Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Death, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: increased body temperature, seizure, death

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was 11 years old and 8 months at the time of vaccine No side effects noted. 

Administered by: Private       Purchased by: ?
Symptoms: Death, Respiratory tract haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   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: Trisomy 18, Scoliosis, Closed Ventricular Septal Defect, Ectopic Kidney, Gastrostomy Tube dependent, GERD, and Obstructive Sleep Apnea
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood in airway, Death

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Influenza like illness
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu like symptoms for 2 days then was found deceased

Administered by: Other       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Apnoea test abnormal, Arteriovenous malformation, Blood sodium increased, Brain death, Brain herniation, COVID-19, Cardiac arrest, Central nervous system lesion, Cerebellar haemorrhage, Death, Electrocardiogram abnormal, Endotracheal intubation, Haemorrhage intracranial, Hypernatraemia, Hypotension, Intensive care, Mechanical ventilation, Neoplasm, Resuscitation, SARS-CoV-2 test positive, Scan with contrast, Sinus tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: see above. Was covid positive on admission 6/19. Family gave a history of previous covid infection earlier this year.
CDC Split Type:

Write-up: Date of Admission: 6/19/2021 Date of Death: 6/20/2021 Primary Care Physician: No primary care provider on file. REASON FOR ADMISSION: Patient is a 13-year-old previously healthy male who was admitted after out-of-hospital cardiac arrest with ROSC after CPR for 15 minutes in the field, found to be in the context of large cerebellar hemorrhage secondary to brain lesion (AVM vs tumor). BRIEF SUMMARY OF HOSPITALIZATION: Patient was intubated prior to arrival to the ED. Upon arrival he was started on epinephrine and norepinephrine drips to maintain perfusion and was administered bicarbonate x2. Head CTA was obtained and was notable for midbrain hemorrhage and tonsillar herniation, and no contrast enhanced blood flow in the brain. Brain death exams were completed at 09:59 and 14:20. APNEA test was performed at 13:30, which is the official time of brain death. Official cause of death was brainstem herniation from intracranial hemorrhage. Mechanical ventilation was continued to allow family time to grieve and perform last rites. Time of cardiac death after mechanical ventilation withdrawal was 18:36. HOSPITAL COURSE BY PROBLEM: FEN/Renal/Endo: #Central DI He received 1.5 L of normal saline bolus in the ED and an additional 3 L of ringers lactate bolus overnight in the ICU to maintain perfusion and decrease heart rate. His sodium was 141 upon presentation but reached a maximum of 160 due to central diabetes insipidus. He was started on 0.45% normal saline at 100 mL/hr to improve hypernatremia, which was monitored Q1h until normonatremic. He additionally required vasopressin drip to be started due to central DI, which was increased to a maximum of 20 mU/kg/hr. CV: At time of admission, epinephrine was running at 0.1 mcg/kg/min and norepinephrine was 0.1 mcg/kg/hr. Norepinephrine was increased shortly thereafter to 0.12 mcg/kg/min. In the morning after admission, he had tachycardia to the 190s, which appeared to be narrow complex. Epinephrine and norepinephrine were discontinued. Two doses of adenosine were administered (6 mg first dose, 12 mg second dose) due to suspected SVT. The rate decreased for ~4 seconds after the second dose however returned to ~180. EKG arrived which showed sinus tachycardia so no further medications or cardiac interventions were done. Fluid rates were increased to 2x MIVF rate and additional 500 mL bolus of LR was administered. Norepinephrine and epinephrine were restarted and escalated due to low blood pressures in the early afternoon.to allow family time with patient. Both titrated to effect. Pulm: Patient was mechanically ventilated to achieve normal pH, normocarbia, and high arterial oxygen tension per brain death protocol. He had no primary pulmonary disease during this admission. Neuro: #Intraparenchymal hemorrhage #Tonsillar herniation Neurosurgery was consulted. Mannitol x1 and hypertonic saline 23% x1 were administered to decrease intracranial pressures. Keppra 2g was administered for seizure prophylaxis. No sedation was needed during patient''s hospitalization. PERTINENT STUDIES & CONSULTS: Pediatric neurology Neurosurgery PENDING TESTS RESULTS: None RECOMMENDATIONS AND FOLLOWUP: None No future appointments. PHYSICAL EXAMINATION: BP 108/78 | Pulse (!) 144 | Temp 36.5 ?C (97.7 ?F) | Resp (!) 15 | Ht 1.65 m (5'' 4.96") | Wt 46.5 kg (102 lb 8.2 oz) | SpO2 99% | BMI 17.08 kg/m? Estimated body mass index is 17.08 kg/m? as calculated from the following: Height as of this encounter: 1.65 m (5'' 4.96"). Weight as of this encounter: 46.5 kg (102 lb 8.2 oz). ALLERGIES No Known Drug Allergies

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Product administered to patient of inappropriate age
SMQs:, Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Died three days after vaccine; 13 year old boy dies three days after the Moderna vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Died three days after vaccine) in a 13-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (13 year old boy dies three days after the Moderna vaccine). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (13 year old boy dies three days after the Moderna vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product was not provided by the reporter. Treatment information was unknown. Company comment: This is a case of death in a 13-year-old male subject with unknown medical history, who died one day after receiving the vaccine. Very limited information has been provided at this time. Further information has been requested.; Sender''s Comments: This is a case of death in a 13-year-old male subject with unknown medical history, who died one day after receiving the vaccine. Very limited information has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of death

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Death, Full blood count, Metabolic function test normal, Pulseless electrical activity, SARS-CoV-2 test negative, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiac arrhythmia terms, nonspecific (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   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: one dose of dramamine given in the evening prior to arrival.
Current Illness: none
Preexisting Conditions: none, remote history of asthma
Allergies: none
Diagnostic Lab Data: CBC, CMP normal except slightly elevated glucose COVID PCR negative
CDC Split Type:

Write-up: patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death.

Administered by: Unknown       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: USPFIZER INC202101091051

( AUTHOR'S NOTE:  2 Children died and are listed on this same report.
This may have been counted as a single death)

Write-up: dead from second dose of Pfizer Covid 19 vaccine; This is a spontaneous report from a Pfizer-sponsored program by a non-contactable consumer. This report reported same event for two patients. This is the first dose of two reports. A 13-year-old female patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE at the age of 13-year-old for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received the first dose of bnt162b2 (BNT162B2) for covid-19 immunisation. A 13 years old female is dead from second dose of Pfizer Covid 19 vaccine. Both had no prior conditions with the heart and now are dead. The patient died on an unspecified date. It was unknown if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101091793 same report/drug/AE, different patients; Reported Cause(s) of Death: dead from second dose of Pfizer Covid 19 vaccine

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood chloride normal, Blood creatinine normal, Blood glucose increased, Blood potassium decreased, Blood sodium normal, Blood urea normal, Carbon dioxide decreased, Cardioversion, Death, Dizziness, Dyspnoea, Feeling abnormal, Full blood count, Haematocrit normal, Haemoglobin normal, Loss of consciousness, Metabolic function test, Nausea, Platelet count normal, Resuscitation, SARS-CoV-2 test negative, Supraventricular tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-27
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None known
Diagnostic Lab Data: Initial CBC with WBC 6.59, Hg 12.2, HCT 35.3, platelets 278. CMP with CO2 18, anion gap 22, glucose 270, Na 139, K 2.8, Cl 103, BUN 16, Creatinine 0.77, Albumin 3.4, ALK 97, AST 152, ALT 32, bilirubin 0.3. COVID PCR not detected.
CDC Split Type:

Write-up: Patient received first COVID vaccine on 7/11/21. She was well until 7/26/21 when she developed nausea, vomiting, shortness of breath and dizziness. At approximately 04:00 on 7/27/21, she woke up feeling poorly, went into the bathroom and then lost consciousness. EMS was called, she was in a tachycardia at 180 bpm, BP 88/64, unresponsive. EMS report states she was "in SVT and cardioverted at 30J then 70 J. Still in SVT but becoming more alert. HR 165 bpm, sats 98%." In ED, she was felt to be in ventricular tachycardia, She received attempted resuscitation with multiple rounds of CPR including chest compressions, defibrillation for reported ventricular fibrillation, and medications. She was unable to be resuscitated and death was pronounced in the ED. Autopsy is pending.

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Disseminated intravascular coagulation, International normalised ratio, Multiple organ dysfunction syndrome, N-terminal prohormone brain natriuretic peptide, Platelet count, Prothrombin time, Pulmonary haemorrhage, Pyrexia, Septic shock, Troponin T
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-14
   Days after onset: 1
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: Medical History/Concurrent Conditions: Dysphagia; Extremely preterm (less than 28 weeks); Hypoxic-ischaemic encephalopathy; Posthaemorrhagic hydrocephalus; Reflux oesophagitis; Respiratory insufficiency; Symptomatic epilepsy
Allergies:
Diagnostic Lab Data: Test Name: pTT; Result Unstructured Data: Test Result:$g180 seconds; Test Name: INR; Result Unstructured Data: Test Result:4.9; Test Name: proBNP; Result Unstructured Data: Test Result:24937 pg/mL; Test Name: Platelets; Result Unstructured Data: Test Result:min 3410x31uml; Test Name: Quick; Result Unstructured Data: Test Result:<10; Test Name: Troponin T; Result Unstructured Data: Test Result:1580 pg/mL
CDC Split Type: DEPFIZER INC202101072828

Write-up: Disseminated intravascular coagulation; Lung hemorrhage; Pyrexia; Multiorgan failure; Septic shock; This is a spontaneous report from a non-contactable other HCP. DE-PEI-202100168078. A 13-yars-old male patient received bnt162b2 (COMIRNATY, Formulation: Solution for Injection, Batch/Lot Number: 10020A) dose 2 0.3 mL via an unknown route of administration on 11Aug2021 (at the age of 13-years-old) as dose 1, single for COVID-19 immunisation. The patient''s medical history included extremely preterm (less than 28 weeks), Hypoxic-ischaemic encephalopathy, posthaemorrhagic hydrocephalus, symptomatic epilepsy, dysphagia, respiratory insufficiency, reflux oesophagitis on an unspecified date. The patient previously received first dose of bnt162b2 (COMIRNATY, Formulation: Solution for Injection) dose 1, Batch/Lot number unknown) for COVID-19 immunisation on 16Jun2021. Concomitant medications were not reported. The patient underwent lab tests and procedures which included platelets min 3410x 31uml, Quick <10, INR$g4.9, pTT $g180 sec, proBNP 24937 pg/ml, Trop T 1580 pg/ml on an unknown date. The patient experienced multiorgan failure, lung hemorrhage, disseminated intravascular coagulation, pyrexia and septic shock on 13Aug2021. The patient died due to Unknown cause of death on 14Aug2021. Seriousness for the events was reported as death, hospitallization and life threatening. The autopsy details were not reported. Sender Comment: Platelets min 3410^31uml, Quick <10, INR$g4,9; pTT $g180 sec, proBNP 24937 pg/ml, Trop T 1580 pg/ml Relatedness of drug to reaction(s)/event (s) Result of Assessment D. Unclassifiable No follow-up attempts possible. No further information expected.; Reported Cause(s) of Death: Unknown cause of death

Administered by: Other       Purchased by: ?
Symptoms: Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-03
   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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESPFIZER INC202101170757

Write-up: pulmonary edema; This is a spontaneous report from a Pfizer-sponsored program, from a contactable consumer (patent''s uncle) through the Pfizer company doctor. A 14-year-old male patient received bnt162b2 (COMIRNATY), 1st dose on 06Jul2021 (Lot Number: EX0893) and 2nd dose on 27Jul2021 (Lot Number: EW2246, both via an unspecified route of administration as single dose for COVID-19 immunization. Medical history none. Concomitant medications were not reported. The patient experienced pulmonary edema (death) on 03Sep2021. The patient died on 03Sep2021. The autopsy revealed that the cause of death was pulmonary edema.; Reported Cause(s) of Death: pulmonary edema

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Intensive care
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness:
Preexisting Conditions: Trisomey 21, Atrioventricular canal s/p repair, hypothyroidism, asthma, obstructive sleep apnea, cervical spine instability, hypotonia, scoliosis, feeding difficulties, renal dysplasia, autism, chronic constipation, bronchopulmonary dysplasia, mixed conductive and sensorineural hearing loss, binocular vision disorder, gastroesophgeal reflux,
Allergies: Cefdinir, Sulfa, Ex-Lax, NSAIDS
Diagnostic Lab Data:
CDC Split Type:

Write-up: I do not know the exact date of the first or second Moderna Vaccine. I am the PICU attending who cared for the patient after her cardiac arrest which we believe was about 3-4 days after her second Moderna Vaccine

Administered by: Public       Purchased by: ?
Symptoms: Cardiac failure, Death
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-20
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination
Current Illness: No
Preexisting Conditions: No
Allergies: Nothing
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart failure

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: none noted
Preexisting Conditions: Acne, no other conditions noted
Allergies: None noted
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unexplained death within 48 hours

Administered by: Pharmacy       Purchased by: ?
Symptoms: Resuscitation, Syncope, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lopressor 25mg BID
Current Illness: Diagnosed May 2021 hypertrophic cardiomyopathy
Preexisting Conditions: Diagnosed May 2021 hypertrophic cardiomyopathy
Allergies: unknown
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: 7/22/2021 Child collapsed on soccer field while playing soccer at a local camp. CPR was initiated immediately. EMS arrived and found patient in vtac. Shock x 5. ACLS, intubation attempted. Transported to Medical Center. Patient had covid in April 2021. Dx in May 2021 hypertrophic cardiomyopathy. Started on lopressor 25mg BID. Patient had reported to parents that he had not recently taken his medications. Patient had his second covid vaccine on Sunday 7/18/2021.

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Autopsy, Drowning, Gene sequencing, Intracardiac mass, Myocardial necrosis, Myocarditis, Pain, Pathology test, SARS-CoV-2 test negative, Subgaleal haemorrhage, Toxicologic test normal, Ventricular hypertrophy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Autopsy report 6/21/2021. Pertinent findings include: no external indication of scalp injury, with small subgaleal hemorrhage over the left occiput; normal epidural, subdural, and subarachnoid evaluations; mildly elevated cardiac mass 420 mg; normal pericardial appearance; normal coronary artery origins from the aorta and free of atherosclerosis; increased left ventricular wall thickness (1.8 cm) and normal right ventricular wall thickness (0.3 cm); normal gross appearance of the endocardium, myocardium, and cardiac valves; small foci of myocardial inflammation of the lateral wall of the left ventricle with myocyte necrosis; negative myocyte disarray; negative toxicology; negative SARS-CoV-2 RT-PCR; Ambry Genetics CardioNext analysis of 92 genes associated with inherited cardiomyopathies and arrhythmias negative for pathologic findings, positive for 2 variants of unknown significance.
CDC Split Type:

Write-up: He was in his usual state of good health. 5 days after receiving the vaccine, he complained of brief unilateral shoulder pain (unclear to family which shoulder), which the family attributed to a musculoskeletal source. No chest pains, shortness of breath, or palpitations. He was playing with 2 friends at a community pond, swinging from a rope swing, flipping in the air, and landing in the water feet first. He surfaced, laughed, told his friends "Wow, that hurt!", then swam toward shore, underwater as was his usual routine. The friends became worried when he did not re-emerge. His body was retrieved by local authorities more than an hour later.

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Body temperature decreased, Brain death, Brain hypoxia, C-reactive protein, Cardiac arrest, Coma, Computerised tomogram, Computerised tomogram head, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Headache, Magnetic resonance imaging, Pain in extremity, SARS-CoV-2 antibody test positive, Ultrasound Doppler
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), Ischaemic central nervous system vascular conditions (narrow), 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), Hypertension (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 27
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma; Barlow''s syndrome; Marfan''s syndrome
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210713; Test Name: arterial pressure; Result Unstructured Data: Test Result:90/60 mmHg; Test Date: 20210713; Test Name: temperature control; Result Unstructured Data: Test Result:36 Centigrade; Test Date: 20210713; Test Name: CT scan; Result Unstructured Data: Test Result:The ascending aorta is moderately dilated; Comments: No aortic dissection or large vsx, no intracranial bleeding, the super sigmoid aortography does not show any aortic insufficiency; Test Date: 20210715; Test Name: CT scan; Result Unstructured Data: Test Result:appearance of parenchymal parenchymal hemispherica; Comments: appearance of parenchymal parenchymal hemispherical hemispherical right upper cerebellar areas of ischemic appearance; Test Date: 20210713; Test Name: brain CT scan; Result Unstructured Data: Test Result:no bleeding; Comments: no traumatic injury; Test Date: 20210723; Test Name: brain CT scan; Result Unstructured Data: Test Result:stability of ischemic; Comments: lesions appearance of cerebral edema compatible with anoxo-ischemic lesions, put under Mannitol; Test Date: 20210727; Test Name: brain CT scan; Result Unstructured Data: Test Result:increase in cerebral edema; Comments: reaching almost the entire sustentorial stage, sudden episodes of desaturation.; Test Date: 20210713; Test Name: C-reactive protein; Result Unstructured Data: Test Result:1.4; Test Name: Trans-thoracic echocardiography; Result Unstructured Data: Test Result:finding a 30%; Comments: altered left ventricular ejection fraction with kinetic disorders suggestive of Takotsubo; Test Date: 20210713; Test Name: Electrocardiography; Result Unstructured Data: Test Result:Not very evocative; Comments: Respiratory rate; Test Date: 20210723; Test Name: electroencephalogram; Result Unstructured Data: Test Result:flat; Comments: with a few waves of intermittent activity; Test Date: 20210727; Test Name: electroencephalogram; Result Unstructured Data: Test Result:Pathological; Comments: Keppra introduction; Test Date: 20210713; Test Name: complete blood count; Result Unstructured Data: Test Result:normal; Test Date: 20210713; Test Name: cardiac magnetic resonance imaging; Result Unstructured Data: Test Result:cardio; Comments: in favor of a takotsubo; Test Date: 20210713; Test Name: covid; Test Result: Positive ; Comments: (Ig G antiS and antiN and IgM), re-reading of the entry serology concluded with a Covid infection starting at the same time as the anti-covid vaccination; Test Date: 20210713; Test Name: Left transcranial doppler; Result Unstructured Data: Test Result:left more disturbed; Comments: than the right (Vdiastolic 20 vs 40 on the right)
CDC Split Type: FRPFIZER INC202101056242

Write-up: This is a spontaneous report from a contactable physician downloaded from the Regulatory Authority-WEB [FR-AFSSAPS-MP20215396]. A 15-year-old female patient received bnt162b2 (COMIRNATY), intramuscular on 11Jul2021 07:30 (Lot Number: Unknown) (at the age of 15-year-old) as dose 1, single for COVID-19 immunization. Medical history included ongoing asthma, ongoing Barlow''s syndrome, ongoing Marfan''s syndrome. The patient''s concomitant medications were not reported. In good health overall, apart from a loss of 10kg over one year (since entering high school). During the day (11Jul2021), asthenia and isolated arm pain. The next day (12Jul2021), headaches yielding under Doliprane. On 13Jul2021, around 16:30 (last moment conscious view), her mother drops her off to her father. Father watered the garden and she cleaned the garage to prepare for her birthday party. On 13Jul2021 17:20, her father found her in cardio respiratory arrest, back to the ground, next to a ladder. No flow was unknown. At 17:30 arrival of firefighters: 2 external electric shocks were given and 1 mg of adrenaline injected. Moderately reactive pupils. At 17:50 arrival of Specialist mobile emergency unit: asystole (Life-threatening). Two injections of 1 mg of adrenaline, transition to ventricular fibrillation. 2 external electric shock, 2 ampule of Cordarone and one ampule of Calcium Gluconate. Return to regular sinus rythme without disturbance of repolarization and resumption of a pulse. Orotracheal intubation (probe no 6). New: 1 external electric shock, one ampule of Cordarone and 1 mg of adrenaline. Return of a sinus rhythm but presence of a sub ST in infero lateral. 90/60 mmHg arterial pressure excluding sedation. Tight areactive bilateral miosis pupils. Ventilated in Ventilator-Associated Conditions but presence of spontaneous ventilation requiring sedation by Hypnovel and Sufentanyl and 10 mg of Nimbex. Parallel introduction of Noradrenaline 0.8 mg/h. No filling. In total: low flow of 30 minutes. Recovered and transfer to intensive care. Examinations: biology: complete blood count normal, C-reactive protein 1.4. Coroner considered as normal no coronary dissection. Computed tomography scan Computed tomography arterial portography: No aortic dissection or large vsx, no intracranial bleeding, the super sigmoid aortography does not show any aortic insufficiency. The ascending aorta is moderately dilated. Computerised tomogram head: no bleeding, no traumatic injury. Electrocardiogram: Not very evocative. Respiratory rate. Maintenance of sedation, temperature control at 36 degrees. Complicated cardiac arrest of a Takotsubo. Trans-thoracic echocardiography finding a 30% altered left ventricular ejection fraction with kinetic disorders suggestive of Takotsubo (post stress?). More doubt about intra-left ventricular thrombus. Low left ventricular filling pressures. Integral time speed= 8. Inferior vena cava= 15. 15Jul2021 Appearance in the morning of continual clonies of the multiple sulfatase deficiency, put under Keppra increased to 750x2. Electroencephalography results pending + Left transcranial doppler more disturbed than the right (Vdiastolic 20 vs 40 on the right), Control contrast enhanced computed tomography scan superimposable at the level of large vsx, but appearance of parenchymal parenchymal hemispherical hemispherical right upper cerebellar areas of ischemic appearance. 20Jul2021 pathological awakening, inhalation lung disease, myocarditis assessment in progress (negative). 23Jul2021 no sign of wakign up flat electroencephalogram alternating with a few waves of intermittent activity. Computered tomography scan stability of ischemic lesions appearance of cerebral edema compatible with anoxo-ischemic lesions, put under Mannitol. Cardio: cardiac magnetic resonance imaging in favor of a takotsubo, myocarditis unlikely, infective and immunological workup negative. 27Jul2021 Pathological electroencephalogram, Keppra introduction. Computered tomography scan increase in cerebral edema reaching almost the entire sustentorial stage, sudden episodes of desaturation. The COVID serology returns positive (Ig G antiS and antiN and IgM), re-reading of the entry serology concluded with a Covid infection starting at the same time as the anti-covid vaccination. 30Jul2021 retro-rolandic aspect of brain death, vegetative coma. Decision to limit therapy. Complete file no further information. The patient died on 07Aug2021. An autopsy was not performed. Cause of Death: Anoxia cerebral and Cardiac arrest while outcome of the other events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Reported Cause(s) of Death: Cardiac arrest; Anoxia cerebral

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-13
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JOPFIZER INC202101119141

Write-up: Death/passed away; This is a spontaneous report from a contactable consumer or other non HCP (parent, father of patient). A 15-year-old male patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in the left arm on 09Aug2021 at 09:00 AM (at the age of 15-year-old; lot number: FF2154) as DOSE 1, SINGLE for COVID-19 immunisation. The patient''s medical history and concomitant medications were not provided. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The father reported that the patient (the son) received the dose 1 of the Pfizer vaccine on 09Aug2021 at 9AM on left arm. Unfortunately, patient passed away (death) on Friday 13Aug2021 at 04:30 without any history of illness. The event resulted in Emergency room/department or urgent care. Prior to vaccination, patient did not diagnose with COVID-19. Since the vaccination, patient did not test for COVID-19. Device date was 29Aug2021. No treatment received. Outcome of the event was fatal. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Death/passed away

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral ventricular rupture
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-20
   Days after onset: 4
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: JPMODERNATX, INC.MOD20213

Write-up: Cerebral haemorrhage; Cerebral ventricular rupture; This case was received via the Regulatory Authority (Reference number: JP-TAKEDA-2021TJP095727) on 24-Sep-2021 and was forwarded to Moderna on 27-Sep-2021. This case, initially reported to the Regulatory Authority by a clerical work, was received via the RA(Ref, v21128837). The patient''s underlying condition, cerebral arteriovenous malformation, was discussed with the interviewing physician, and the possibility of vaccination was discussed. On 16-Sep-2021, at 11:00, the patient received the 1st dose of this vaccine. Around 20:00, the patient had a headache and vomiting, so the patient''s family called for ambulance. At 20:50, the patient was taken to the hospital. The patients JCS3 was 300 on arrival. CT showed cerebral haemorrhage and cerebral ventricular rupture from cerebral arteriovenous malformation. On 20-Sep-2021, the patient was confirmed dead. The outcome of cerebral haemorrhage and cerebral ventricular rupture was reported as fatal. Follow-up investigation will be made. Company Comment: Although the events "cerebral haemorrhage" and "cerebral ventricular rupture" developed after the administration of COVID-19 vaccine mRNA (mRNA 1273), factors such as concurrent conditions and predisposing factors of the patient may have also had an influence.; Reporter''s Comments: Although the events "cerebral haemorrhage" and "cerebral ventricular rupture" developed after the administration of COVID-19 vaccine mRNA (mRNA 1273), factors such as concurrent conditions and predisposing factors of the patient may have also had an influence.; Sender''s Comments: This case concerns a 15-year-old, male patient with medical history of cerebral arteriovenous malformation, who experienced the unexpected serious adverse event of special interest of cerebral haemorrhage and unexpected serious adverse event of cerebral ventricular rupture . The events occurred approximately 9 hours after the first dose of Spikevax (Moderna COVID-19 vaccine) and had fatal outcome with death occurring 3 days after following day. The rechallenge was not applicable as the events occurred after the first dose. The event was considered related to the vaccine per the reporter''s assessment. The medical history of the patient of previous cerebral arteriovenous malformation remain as a significant confounder. The benefit-risk relationship of Spikevax (Moderna COVID-19 vaccine) is not affected by this report.; Reported Cause(s) of Death: Cerebral haemorrhage; Cerebral ventricular rupture

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Bronchospasm, Death, Dyspnoea, Loss of consciousness, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-24
   Days after onset: 1
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: Test Date: 20211024; Test Name: Autopsy; Result Unstructured Data: Test Result:spontaneous bronchospasm; Comments: Incomplete, final results awaited
CDC Split Type: MYPFIZER INC202101484694

Write-up: was found unconscious; breathing difficulties; autopsy was performed on the same day at 3:40pm and found there was spontaneous bronchospasm; he was pronounced dead on the same day; injection site pain; This is a spontaneous report from an Internet Source from a non-contactable consumer via Pfizer colleague. A 15-year-old male patient received bnt162b2 (COMIRNATY) via an unknown route of administration on 23Oct2021 (at the age of 15-year-old) (Batch/Lot number: Not provided), dose 2, single for COVID-19 immunization, received at his school. The patient medical history and concomitant medications were not reported. The patient did not have any allergies to previous vaccines or medications and was not known to have any chronic illness. The patient received COVID-19 Vaccine (COVID-19 Vaccine, MANUFACTURER UNKNOWN) via an unknown route of administration on 23Oct2021 (Batch/Lot number: Not provided), dose 1, single for COVID-19 immunization. Patient also did not report any problems or complications after receiving the first dose injection. The patient experienced injection site pain (non-serious) on 23Oct2021 with outcome of unknown, breathing difficulties (hospitalization) on 24Oct2021 09:30 with outcome of unknown, was found unconscious (hospitalization) on 24Oct2021 09:30 with outcome of unknown, autopsy was performed on the same day at 3:40pm and found there was spontaneous bronchospasm (death) on 24Oct2021 10:40, he was pronounced dead on the same day (death) on 24Oct2021 10:40. The patient was hospitalized for breathing difficulties and was found unconscious from 24Oct2021 for 1 day. Therapeutic measures were taken as a result of breathing difficulties, was found unconscious. The patient died on 24Oct2021. An autopsy was performed that revealed found there was spontaneous bronchospasm. The clinical course of events was as follows: He was reported to have had injection site pain only. However a day after he received his second jab, he was found to have suffered from breathing difficulties and then was found unconscious at his home at about 9.30am. Patient was rushed to the private hospital here but he was pronounced dead on the same day (24Oct2021) at 10.40am. An autopsy was performed on the same day at 3.40pm and found there was spontaneous bronchospasm. All tissue samples in the body were sent for further examination by a hospital''s pathology forensic physician. The autopsy report is categorised as still incomplete because there are still tests that have not been received. A complete autopsy report to find out the cause of his death, is awaited. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Autopsy-determined Cause(s) of Death: found there was spontaneous bronchospasm

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Death, Laboratory test, Lung assist device therapy, Oral contraception, Pulmonary embolism, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Reported to be on Drospirenone-Ethinyl Estradiol 3-0.02 MG per tab
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use. Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21.

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Condition aggravated, Death, Headache
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness: Headache, upset stomach
Preexisting Conditions: ADHD
Allergies: NKDA
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Prodrome of headache and gastric upset over 2 days following second dose. Then felt fine. Found the following day dead in bed. Autopsy pending

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, General physical health deterioration, Haemophagocytic lymphohistiocytosis, Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-15
   Days after onset: 73
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 32 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Artane, azithromycin, calcium carbonate, dicyclomine, doxycycline, escitalopram, flovent, gabapentin, lansoprazole, melatonin, ondansetron, tedizolid,
Current Illness: disseminated mycobacterium chelonae infection
Preexisting Conditions: ataxia telangiectasia; EBV-associated lymphoma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: ~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: He had no previous symptoms. I was with him one hour before and my assistant saw him 20 minutes prior and he did not show any irregularities.
CDC Split Type:

Write-up: My son died, while taking his math class on Zoom. We are waiting for the autopsy because the doctors did not find anything. He was a healthy boy, he had a good academic index, he wanted to be a civil engineer. He was the best thing in my life.

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-13
   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: unknown
Current Illness: unknown
Preexisting Conditions: enlarged heart
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient died 6 days after receiving dose #2

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, Flovent, doxycycline, drospirenone and ethinyl estradiol, and Zoloft
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: pulmonary embolism

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiomegaly
SMQs:, Cardiac failure (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-24
   Days after onset: 23
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: USPFIZER INC202101177018

Write-up: killed this young man/he died of an enlarged heart (500+ grams); The initial case was missing the following minimum criteria: unidentified reporter. Upon receipt of follow-up information on 20Sep2021, this case now contains all required information to be valid. This is a spontaneous report from Pfizer sponsored Program, via contactable consumers. A 16-year-old male patient received BNT162B2 via an unspecified route of administration on 19Apr2021 (Lot Number: ER8731; Expiration Date: Jul2021) (at 16-year-old) as dose 1, single for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient died in 24Apr2021. His father claimed he took the Pfizer vaccine five days before (24Apr2021) he died and that he died of an enlarged heart (500+grams) from Apr2021. It''s not reported if autopsy performed. Follow-up attempts are completed. No further information is expected. ; Reported Cause(s) of Death: died of an enlarged heart

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   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: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: fatigue then death

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101426032

Write-up: death; This is a spontaneous report from a contactable consumer. A 16-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE at the age of 16-year-old for covid-19 immunisation. The patient medical history and concomitant medications were not reported. patient previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 13Jul2021 at the age of 16-year-old for covid-19 immunization. The patient experienced death on 13Oct2021. The patient died on 13Oct2021. The lot number for vaccine (BNT162B2), was not provided and will be requested during follow-up; Reported Cause(s) of Death: death

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Completed suicide
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: ADHD; Self injurious behaviour
Allergies:
Diagnostic Lab Data: Test Date: 20210715; Test Name: Body temperature; Result Unstructured Data: Test Result:36.2; Comments: Before vaccination
CDC Split Type: JPPFIZER INC202101008056

Write-up: Suicide; This is a spontaneous report from a contactable physician received from the Regulatory Authority. Regulatory authority report number is v21122543. The 16-year and 5-month-old male patient received first dose of bnt162b2 (COMIRNATY) at 16-year-old on 15-JUL-2021 12:00 as dose 1, single (lot number: EY0583, expiration date: 31Oct2021) for COVID-19 immunisation. Body temperature before vaccination was 36.2 degrees Centigrade. Medical history included attention deficit hyperactivity disorder (ADHD) and Self injurious behaviour. Concomitant medications and family history were not provided. The course of the events was as follows: On 15Jul2021 at 12:00 (the day of vaccination), the patient received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot# EY0583, Expiration date 31Oct2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 23Jul2021 at 18:30 (8 days after the vaccination), the patient experienced suicide and died. The outcome of the event was fatal. It was not reported if an autopsy was performed. The course of the event was as follows: On 23Jul2021, the patient jumped off the top floor of the apartment and died. It was assumed the he killed himself. The reporting physician classified the event as serious (fatal) and assessed that the event was not related to BNT162b2. Other possible cause of the event such as any other diseases was ADHD. The reporting physician commented as follows: The patient was prescribed oral medicines for ADHD at a psychiatry department, but recently he had stopped taking them, and self injurious behaviour had been noted.; Sender''s Comments: Event suicide represents an intercurrent medical condition and unrelated to bnt162b2 . The underlying history of attention deficit hyperactivity disorder (ADHD) and Self injurious behavior may play a explanation.; Reported Cause(s) of Death: Suicide

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Blood test, Body temperature, Cardiac arrest, Cardio-respiratory arrest, Computerised tomogram, Electrocardiogram, Intestinal ischaemia, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-01
   Days after onset: 16
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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210831; Test Name: blood pressure; Result Unstructured Data: Test Result:decreased; Test Date: 20210816; Test Name: blood test; Result Unstructured Data: Test Result:An obvious cause of cardiac arrest was unknown; Comments: An obvious cause of cardiac arrest was unknown; Test Date: 20210810; Test Name: body temperature; Result Unstructured Data: Test Result:36.2 Centigrade; Comments: Before vaccination; Test Date: 20210816; Test Name: CT; Result Unstructured Data: Test Result:An obvious cause of cardiac arrest was unknown; Comments: An obvious cause of cardiac arrest was unknown; Test Date: 20210831; Test Name: CT; Result Unstructured Data: Test Result:NOMI(Non-occlusive mesenteric ischaemia); Test Date: 20210816; Test Name: electrocardiogram; Result Unstructured Data: Test Result:An obvious cause of cardiac arrest was unknown; Comments: An obvious cause of cardiac arrest was unknown
CDC Split Type: JPPFIZER INC202101184843

Write-up: Cardiac arrest; cardiopulmonary arrest; NOMI(Non-occlusive mesenteric ischaemia); ventricular fibrillation; This is a spontaneous report from a contactable physician received from the Reglatory Agency. Regulatory authority report number is v21126302. A 16-year-old (also reported as 16-year and 6-month-old) male patient received bnt162b2 (COMIRNATY, Lot Number: FF0843; Expiration Date: 31Oct2021), dose 1 via an unspecified route of administration on 10Aug2021 13:00 as single dose for covid-19 immunisation. Medical history was none. The patient had no family history. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). The patient''s concomitant medications were not reported. Body temperature before vaccination was 36.2 degrees Centigrade. On 10Aug2021 at 13:00 (the day of vaccination), the patient received the first dose of BNT162b2. On 16Aug2021 at 16:40 (6 days, 3 hours and 40 minutes after the vaccination), the patient experienced cardiac arrest. The patient was immediately transported and admitted to the reporting hospital. On 01Sep2021 (22 days after the vaccination), the outcome of the event was fatal. The course of the event was as follows: On 16Aug2021 at 16:40 (6 days, 3 hours and 40 minutes after the vaccination), the patient was immediately transported the reporting hospital because of cardiopulmonary arrest (CPA). Before arrival to the hospital, automatic external defibrillator (AED) was conducted once. After the arrival, asystole, then VF(ventricular fibrillation) were noted. And return of spontaneous circulation (ROSC) was achieved after the one attempt of direct-current defibrillator (DC). The patient was hospitalized after resuscitated from the CPA. An obvious cause of cardiac arrest was unknown on computerised tomogram (CT), the blood test and electrocardiogram. The patient underwent tracheal intubation, and was managed by artificial respiration under hospitalization. Although targeted temperature management (TTM) was performed, there was no recovery of consciousness. On 31Aug2021 (21 days after the vaccination), blood pressure decreased. NOMI(Non-occlusive mesenteric ischaemia) was diagnosed through CT. On 01Sep2021 (22 days after the vaccination), the death was confirmed. The reporting physician classified the event as serious (Hospitalized) and assessed that the causality between the event and BNT162b2 as unassessable. Other possible cause of the event such as any other diseases was not reported. The patient died on 01Sep2021. It was not reported if an autopsy was performed. The outcome of event ventricular fibrillation was recovered on 16Aug2021, the rest of events was fatal.; Reported Cause(s) of Death: Cardiac arrest; cardiopulmonary arrest; Non-occlusive mesenteric ischaemia

Administered by: Other       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: DEPFIZER INC202101245513

Write-up: death; This is a spontaneous report from a contactable physician based on information received by Pfizer from Biontech [manufacturer control number: 88130], license party for BNT162B2 (COMIRNATY). A 16-year-old female patient received BNT162B2 (COMIRNATY, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date (at 16-year-old) as dose number unknown, single for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. It was reported that parents stated on 16 years old female patient who received a vaccination in the morning and was found dead in her bed in the afternoon. No further details and no cause of death could be obtained by reporting physician. The patient died on an unspecified date. It was not reported if an autopsy was performed. The lot number for BNT162B2, was not provided and will be requested during follow up.; Sender''s Comments: The information on the circumstances of the patient''s death is too limited to perform a meaningful company causality assessment: this event is handled as related to the suspect product BNT162B2 as a cautionary measure and for reporting purposes. 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: death

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Chest pain, Death, Dyspnoea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin
Current Illness: NA
Preexisting Conditions: spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation
Allergies: bananas, cephalexin, kiwi, mango, pineapple, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death

Administered by: Unknown       Purchased by: ?
Symptoms: Completed suicide
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown, History of Mental Illness
Current Illness: Mental Illness,
Preexisting Conditions: Mental Illness
Allergies: None Reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient Committed Suicide with a firearm.

Administered by: Other       Purchased by: ?
Symptoms: Completed suicide
SMQs:, Suicide/self-injury (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death by suicide.

Administered by: Private       Purchased by: ?
Symptoms: Brain oedema, Cerebral infarction, Computerised tomogram head abnormal, Decompressive craniectomy, Haemorrhage intracranial, Intracranial pressure increased, Intraventricular haemorrhage, Ventricular drainage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Headache started around 3 weeks prior to event that delayed dose of second vaccine. Headache was very severe and she saw PCP for it twice and it lasted a week. It then resolved and she got her second vaccine.
Preexisting Conditions: None except obesity with BMI 39
Allergies: None
Diagnostic Lab Data: CT scans 6/7 and 6/8
CDC Split Type:

Write-up: Patient had massive acute intracranial hemorrhage. Was found down in bathroom. In ED CT scan showed large intraventricular hemorrhage, EVD placed, patient progressed to massive brain swelling and infarctions, decompressive craniectomy, unable to control intracranial pressure, parents agreed to DNR status and patient is not expected to survive.

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Cardiac arrest
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)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   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: Vienva 0.1-20 mg-mcg per tablet
Current Illness: No.
Preexisting Conditions: Obesity, Family history of clotting disorder (her workup with negative), and depression.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cardiac arrest without resuscitation. Unknown cause of cardiac arrest. Awaiting autopsy report.

Administered by: Private       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: 2021-08-29
   Days after onset: 40
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 51 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CETIRIZINE, ERGOCALCIFEROL,
Current Illness: STAGE IV TESTICULAR EMBRYONAL RHABDOMYOSARCOMA W/ LUNG & BONE METASTASES
Preexisting Conditions: SEE ABOVE
Allergies: VANCOMYCIN, TEMSIROLIMUS
Diagnostic Lab Data:
CDC Split Type:

Write-up: SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Hyperglycaemia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-23
   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: Benadryl
Current Illness:
Preexisting Conditions: Obesity
Allergies: Orange Juice
Diagnostic Lab Data: Autopsy performed 07/27/2021
CDC Split Type:

Write-up: Acute Hyperglycemic Crisis

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, C-reactive protein increased, COVID-19, Cardiac arrest, Cardioversion, Chest discomfort, Chest pain, Condition aggravated, Death, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Full blood count, Inappropriate schedule of product administration, Life support, Malaise, Metabolic function test, Resuscitation, SARS-CoV-2 test positive, Tachycardia, Troponin increased, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), 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 (narrow), Respiratory failure (broad), Medication errors (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-23
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: COVID-19 August 2021
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: See above. CBC, BMP. Troponin elevated at 20. CRP significantly elevated. CTA chest negative for PE. EKG with ST elevations. Echocardiogram with depressed EF 40-45%. SARS-CoV-2 positive.
CDC Split Type:

Write-up: Patient reported symptomatic (non-severe) case of COVID-19 August 2021 and recovered fully. She reported receiving Pfizer COVID vaccine 9/3/21 and second dose 9/15/21. She present to the emergency department of my hospital 10/23/21 with chest pain and dyspnea for 48h. Was feeling completely well prior to onset of chest discomfort. Symptoms were mild. No sick contacts or family members. ED evaluation remarkable for normal exam, no hypoxia, normal blood pressure. EKG with diffuse ST elevation. Troponin elevated at 20. CTA chest negative for PE or pneumonia. SARS-CoV-PCR positive but thought to be persistent positive rather than reinfection because of lack of clinical symptoms, recent COVID-19 and recent vaccination. Cardiologist consulted, thought acute coronary syndrome unlikely based on age and lack of risk factors. STAT Echo resulted depressed EF 40-45%. Simultaneously she had become increasingly tachycardic and EKG appeared more ischemic. Cardiac cath lab was activated and she was about to be transported when she suffered cardiac arrest. Initial rhythm was VT. Received ACLS protocol CPR x 65 minutes including multiple cardioversion, amiodarone, lidocaine, magnesium and other antiarrhythmics. Unfortunately she was not able to be resuscitated and died. Cause of death possible acute myocarditis.

Administered by: Other       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Raynaud''s syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type: BRPFIZER INC202101144750

Write-up: had a reaction and is hospitalized in serious condition / the patient had died; This is a spontaneous report from a contactable consumer received through COVAES portal (firstly by logistic colleague). A female patient of an unspecified age received first dose of bnt162b2 (COMIRNATY, Formulation: solution for injection, Lot number: unknown) via an unspecified route of administration on an unspecified date (age at the vaccination: 17-years-old) as DOSE 1, SINGLE for covid-19 immunisation. At the time of vaccination, pregnancy was reported as unknown. Medical history included raynaud''s phenomenon from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Other vaccine in four weeks was reported as unknown. Prior to the vaccination, the patient was not diagnosed with COVID-19. The reporter reported an adverse event that occurred in the school where she worked, a student took the 1st dose of the pfizer vaccine and she had a reaction and was hospitalized in serious condition in the hospital. The reporter informed that the patient had died on an unspecified date for an unspecified reason. Treatment AE was reported as unknown. It was unknown if any autopsy was performed.; Reported Cause(s) of Death: had a reaction and is hospitalized in serious condition / the patient had died

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Computerised tomogram, Drug ineffective, Hypotension, Pneumonia, Pulmonary sepsis, Respiratory failure, SARS-CoV-2 test, Septic shock, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-18
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pfizer, Inc. EUA 027034
Current Illness: Down''s syndrome
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210911; Test Name: chest tomography; Result Unstructured Data: Test Result:major pulmonary impairment; Test Date: 20210911; Test Name: COVID-19 PCR test; Test Result: Positive
CDC Split Type: BRPFIZER INC202101233825

Write-up: vomit with secretion; started to present severe symptoms of the disease / COVID-19/ fever / weakness / the reporter believes that the patient''s fever and weakness were related to COVID-19; started to present severe symptoms of the disease / COVID-19/ fever / weakness / the reporter believes that the patient''s fever and weakness were related to COVID-19; blood pressure low; weakness; septic shock; pulmonary sepsis; unspecified pneumonia; respiratory failure; This is a spontaneous report from two contactable consumers (patient''s father and patient''s aunt) received through portal. A 17-year-old male patient received bnt162b2 (COMIRNATY), dose 1 via Intramuscular, administered in right arm on 23Aug2021 12:00 AM (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included ongoing Down''s syndrome (He was born with it). He did not have any medical history, only Down''s Syndrome. Concomitant medication included alprazolam taken for sedative therapy, start and stop date were not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. No allergic to any medications, food or other products. The patient did not receive any other vaccines within 4 weeks PRIOR to the COVID-19 vaccine. 13 days after taking the vaccine, the patient started to present severe symptoms of the disease and died in 7 days. The patient after taking the vaccine got sick and as result of the disease he died. The causes were written on the death certificate as follows bellow: Septic shock, Pulmonary sepsis, Unspecified pneumonia and Covid-19. The patient did not leave the house, did not receive visitors and his health was very good. The house members did the tests and as per the results, they were not infected. Reporter said that the patient was a very healthy boy and refused to take any vaccine, but he received the Pfizer vaccine against covid-19 on 23Aug2021. He started to show symptoms of fever on 06Sep2021 at 01:00 AM and as the fever did not go away and because he presented weakness (in Sep2021) and vomiting with secretions on 10Sep2021, he was taken to the emergency care unit on 11Sep2021. His condition was considered serious and, on that same day, he was taken to the ICU of the hospital. The patient underwent a PCR test on 11Sep2021 and on 14Sep2021 he received a positive result (the reporter believes that the patient''s fever and weakness were related to COVID-19). On 11Sep2021, he also performed a chest tomography and the result showed major pulmonary impairment, therefore, the patient was intubated from 11Sep2021 on with oxygen supplementation. Oxygen flow was decided according to the patient''s health status and the patient received supplemental oxygen during the 7 days of hospitalization. On the day of intubation, the patient had low blood pressure (in Sep2021) and received norepinephrine. The reporter does not know how the patient''s blood pressure was during hospitalization. During intubation, the reporter had no contact with the patient and did not talk to the medical team, so she was unable to say if there was a worsening of the Down Syndrome and was unable to say any exams and/or treatments performed. The physician only commented that all the patient''s organs were normal, with only the respiratory system being compromised. On 18Sep2021 (date of death), the patient suffered a respiratory arrest, respiratory failure, but the reporter was unable to give further details. The reporter commented that she did not know that the patient had pneumonia during hospitalization, she only found out when she saw the investigation. She reported that the patient used alprazolam as a concomitant medication and was unable to say whether the patient used it in the hospital until the date of death. The patient was hospitalized from 11Sep2021 to 18Sep2021. The patient died on 18Sep2021. In case of death, an autopsy was performed. Autopsy results: the medical report indicated the cause of death as pulmonary sepsis, nonspecific pneumonia and covid-19. The reporter said that the result of covid-19 in the final medical report had a question mark, indicating it as inconclusive, but she believed that the patient had COVID-19 due to the exam done on 11Sep2021, which was positive. An autopsy was performed that revealed pulmonary sepsis, unspecified pneumonia, covid-19, septic shock. The outcome of events COVID-19, drug ineffective, septic shock, pulmonary sepsis, unspecified pneumonia and respiratory failure was fatal, vomit with secretion was recovered on 10Sep2021, blood pressure low and weakness was unknown. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: COVID-19; respiratory failure; Autopsy-determined Cause(s) of Death: COVID-19; pulmonary sepsis; unspecified pneumonia; septic shock

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20213

Write-up: Death; Bilateral myocarditis; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (Death) and MYOCARDITIS (Bilateral myocarditis) in a 17-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 20-Jul-2021, the patient received dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, the patient experienced DEATH (Death) (seriousness criteria death and medically significant) and MYOCARDITIS (Bilateral myocarditis) (seriousness criterion medically significant). The patient died on an unknown date. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, MYOCARDITIS (Bilateral myocarditis) outcome was unknown. Concomitant product was not provided. Treatment medication was not reported. Patient died at 17 was reported. Company Comment: This case concerns a 17-year-old male patient with no reported medical history, who experienced the unexpected, serious event of death and expected and AESI event of myocarditis. Time to onset from vaccination was not reported. Date of death was not reported and autopsy report is not available. The rechallenge was not applicable, since vaccination dose number were not specified. The benefit-risk relationship of Spikevax is not affected by this report. Further information is expected. This case was linked to MOD-2021-332861 (Patient Link).; Sender''s Comments: This case concerns a 17-year-old male patient with no reported medical history, who experienced the unexpected, serious event of death and expected and AESI event of myocarditis. Time to onset from vaccination was not reported. Date of death was not reported and autopsy report is not available. The rechallenge was not applicable, since vaccination dose number were not specified. The benefit-risk relationship is not affected by this report. Further information is expected.; Reported Cause(s) of Death: Unknown cause of death

Administered by: Unknown       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: CAMODERNATX, INC.MOD20213

Write-up: Found dead in the bedroom; This spontaneous case was reported by a non-health professional and describes the occurrence of DEATH (Found dead in the bedroom) in a 17-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In September 2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 2021 The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. Treatment information was unknown. Patient was found dead in the bedroom, few days after 2nd dose of Moderna vaccine. Company comment: This case involves a 17-year-old male subject with unknown medical history who experienced the serious unlisted adverse event of death a few das after receiving his second dose of mRNA-1273. The patient was found dead in his bedroom. No further information is currently available on the reason of his death or events that may have resulted in death. The reporter declined further information on his name or address. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case involves a 17-year-old male subject with unknown medical history who experienced the serious unlisted adverse event of death a few das after receiving his second dose of mRNA-1273. The patient was found dead in his bedroom. No further information is currently available on the reason of his death or events that may have resulted in death. The reporter declined further information on his name or address. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Death, Fatigue, Headache, Pain, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Medical examiner report is pending.
CDC Split Type:

Write-up: Developed fatigue, body aches, headache 1 day after vaccination on 3/3. The morning of 3/5 complained of chest pain. Took Tylenol at 8:30 am. At 10:30 am his family found him unresponsive. EMS was called and he was pronounced dead in the home.

Administered by: Senior Living       Purchased by: ?
Symptoms: Abscess limb, Death, Decreased activity, Groin abscess, Increased upper airway secretion
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra 1000 mg, Lamictal , Vimpat, Quetiapina, Lorazepam, Zyprexa, Motrin, Vitamina K, Acido Folico, Sultato Ferroso, Multivitam?nico 365
Current Illness: None
Preexisting Conditions: Portal hypertension (secondary to portal vein thrombosis), Leukopenia, Thrombocytopenia, Epilepsy, Splenomegaly, Esophageal Varices, Asthma, Pancytopenia and Severe mental retardation.
Allergies: Dilantin and aspirin
Diagnostic Lab Data: None
CDC Split Type: PR-55-21

Write-up: Resident did not express having any symptoms, the only thing that the POC observed abscesses in the arm, groin, thigh and knees after the first vaccination. After the second dose, he was hypoactive. On 2/27 at about 3:30 am he asked him to turn on his side, between 4 am and 5 am POC went to the room I notice it strange, because his head was wrapped in the sheet. When the POC removed the sheet, she observed that her mouth and nose were full of secretions. So he turned it and he himself did not react. He called the emergency who certifies that he had no vital signs. (emergency arrives within 5:45 am to 6:00 am)

Administered by: Public       Purchased by: ?
Symptoms: Autopsy, 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: 2021-06-06
   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: VANAFLAXINE BUSPIRONE ABILIFY SPRINTEC
Current Illness: CHLAMYDIA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: AUTOPSY 6/8/21
CDC Split Type:

Write-up: DEATH FROM BLOOD CLOT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-04
   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: None
Current Illness: None
Preexisting Conditions: Holcomb''s disease; hypertrophic cardiomyopathy
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: death

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time prolonged, Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Alanine aminotransferase increased, Anisocytosis, Aspartate aminotransferase normal, Base excess abnormal, Basophil count, Basophil percentage decreased, Blood albumin decreased, Blood bicarbonate decreased, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood fibrinogen decreased, Blood glucose increased, Blood magnesium normal, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Bronchoscopy abnormal, Calcium ionised decreased, Carbon dioxide abnormal, Carbon dioxide decreased, Cardiac arrest, Catheterisation cardiac abnormal, Chest X-ray abnormal, Coronary artery occlusion, Culture, Death, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, Eosinophil count decreased, Eosinophil percentage decreased, Fatigue, Fibrin D dimer, Full blood count, Haematocrit decreased, Haemofiltration, Haemoglobin decreased, Haemorrhage, Hypoxia, Immature granulocyte count increased, Intensive care, International normalised ratio increased, Lung assist device therapy, Lung opacity, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Mechanical ventilation, Metabolic function test, Monocyte count, Monocyte percentage decreased, Myocardial infarction, Neutrophil count increased, Oxygen saturation decreased, PCO2 decreased, PO2 decreased, Platelet count decreased, Prothrombin time prolonged, Pulmonary alveolar haemorrhage, Pulmonary haemorrhage, Pyrexia, Red blood cell count decreased, Red blood cell nucleated morphology present, Red cell distribution width increased, Right ventricular failure, SARS-CoV-2 test negative, Sepsis, Septic shock, Sinus tachycardia, Tachycardia, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ergocalciferol, vitamin D2, 50,000 Units capsule pimecrolimus cream (ELIDEL) 1 % cream triamcinolone ointment (KENALOG) 0.1 % ointment
Current Illness: Lupus
Preexisting Conditions: Lupus diagnosis on 7/21/21
Allergies: Bactrim
Diagnostic Lab Data: Results for patient 9/1/2021 04:10 Arterial pH: 7.35 Arterial pCO2: 31.5 (L) Arterial pO2: 71.6 Arterial HCO3: 16.8 (L) Arterial Total CO2: 17.8 (L) Arterial Base Excess/Deficit: -7.6 Arterial Measured O2 Saturation: 90.0 Sodium Blood: 136 Potassium Blood: 4.4 Chloride Blood: 114 (H) Carbon Dioxide: 17.8 (L) Glucose Blood: 241 (H) BUN: 27 (H) Creatinine Blood: 0.82 Calcium Blood: 6.8 (L) WBC: 11.3 (H) RBC: 2.33 (L) Hemoglobin: 7.2 (L) Hematocrit: 22.8 (L) MCV: 97.9 MCH: 30.9 MCHC: 31.6 (L) Platelet Count: 184 MPV: 11.4 (H) RDW: 17.9 (H) Nucleated RBC Automated: 0.2 (H) Differential Type: MANUAL DIFF % Seg: 97.5 (H) % Lymphocytes: 1.0 (L) % Monocytes: 1.0 % Meta: 0.5 (H) Absolute Neutrophils: 11.018 (H) Abs Seg: 11.02 (H) Absolute Lymphocytes: 0.11 (L) Absolute Monocytes: 0.11 Abs Meta: 0.06 (H) Total Cells Counted: 198 Anisocytosis: SLIGHT Results for patient 9/1/2021 13:38 Arterial pH: 7.11 (LL) Arterial pCO2: 62.6 (HH) Arterial pO2: 70.3 Arterial HCO3: 18.8 (L) Arterial Total CO2: 20.7 Arterial Base Excess/Deficit: -12.7 Arterial Measured O2 Saturation: 85.2 (L) Sodium Blood: 137 Potassium Blood: 4.7 Chloride Blood: 119 (H) Carbon Dioxide: 20.7 (L) Glucose Blood: 226 (H) BUN: 31 (H) Creatinine Blood: 0.89 Calcium Blood: 6.6 (L) WBC: 17.0 (H) RBC: 2.90 (L) Hemoglobin: 8.9 (L) Hematocrit: 28.7 (L) MCV: 99.0 MCH: 30.7 MCHC: 31.0 (L) Platelet Count: 187 MPV: 11.0 (H) RDW: 16.9 (H) Nucleated RBC Automated: 0.1 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 94.1 (H) % Imm Gran: 1.2 (H) % Lymphocytes: 1.1 (L) % Monocytes: 3.2 % Eosinophils: 0.0 % Basophils: 0.4 Absolute Neutrophils: 15.930 (H) Abs Imm Gran: 0.21 (H) Absolute Lymphocytes: 0.19 (L) Absolute Monocytes: 0.55 (H) Absolute Eosinophils: 0.00 Absolute Basophils: 0.07 Results for patient 9/4/2021 16:04 Arterial pH: 7.40 Arterial pCO2: 47.4 (H) Arterial pO2: 60.2 (L) Arterial HCO3: 28.5 (H) Arterial Total CO2: 29.9 (H) Arterial Base Excess/Deficit: 3.7 Arterial Measured O2 Saturation: 89.7 (L) Sodium Blood: 146 (H) Potassium Blood: 3.0 (L) Chloride Blood: 106 Carbon Dioxide: 29.9 Glucose Blood: 176 (H) BUN: 67 (HH) Creatinine Blood: 2.53 (H) Calcium Blood: 8.3 (L) Ionized Calcium: 4.66 Magnesium Blood: 1.9 WBC: 8.7 RBC: 2.47 (L) Hemoglobin: 7.2 (L) Hematocrit: 21.9 (L) MCV: 88.7 MCH: 29.1 MCHC: 32.9 Platelet Count: 96 (L) MPV: 11.2 (H) RDW: 16.1 (H) Nucleated RBC Automated: 0.6 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 93.0 (H) % Imm Gran: 1.6 (H) % Lymphocytes: 1.5 (L) % Monocytes: 3.7 % Eosinophils: 0.0 % Basophils: 0.2 Absolute Neutrophils: 8.120 (H) Abs Imm Gran: 0.14 (H) Absolute Lymphocytes: 0.13 (L) Absolute Monocytes: 0.32 Absolute Eosinophils: 0.00 Absolute Basophils: 0.02 PT Result: 16.1 (H) INR Result: 1.25 PTT Result: 94.3 (H) TT Result: $g100.0 (H) D Dimer: 2.56 (H) Fibrinogen: 192 (L) Heparin Level.: 0.36 PREOPERATIVE DIAGNOSIS: STEMI POSTOPERATIVE DIAGNOSIS: stemi Procedure(s): Left heart catheterization with coronary angiography JL3 and SCR ANESTHESIA: General ESTIMATED BLOOD LOSS: Minimal COMPLICATIONS: None CONDITION: Critical ACCESS: 5 Fr left FA FINDINGS: Totally occluded left anterior descending & circumflex coronary arteries. Right coronary artery patent
CDC Split Type:

Write-up: Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine. At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6$g8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO. On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl. Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID Parents spanish speaking. Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation. Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am

Administered by: Other       Purchased by: ?
Symptoms: Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-07
   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: ADHD medication
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died on July 7, 2021 of a pulmonary embolism. The clots were in his lungs.

Administered by: Private       Purchased by: ?
Symptoms: Autopsy, Death, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-25
   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: Bacterial Epiglottitis
Preexisting Conditions: Obesity
Allergies: Unknown
Diagnostic Lab Data: Autopsy 9/27/2021
CDC Split Type:

Write-up: Patient died and preliminary autopsy revealed Massive pulmonary embolism