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Report #2827816

Received Feb 24, 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
90 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 28, 2024
Onset
Feb 24, 2025
Days to onset
119
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA7+3043332IM / RA

Symptoms (1)

Death

Symptom narrative

Death

Medical history

I48.21 PERMANENT ATRIAL FIBRILLATION Cardiovascular and Coagulations 8/29/2023 Primary Diagnosis (#67) 8/29/2023 update C Z51.5 ENCOUNTER FOR PALLIATIVE CARE Medical Management 10/3/2024 Diagnosis Rank Insignificant 10/3/2024 update C N13.9 OBSTRUCTIVE AND REFLUX UROPATHY, UNSPECIFIED Has Dx of BPH will use this Dx for cath placement. Medical Management 6/26/2024 Diagnosis Rank Insignificant 6/26/2024 update C I50.42 CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE Cardiovascular and Coagulations 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C I50.33 ACUTE ON CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE Cardiovascular and Coagulations 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C N18.30 CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED Medical Management 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C R26.89 OTHER ABNORMALITIES OF GAIT AND MOBILITY N/A, not an acceptable Primary Diagnosis 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C R27.9 UNSPECIFIED LACK OF COORDINATION N/A, not an acceptable Primary Diagnosis 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C Z74.1 NEED FOR ASSISTANCE WITH PERSONAL CARE N/A, not an acceptable Primary Diagnosis 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C D50.9 IRON DEFICIENCY ANEMIA, UNSPECIFIED Medical Management 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C G47.39 OTHER SLEEP APNEA Medical Management 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C I35.1 NONRHEUMATIC AORTIC (VALVE) INSUFFICIENCY Cardiovascular and Coagulations 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C I65.29 OCCLUSION AND STENOSIS OF UNSPECIFIED CAROTID ARTERY Medical Management 8/29/2023 Diagnosis Rank Insignificant 8/29/2023 update C Z95.828 PRESENCE OF OTHER VASCULAR IMPLANTS AND GRAFTS

Allergies

Amlodipine, sulfa