Benign paroxysmal vertigo, unspecified ear; Unspecified sensorineural hearing loss; Tinnitus, unspecified ear; Essential (primary) hypertension; Chronic ischemic heart disease, unspecified; Allergic rhinitis, unspecified; Spinal stenosis, lumbar region with neurogenic claudication; Hyperlipidemia, unspecified; Benign paroxysmal vertigo, bilateral; Unspecified atrial fibrillation; Gastro-esophageal reflux disease without esophagitis; Primary generalized (osteo)arthritis; Muscle weakness (generalized); Difficulty in walking, not elsewhere classified; Edema, unspecified; Peripheral vascular disease, unspecified; Low back pain, unspecified; Other obesity due to excess calories; Orthostatic hypotension; Primary insomnia; Chronic respiratory failure with hypoxia; Primary osteoarthritis, unspecified site; Chronic kidney disease, stage 3 unspecified; Syncope and collapse; Localized edema; Long term (current) use of anticoagulants; Personal history of other infectious and parasitic diseases; Personal history of other diseases of the digestive system; Carpal tunnel syndrome, right upper limb; Trigger finger, left little finger; Supraventricular tachycardia; Ileus, unspecified; Panniculitis affecting regions of neck and back, sacral and sacrococcygeal region; Depression, unspecified
Preexisting Conditions:
Allergies: Trazadone
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient Died unexpectly @ 11:21 AM vaccine given by Dr.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-06
   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: TERAZOSIN 5MG, CALCITROL .25MCG, OTC ITEMS UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HISTORY OF MEDICATIONS FOR KIDNEY DISEASE AND ENLARGED PROSTATE.
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT PASSED AWAY UNEXPECTEDLY. UNKNOWN TIME OR CIRCUMSTANCES SURROUNDING THE DEATH.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-09
   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: ACETAMINOPHEN 500MG TAB TAKE TWO TABLETS BY MOUTH THREE TIMES A DAY AS NEEDED FOR PAIN OR FEVER AMLODIPINE BESYLATE 5MG TAB TAKE ONE TABLET BY MOUTH EVERY MORNING APIXABAN 5MG TAB TAKE ONE TABLET BY MOUTH EVERY 12 HOURS ATORVASTATIN CALC
Current Illness: N/A
Preexisting Conditions: History of cardiac pacemaker, mild cognitive impairment, aflutter on Eliquis, aortic valve disease s/p AVR, BPH/LUTS, urinary retention requiring foley catheter placement x approx. 1 year.
Allergies: No known allegies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has a hx of cardiac pacemaker, mild cognitive impairment, aflutter on Eliquis, aortic valve disease s/p AVR, BPH/LUTS, urinary retention requiring foley catheter placement x approx. 1 year.. Patient was seen for routine home visit by Nurse Care Manager on May 8, 2023 at 1100. Patient was administered Moderna COVID-19 bivalent booster around approx. 1115, and was observed for remainder of Nursing visit until completed at 1200 w/o evidence of acute reaction/side effects, stable vital signs and examination. Patient had received COVID-19 Moderna vaccines in the community x 3 w/o documented or reported side effects. The Team was informed on May 10, 2023 that the patient was found deceased in his home on May 9, 2023 and was pronounced so by EMS at 1636. Due to timing of patient receiving vaccine and patient''s time of death, it was discussed to enter a report for continuity of care.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-10
   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: Vitamin C 1000 mg daily, Vitamin B12, multi-vitamin.
Current Illness: No acute illness.
Preexisting Conditions: CHF, type 2 diabetes, persistant atrial fibrillation, CAD, HTN.
Allergies: Augmentin, hydochlorothiazide, losartan causing hives.
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Death. The patient went to bed the night he was given vaccine and died during the night.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-11
   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: new dx diabetes, hyperlipidemia
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient death. Unknown if related to vaccine.

Administered by: Private       Purchased by: ?
Symptoms: Sudden death, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Noninfectious myocarditis/pericarditis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-28
   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: N/A
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden, unexpected death; found unresponsive in an adult bed with adults the day after receiving Rotavirus, Prevnar, HIB, and Pediarix (not otherwise specified in medical record) at 2 month well child check

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-14
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INCPV20230008612

Write-up: got sick; he was dead; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the parent. A male patient received BNT162b2, BNT162b2 omi ba.4-5 (BNT162B2, BNT162B2 OMI BA.4-5), on 02Jan2023 as dose number unknown (booster), single (Batch/Lot number: unknown) for covid-19 immunisation. The patient''s relevant medical history and concomitant medications were not reported. Vaccination history included: Covid-19 vaccine (Primary Immunization series complete but unknown manufacturer.), for COVID-19 Immunization. The following information was reported: DEATH (death, medically significant) with onset 14Jan2023, outcome "fatal", described as "he was dead"; ILLNESS (non-serious), outcome "unknown", described as "got sick". The event "he was dead" required emergency room visit. The patient date of death was 14Jan2023. The reported cause of death was unknown. It was not reported if an autopsy was performed. Details were as follows: Patient received the shot on 02Jan2023, and by the 14Jan2023, he was dead. The reporter noted that when the patient first got sick (not further specified), he stayed over his friend''s house, and reporter urged him to go to the emergency room. The information on the batch/lot number for BNT162b2, BNT162b2 omi ba.4-5 has been requested and will be submitted if and when received.; Reported Cause(s) of Death: he was dead

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Death
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: 2023-04-29
   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: Simvastatin 5 MG Tablet 1 tablet in the evening Orally Once a night metFORMIN HCl ER 750 MG Tablet Extended Release 24 Hour 1 tablet with a meal Orally tid Centrum Adults - Tablet once a day Orally once a day Lisinopril 20 MG Tablet 1 table
Current Illness:
Preexisting Conditions: NIDDM HTN High Cholesterol
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Participant death after cardiac arrest on 4/29/23.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Many, patient was 92 and a resident of a long term care facility on end of life care at time of vaccination.
Current Illness: acute hyperkalemia
Preexisting Conditions: diabetic neuropathy, gout, hypomagnesia, morbid obesity, major depressive disorder, insomnia, obstrucive sleep apnea, chronic pain, age related macular degeneration, pulmonary HTN, chronic atrial fibrillation, chronic systolic heart failure, atherosclerosis of arteries of the extremities, lymphedema, GERD, BPH, oropharyngeal dysphagia, permanent cardia pacemaker.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died of expected causes less than 2 weeks after vaccination

Administered by: Private       Purchased by: ?
Symptoms: Terminal state
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-16
   Days after onset: 45
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol Lovenox Fluticasone-Salmeterol Lopressor Provigil Prednisone Daliresp Zoloft Theophylline
Current Illness: Acute on chronic hypoxemic respiratory failure Acute on chronic hypercapnic respiratory failure COPD Malignant neoplasm of supraglottis, remission Severe protein calorie malnutrition Hypertension Anemia, chronic
Preexisting Conditions: GERD Former smoker COPD?on 3 L NC at home CHF Malignant neoplasm of supraglottis Anemia C-section Endometrial ablation Cervical conization Tonsillectomy Supraglottic mass biopsy Port placement
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was called to the bedside by RN at the request of the family to further discuss care. They would like to continue with comfort care. We discussed the next steps for comfort care measures to be in place. They understand that this is terminal and do not want her to suffer. I have placed comfort care orders and discussed with the RN. Will remain available for further needs of the family and the patient.

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-19
   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: UNSPECIFIED HYDRONEPHROSIS OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED MALIGNANT NEOPLASM OF BLADDER MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED HYPERLIPIDEMIA, UNSPECIFIED PERIPHERAL VASCULAR DISEASE, UNSPECIFIED POLYNEUROPATHY, UNSPECIFIED ATHSCL HEART DISEASE OF NATIVE CORONARY ARTERY W/O ANG PCTRS TIA (TIA), AND CEREB INFRC W/O RESID DEFICITS CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED
Preexisting Conditions:
Allergies: Loratadine, Benadryl, Demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-01-22
   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: Influenza A (dx 1/2/23)
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccines 01/20/23, died 01/22/23. Diagnosed with Influenza A 1/2/23- Asymptomatic at time of vaccines. Do not suspect vaccines contributed to death of patient.

Administered by: Senior Living       Purchased by: ?
Symptoms: Chronic respiratory failure, Condition aggravated, Death, General physical health deterioration, Hypoxia, Laboratory test abnormal, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-26
   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: Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML GuaiFENesin ER Tablet Extended Release 12 Hour 600 MG Torsemide Tablet 20 MG Tylenol 1000 MG Gabapentin Capsule 100 MG ATORVASTATIN CALCIUM F/C 20MG TABLET Mesalamine Oral Tablet Delayed Re
Current Illness: UTI-MRSA (results back after death) ACUTE WHEEZING/RESPIRATORY ILLNESS
Preexisting Conditions: OSTEOARTHRITIS CHRONIC OBSTRUCTIVE PULMONARY DISEASE CHRONIC RESPIRATORY FAILURE WITH HYPOXIA HYPERLIPIDEMIA CHRONIC KIDNEY DISEASE, STAGE 3B OBESITY OBSTRUCTIVE SLEEP APNEA CROHN''S DISEASE METABOLIC ENCEPHALOPATHY OSTEOPOROSIS HEART FAILURE
Allergies: Statins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident has been declining. However, day after receiving vaccination had hypoxia and wheezing. Stat labs were ordered, but not obtained prior to death.

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. past away unexpectedly on 5/25/2023, the cause was ruled a heart attack. This was reported to us by a friend, after she found his vaccination information from 5/13/2023 and saw that cardiac events are a potential adverse effect for the vaccine.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-31
   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: (See below)
Preexisting Conditions: (See below)
Allergies: Penicillin
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Resident admitted to facility on 5/23/2023 on Hospice Care. Resident received vaccine at approximately 1000 on 5/30 at PRIVACY Pharmacy. On 5/31 at 0420, staff found resident unresponsive, not breathing. Pronouncement of death 0420 on 5/31.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Dyspnoea, Dysstasia, Fatigue, Retching
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-28
   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
Current Illness: heart disease, oxygen use
Preexisting Conditions: heart disease
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt received Shingrx on Saturday, May 27 2023 at 3 pm. Patient started having dry heaves at 4 am on 5-28-23. Difficult breathing, fatigue and had difficult standing on her own. Family then attended the patient with assistance on getting oxygen and laying with her to calm her down. She did get calmed but passed away at approximately 8:30 am on that same day. No ambulance or dr''s were involved. Not sure if Shingrix was involved, but we are reporting at this time.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-04-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bronchitis, Death, Fatigue, Mobility decreased, Nervous system disorder
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-28
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 80 mg, lisinopril 5 mg, metformin 500 mg, metoprolol succinate Er 25 mg, victoza 3 pak 18 mg/3mL
Current Illness: NA
Preexisting Conditions: hypercholesteremia, type 2 diabetes, hypertension
Allergies: None
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient received covid vaccine on 5/11/23 and reported feeling fatigued the next day. Patient''s wife reported patients increased fatigue throughout the next couple of days where he could not get out of bed. Patient was admitted to the hospital on 5/15/23 where he was diagnosed with bronchitis and degenerative neuro system. The patient passed away on 5/28/23.

Administered by: Senior Living       Purchased by: ?
Symptoms: Breath sounds abnormal, Death, Headache, Increased bronchial secretion, Livedo reticularis, Malaise, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-06-11
   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: No medicine given at the time of vaccination.
Current Illness:
Preexisting Conditions: Pelvis fracture, back pain, hypertension, gastroesophageal reflux, hyperlipidemia, IBS, rheumatoid arthritis
Allergies: Abatacept, Aleve, Simponi, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: June 11, 2023 midnight: Headache and not feeling well. Requested a cool washcloth for her head. Had a small liquid emesis. Prn emetrol offered but declined. Requested to go to restroom and had a large bowel movement. She stated she felt better. Assisted back to bed. She was monitored often. 2 tylenol 325mg given for temp. Around 3am, she was found unresponsive with secretions, rattles in lungs. Mottling started from hip to feet. Family called. She was monitored often. Family arrived to be with her. She passed around 5am.

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Death, Pneumonia
SMQs:, Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2023-05-26
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine was given on friday, felt weak over weekend went to Doctor on Monday and diagnosed with double pneumonia and sent straight to hospital and passed away within 4 days

Administered by: Senior Living       Purchased by: ?
Symptoms: Ammonia, Blood thyroid stimulating hormone, Death, Metabolic function test
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-28
   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: Alprazolam, Citalapram, Ducosate, Flomax, Fluticosone, PO potasium Chloride, Ventolin HFA, Vitamin b12, d3, Buspirone, Doxycycline, iron sulfate, lasix, Lactobacillas, mucinex, ompeprazole. tylenol, Gabapentin, albuterol nebs.
Current Illness: Pneumonia, Bilateral lower ext edema, CHF
Preexisting Conditions: Anemia, Osteomyelitis, CAD< GERD, B-12 deficiency, covid, anxiety, depression, poly neuropathy, ankylosing Spondylitis, BPH,
Allergies: NKA
Diagnostic Lab Data: 5/23 amonia, TSH, BMP
CDC Split Type:

Write-up: Resident expired 5/28/2023

Administered by: Private       Purchased by: ?
Symptoms: Death, Respiratory arrest, Resuscitation, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-05-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PCP office notified of deceased patient on 5/18/2023. Per ED documents, patient was brought in unresponsive, CPR in progress. Also noted, 2-year-old found lying on top of the patient and patient was not breathing. PCP office instructed by Risk Management department to file VAERS report on 6/19/2023.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-06-21
   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: Eliquis Metoprolol Levothyroxine Furosemide tramadol vitamin D multiple vitamin acetaminophen
Current Illness: a fib HTN HLD hypothyroidism morbid obesity lymphedema recurrent cellulitis at LEs
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found expired in bed the next day

Administered by: Private       Purchased by: ?
Symptoms: Death, Positive airway pressure therapy, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2023-06-20
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amiodarone Zithromycin Pulmicort Lovenox Lasix Protonix Miralax Predinsone Requip
Current Illness: Acute on chronic hypoxic respiratory failure COPD exacerbation Hypertension Coronary artery disease BPH GERD
Preexisting Conditions: COPD with chronic hypoxic respiratory failure on chronic home noninvasive ventilation, hypertension, hyperlipidemia, GERD, A-fib. Past surgical history includes right eye surgery requiring suturing the right eyes shut for several months. He also had peripheral arterial vascular surgery in 2001.
Allergies: Alfuzosin Atorvastatin Levofloxacin Lincomycin Neomycin Niacin Oxycodone Penicillins Polymyxin B Pravastatin Simvastatin Tadalafil
Diagnostic Lab Data:
CDC Split Type:

Write-up: This patient presented to hospital as a transfer where he has been hospitalized for the last week. He was admitted with complaints of respiratory distress. The patient is on home oxygen with 10 L of O2. He also has a home trilogy machine. Following his admission he continued to require high amounts of oxygen. He was on 100%/ 40L with a NRB as needed and then progressed to requiring Bipap most of the day and night. The patient was a DNR and the family was discussing end of life care with hospice. The patient was pronounced deceased at 1029 on 6/20/2023 with family at bedside.