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Report #2828364

Received Feb 26, 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
62 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 29, 2024
Onset
Feb 25, 2025
Days to onset
119
Hospital days
—

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Death

Medical history

F20.9 SCHIZOPHRENIA, UNSPECIFIED Medical Management 2/23/2004 Primary Diagnosis (#67) 1/31/2023 update C R05.3 CHRONIC COUGH N/A, not an acceptable Primary Diagnosis 3/3/2023 Diagnosis P 3/3/2023 update C U07.1 COVID-19 Pulmonary 9/11/2023 Diagnosis Rank Insignificant 9/11/2023 update C G51.0 BELL'S PALSY N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C L97.112 NON-PRESSURE CHRONIC ULCER OF RIGHT THIGH WITH FAT LAYER EXPOSED Medical Management 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C L24.9 IRRITANT CONTACT DERMATITIS, UNSPECIFIED CAUSE N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C E66.01 MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES NTA (1 pts) Medical Management 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C N43.3 HYDROCELE, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C L98.492 NON-PRESSURE CHRONIC ULCER OF SKIN OF OTHER SITES WITH FAT LAYER EXPOSED Medical Management 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C E11.69 TYPE 2 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION NTA (2 pts) Medical Management 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C E66.9 OBESITY, UNSPECIFIED Medical Management 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C Z85.038 PERSONAL HISTORY OF OTHER MALIGNANT NEOPLASM OF LARGE INTESTINE N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C Z87.448 PERSONAL HISTORY OF OTHER DISEASES OF URINARY SYSTEM N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C E78.5 HYPERLIPIDEMIA, UNSPECIFIED Medical Management 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C F17.200 NICOTINE DEPENDENCE, UNSPECIFIED, UNCOMPLICATED N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C Z95.818 PRESENCE OF OTHER CARDIAC IMPLANTS AND GRAFTS N/A, not an acceptable Primary Diagnosis 5/16/2022 Diagnosis Rank Insignificant 5/16/2022 update C I25.2 OLD MYOCARDIAL INFARCTION

Allergies

NKA