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Report #2830670

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
Male
Age
78 yrs
State
IA
Recovered
Not recovered
Vaccinated
Jan 9, 2025
Onset
Mar 11, 2025
Days to onset
61
Hospital days
—

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Death

Medical history

G20.A1 PARKINSON'S DISEASE WITHOUT DYSKINESIA, WITHOUT MENTION OF FLUCTUATIONS Acute Neurologic 1/6/2025 Primary Diagnosis (#67) 1/14/2025 update C I27.20 PULMONARY HYPERTENSION, UNSPECIFIED Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E55.9 VITAMIN D DEFICIENCY, UNSPECIFIED Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I50.20 UNSPECIFIED SYSTOLIC (CONGESTIVE) HEART FAILURE Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C N31.9 NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C K59.00 CONSTIPATION, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C G47.00 INSOMNIA, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E83.42 HYPOMAGNESEMIA Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C G47.33 OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC) Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C Z97.8 PRESENCE OF OTHER SPECIFIED DEVICES N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C M10.9 GOUT, UNSPECIFIED Non-Surgical Orthopedic/Musculoskeletal 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C Z79.01 LONG TERM (CURRENT) USE OF ANTICOAGULANTS N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I73.9 PERIPHERAL VASCULAR DISEASE, UNSPECIFIED Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I87.2 VENOUS INSUFFICIENCY (CHRONIC) (PERIPHERAL) Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C Z91.09 OTHER ALLERGY STATUS, OTHER THAN TO DRUGS AND BIOLOGICAL SUBSTANCES N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I77.0 ARTERIOVENOUS FISTULA, ACQUIRED Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C M54.50 LOW BACK PAIN, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C G89.29 OTHER CHRONIC PAIN N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I77.810 THORACIC AORTIC ECTASIA Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I65.29 OCCLUSION AND STENOSIS OF UNSPECIFIED CAROTID ARTERY Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E11.9 TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS NTA (2 pts) Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C Z79.4 LONG TERM (CURRENT) USE OF INSULIN N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C R01.0 BENIGN AND INNOCENT CARDIAC MURMURS N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C Z87.891 PERSONAL HISTORY OF NICOTINE DEPENDENCE N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C R60.0 LOCALIZED EDEMA N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C N40.0 BENIGN PROSTATIC HYPERPLASIA WITHOUT LOWER URINARY TRACT SYMPTOMS N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I25.10 ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E11.42 TYPE 2 DIABETES MELLITUS WITH DIABETIC POLYNEUROPATHY NTA (2 pts) Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E78.5 HYPERLIPIDEMIA, UNSPECIFIED Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E29.1 TESTICULAR HYPOFUNCTION Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C E66.01 MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES NTA (1 pts) Medical Management 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I10 ESSENTIAL (PRIMARY) HYPERTENSION N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C N52.9 MALE ERECTILE DYSFUNCTION, UNSPECIFIED N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C L73.2 HIDRADENITIS SUPPURATIVA N/A, not an acceptable Primary Diagnosis 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C I48.0 PAROXYSMAL ATRIAL FIBRILLATION Cardiovascular and Coagulations 1/6/2025 Diagnosis Rank Insignificant 1/14/2025 update C R53.1 WEAKNESS

Allergies

Brimonidine, Haloperidol