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Report #2826057

Received Feb 13, 2025

Died
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
84 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 7, 2024
Onset
Feb 12, 2025
Days to onset
128
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA7+3043159IM / RA

Symptoms (1)

Death

Symptom narrative

Death

Medical history

F20.9 SCHIZOPHRENIA, UNSPECIFIED Medical Management 5/2/1994 Primary Diagnosis (#67) 1/31/2023 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 6/1/2022 Diagnosis A 6/1/2022 update C E11.21 TYPE 2 DIABETES MELLITUS WITH DIABETIC NEPHROPATHY NTA (2 pts) Medical Management 6/1/2022 Diagnosis B 6/1/2022 update C R80.9 PROTEINURIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 6/1/2022 Diagnosis C 6/1/2022 update C N40.0 BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 6/1/2022 Diagnosis D 6/1/2022 update C F06.8 OTHER SPECIFIED MENTAL DISORDERS DUE TO KNOWN PHYSIOLOGICAL CONDITION N/A, not an acceptable Primary Diagnosis 6/1/2022 Diagnosis E 6/1/2022 update C R41.9 UNSPECIFIED SYMPTOMS AND SIGNS INVOLVING COGNITIVE FUNCTIONS AND AWARENESS N/A, not an acceptable Primary Diagnosis 6/1/2022 Diagnosis F 6/1/2022 update C S62.102A FRACTURE OF UNSPECIFIED CARPAL BONE, LEFT WRIST, INITIAL ENCOUNTER FOR CLOSED FRACTURE Non-Surgical Orthopedic/Musculoskeletal 6/1/2022 Diagnosis G 6/1/2022 update C E43 UNSPECIFIED SEVERE PROTEIN-CALORIE MALNUTRITION NTA (1 pts) Medical Management 1/13/2025 Diagnosis Rank Insignificant 1/13/2025 update C M95.0 ACQUIRED DEFORMITY OF NOSE N/A, not an acceptable Primary Diagnosis 1/11/2023 Diagnosis Rank Insignificant 1/11/2023 update C Z00.00 ENCOUNTER FOR GENERAL ADULT MEDICAL EXAMINATION WITHOUT ABNORMAL FINDINGS

Allergies

NKA