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Report #2829282

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
59 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 6, 2022
Onset
Mar 2, 2025
Days to onset
878
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA3——

Symptoms (1)

Death

Symptom narrative

Death

Medical history

F03.918 UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE Medical Management 12/29/2022 Primary Diagnosis (#67) 12/29/2022 update C R63.4 ABNORMAL WEIGHT LOSS N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis A History 12/29/2022 update C R06.02 SHORTNESS OF BREATH N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis B History 12/29/2022 update C E56.9 VITAMIN DEFICIENCY, UNSPECIFIED Medical Management 12/29/2022 Diagnosis C History 12/29/2022 update C G47.00 INSOMNIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis D 12/29/2022 update C F10.21 ALCOHOL DEPENDENCE, IN REMISSION N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis E 12/29/2022 update C F32.9 MAJOR DEPRESSIVE DISORDER, SINGLE EPISODE, UNSPECIFIED Medical Management 12/29/2022 Diagnosis F 12/29/2022 update C F43.10 POST-TRAUMATIC STRESS DISORDER, UNSPECIFIED Medical Management 12/29/2022 Diagnosis G 12/29/2022 update C E16.2 HYPOGLYCEMIA, UNSPECIFIED Medical Management 12/29/2022 Diagnosis H History 12/29/2022 update C F41.9 ANXIETY DISORDER, UNSPECIFIED Medical Management 12/29/2022 Diagnosis I 12/29/2022 update C R45.1 RESTLESSNESS AND AGITATION N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis J 12/29/2022 update C R52 PAIN, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis K 12/29/2022 update C K59.00 CONSTIPATION, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis L 12/29/2022 update C L85.3 XEROSIS CUTIS N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis M 12/29/2022 update C R51.9 HEADACHE, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis N 12/29/2022 update C J30.9 ALLERGIC RHINITIS, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 12/29/2022 Diagnosis O 12/29/2022 update C E78.00 PURE HYPERCHOLESTEROLEMIA, UNSPECIFIED Medical Management 12/29/2022 Diagnosis Q 12/29/2022 update C G20.A1 PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS Acute Neurologic 7/2/2024 Diagnosis Rank Insignificant 7/2/2024 update C Z00.00 ENCOUNTER FOR GENERAL ADULT MEDICAL EXAMINATION WITHOUT ABNORMAL FINDINGS N/A, not an acceptable Primary Diagnosis 1/16/2024 Diagnosis Rank Insignificant 1/16/2024 update C F03.90 UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY Medical Management 12/30/2022 Diagnosis Rank Insignificant 12/30/2022 update C J34.9 UNSPECIFIED DISORDER OF NOSE AND NASAL SINUSES

Allergies

Olanzapine