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Report #2826969

Received Feb 19, 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
77 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 7, 2024
Onset
Feb 18, 2025
Days to onset
134
Hospital days
—

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Death

Medical history

G35 MULTIPLE SCLEROSIS NTA (2 pts) Acute Neurologic 9/18/2023 Primary Diagnosis (#67) 9/18/2023 update C R60.0 LOCALIZED EDEMA N/A, not an acceptable Primary Diagnosis 11/6/2024 Diagnosis Rank Insignificant 11/6/2024 update C N30.01 ACUTE CYSTITIS WITH HEMATURIA Acute Infections 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C N40.0 BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C Z97.8 PRESENCE OF OTHER SPECIFIED DEVICES N/A, not an acceptable Primary Diagnosis 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C N32.89 OTHER SPECIFIED DISORDERS OF BLADDER Medical Management 7/29/2024 Diagnosis Rank Insignificant 7/29/2024 update C A04.72 ENTEROCOLITIS DUE TO CLOSTRIDIUM DIFFICILE, NOT SPECIFIED AS RECURRENT Acute Infections 5/12/2024 Diagnosis Rank Insignificant 5/12/2024 update C N39.0 URINARY TRACT INFECTION, SITE NOT SPECIFIED Acute Infections 5/3/2024 Diagnosis Rank Insignificant 5/3/2024 update C N31.9 NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED Medical Management 5/3/2024 Diagnosis Rank Insignificant 5/3/2024 update C K51.90 ULCERATIVE COLITIS, UNSPECIFIED, WITHOUT COMPLICATIONS NTA (1 pts) N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C I50.9 HEART FAILURE, UNSPECIFIED Cardiovascular and Coagulations 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C I73.00 RAYNAUD'S SYNDROME WITHOUT GANGRENE Cardiovascular and Coagulations 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C E78.5 HYPERLIPIDEMIA, UNSPECIFIED Medical Management 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C G89.29 OTHER CHRONIC PAIN Left Knee N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C Z86.19 PERSONAL HISTORY OF OTHER INFECTIOUS AND PARASITIC DISEASES N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C F32.A DEPRESSION, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C G47.33 OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC) Medical Management 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C Z87.11 PERSONAL HISTORY OF PEPTIC ULCER DISEASE N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C R13.10 DYSPHAGIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C I42.8 OTHER CARDIOMYOPATHIES Cardiovascular and Coagulations 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C U07.1 COVID-19 Pulmonary 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C I40.0 INFECTIVE MYOCARDITIS Cardiovascular and Coagulations 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C I87.2 VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL) Medical Management 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C L21.9 SEBORRHEIC DERMATITIS, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C Z95.0 PRESENCE OF CARDIAC PACEMAKER N/A, not an acceptable Primary Diagnosis 9/18/2023 Diagnosis Rank Insignificant 9/18/2023 update C K57.30 DIVERTICULOSIS OF LARGE INTESTINE WITHOUT PERFORATION OR ABSCESS WITHOUT BLEEDING

Allergies

Fidaxomicin, oxycodone, contrast media, Gadolinium