Report #2827529

Received Feb 21, 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: 76 yrs
State: MN
Recovered: Not recovered
Vaccinated: Oct 4, 2024
Onset: Feb 19, 2025
Days to onset: 138
Hospital days: —

Vaccines (7)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	006M20A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	040A21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	3	071F21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	054A22A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	5	027E22A	IM / RA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	6	3031900	IM / LA
COVID19	COVID19 (COVID19 (PFIZER-BIONTECH))	PFIZER\BIONTECH	7+	LM2216	IM / LA

Symptoms (1)

Death

Symptom narrative

Patient expired on 2/19/2025.

Current illness

Unknown

Medical history

Colon cancer, a-fib, anemia, chronic kidney disease, type 2 diabetes mellitus

Other medications

Unknown

Allergies

Diazepam, Codeine

Lab data

None