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Report #2830662

Received Mar 11, 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
Female
Age
80 yrs
State
IA
Recovered
Not recovered
Vaccinated
Jun 8, 2023
Onset
Mar 11, 2025
Days to onset
642
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA7+066H22AIM / RA

Symptoms (1)

Death

Symptom narrative

Death

Medical history

G30.9 ALZHEIMER'S DISEASE, UNSPECIFIED Medical Management 5/19/2022 Primary Diagnosis (#67) 5/19/2022 update C C18.7 MALIGNANT NEOPLASM OF SIGMOID COLON Cancer 12/20/2022 Diagnosis B During Stay 12/20/2022 update C N18.30 CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED Medical Management 10/12/2022 Diagnosis C During Stay 10/12/2022 update C M19.90 UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis E 5/19/2022 update C I48.91 UNSPECIFIED ATRIAL FIBRILLATION Cardiovascular and Coagulations 5/19/2022 Diagnosis F 5/19/2022 update C Z96.612 PRESENCE OF LEFT ARTIFICIAL SHOULDER JOINT N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis G 5/19/2022 update C I34.0 NONRHEUMATIC MITRAL (VALVE) INSUFFICIENCY Cardiovascular and Coagulations 5/19/2022 Diagnosis H 5/19/2022 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis I 5/19/2022 update C I27.20 PULMONARY HYPERTENSION, UNSPECIFIED Cardiovascular and Coagulations 5/19/2022 Diagnosis J 5/19/2022 update C G47.00 INSOMNIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis K 5/19/2022 update C F41.9 ANXIETY DISORDER, UNSPECIFIED Medical Management 5/19/2022 Diagnosis L 5/19/2022 update C K58.9 IRRITABLE BOWEL SYNDROME, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis N 5/19/2022 update C G47.33 OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC) Medical Management 5/19/2022 Diagnosis O 5/19/2022 update C I45.10 UNSPECIFIED RIGHT BUNDLE-BRANCH BLOCK Cardiovascular and Coagulations 5/19/2022 Diagnosis Q 5/19/2022 update C K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS N/A, not an acceptable Primary Diagnosis 5/29/2024 Diagnosis Rank Insignificant 5/29/2024 update C R60.1 GENERALIZED EDEMA N/A, not an acceptable Primary Diagnosis 5/29/2024 Diagnosis Rank Insignificant 5/29/2024 update C I12.9 HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE Cardiovascular and Coagulations 5/29/2024 Diagnosis Rank Insignificant 5/29/2024 update C I49.8 OTHER SPECIFIED CARDIAC ARRHYTHMIAS Cardiovascular and Coagulations 5/29/2024 Diagnosis Rank Insignificant 5/29/2024 update C R52 PAIN, UNSPECIFIED According to resident's resident takes APAP 650mg BID, Diclofenac Gel TID for pain and has APAP 1000mg and Tramadol 50mg PRN for pain. N/A, not an acceptable Primary Diagnosis 10/30/2023 Diagnosis Rank Insignificant 10/30/2023 update C D64.9 ANEMIA, UNSPECIFIED Medical Management 2/17/2023 Diagnosis Rank Insignificant 2/17/2023 update C K64.9 UNSPECIFIED HEMORRHOIDS N/A, not an acceptable Primary Diagnosis 12/28/2022 Diagnosis Rank Insignificant 12/28/2022 update C E66.3 OVERWEIGHT Medical Management 12/28/2022 Diagnosis Rank Insignificant 12/28/2022 update C Z96.651 PRESENCE OF RIGHT ARTIFICIAL KNEE JOINT N/A, not an acceptable Primary Diagnosis 10/13/2022 Diagnosis Rank Insignificant During Stay 10/21/2022 update C M20.12 HALLUX VALGUS (ACQUIRED), LEFT FOOT N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis Rank Insignificant 5/19/2022 update C Q66.229 CONGENITAL METATARSUS ADDUCTUS, UNSPECIFIED FOOT N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis Rank Insignificant 5/19/2022 update C Z95.0 PRESENCE OF CARDIAC PACEMAKER N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis Rank Insignificant 5/19/2022 update C M20.42 OTHER HAMMER TOE(S) (ACQUIRED), LEFT FOOT N/A, not an acceptable Primary Diagnosis 5/19/2022 Diagnosis Rank Insignificant 5/19/2022 update C E53.8 DEFICIENCY OF OTHER SPECIFIED B GROUP VITAMINS Medical Management 5/19/2022 Diagnosis Rank Insignificant 5/19/2022 update C Z96.642 PRESENCE OF LEFT ARTIFICIAL HIP JOINT N/A, not an acceptable Primary Diagnosis 4/14/2021 Diagnosis Rank Insignificant History 12/20/2022 update C Z96.652 PRESENCE OF LEFT ARTIFICIAL KNEE JOINT

Allergies

Cephalexin, Lisinopril, PCN