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Report #2824453

Received Feb 4, 2025

DiedHospitalized
A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Male
Age
80 yrs
State
AR
Recovered
Not recovered
Vaccinated
Nov 18, 2021
Onset
Feb 2, 2025
Days to onset
1172
Hospital days
3

Vaccines (3)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA3011F21AIM / RA
COVID19COVID19 (COVID19 (MODERNA))MODERNA2042B21AIM / LA
COVID19COVID19 (COVID19 (MODERNA))MODERNA1023M20AIM / LA

Symptoms (3)

COVID-19DeathSARS-CoV-2 test positive

Symptom narrative

Pt was hospitalized for covid and died.

Current illness

Unknown

Medical history

BPH, CAD, Lymphedema, heart failure, chronic kidney disease, GERD, gilberts syndrome, H/O mechanical aortic and mitral valve replacement, hyperbilirubinemia, obese, pacemaker, PVD, pulmonary hypretension, thrombocytopenia, wafarin anticoagulation.

Other medications

Unknown

Allergies

Penicillin

Lab data

Pt tested positive for covid on 2/2/25