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Report #2829280

Received Mar 4, 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
Mar 2, 2025
Days to onset
146
Hospital days
—

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Death

Medical history

G93.41 METABOLIC ENCEPHALOPATHY Acute Neurologic 8/27/2024 Primary Diagnosis (#67) 8/27/2024 update C K59.00 CONSTIPATION, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 8/23/2024 Diagnosis G 8/23/2024 update C N40.1 BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 10/1/2024 Diagnosis Rank Insignificant 10/1/2024 update C K80.01 CALCULUS OF GALLBLADDER WITH ACUTE CHOLECYSTITIS WITH OBSTRUCTION Medical Management 10/1/2024 Diagnosis Rank Insignificant 10/1/2024 update C Z87.820 PERSONAL HISTORY OF TRAUMATIC BRAIN INJURY N/A, not an acceptable Primary Diagnosis 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C R13.10 DYSPHAGIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C Z78.9 OTHER SPECIFIED HEALTH STATUS N/A, not an acceptable Primary Diagnosis 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C K92.1 MELENA N/A, not an acceptable Primary Diagnosis 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C K81.0 ACUTE CHOLECYSTITIS Medical Management 8/27/2024 Diagnosis Rank Insignificant 8/27/2024 update C N18.31 CHRONIC KIDNEY DISEASE, STAGE 3A Medical Management 7/29/2024 Diagnosis Rank Insignificant 7/29/2024 update C N31.9 NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED Medical Management 3/17/2023 Diagnosis Rank Insignificant 3/20/2023 update C F09 UNSPECIFIED MENTAL DISORDER DUE TO KNOWN PHYSIOLOGICAL CONDITION N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C R56.9 UNSPECIFIED CONVULSIONS Medical Management 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C S72.92XA UNSPECIFIED FRACTURE OF LEFT FEMUR, INITIAL ENCOUNTER FOR CLOSED FRACTURE Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery) 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C F10.11 ALCOHOL ABUSE, IN REMISSION N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C F12.11 CANNABIS ABUSE, IN REMISSION N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C E66.01 MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES NTA (1 pts) Medical Management 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C R60.0 LOCALIZED EDEMA N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C I50.9 HEART FAILURE, UNSPECIFIED Cardiovascular and Coagulations 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C K40.30 UNILATERAL INGUINAL HERNIA, WITH OBSTRUCTION, WITHOUT GANGRENE, NOT SPECIFIED AS RECURRENT Medical Management 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C R29.6 REPEATED FALLS N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C C34.11 MALIGNANT NEOPLASM OF UPPER LOBE, RIGHT BRONCHUS OR LUNG Cancer 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C F41.8 OTHER SPECIFIED ANXIETY DISORDERS Medical Management 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C N40.0 BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C M54.50 LOW BACK PAIN, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C G89.29 OTHER CHRONIC PAIN N/A, not an acceptable Primary Diagnosis 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C M15.9 POLYOSTEOARTHRITIS, UNSPECIFIED Non-Surgical Orthopedic/Musculoskeletal 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C I49.8 OTHER SPECIFIED CARDIAC ARRHYTHMIAS Cardiovascular and Coagulations 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C G40.209 LOCALIZATION-RELATED (FOCAL) (PARTIAL) SYMPTOMATIC EPILEPSY AND EPILEPTIC SYNDROMES WITH COMPLEX PARTIAL SEIZURES, NOT INTRACTABLE, WITHOUT STATUS EPILEPTICUS Medical Management 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED NTA (2 pts) Pulmonary 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C S06.9X9A UNSPECIFIED INTRACRANIAL INJURY WITH LOSS OF CONSCIOUSNESS OF UNSPECIFIED DURATION, INITIAL ENCOUNTER SLP Acute Neurologic 5/26/2022 Diagnosis Rank Insignificant 5/26/2022 update C F32.89 OTHER SPECIFIED DEPRESSIVE EPISODES

Allergies

Doxazosin