Report #2834020

Received Apr 2, 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: 99 yrs
State: IA
Recovered: Not recovered
Vaccinated: May 22, 2024
Onset: Mar 27, 2025
Days to onset: 309
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	5	207h23-2A	IM / LA

Symptoms (4)

Atrial fibrillationCardiac failureCardio-respiratory arrestDeath

Symptom narrative

Passed away while on hospice care, cause of death cardiopulmonary arrest as a consequence of atrial fibrillation and heart failure

Current illness

UTI

Medical history

chronic kidney disease, occlusion and stenosis of carotid artery, GERD, BPH, hypothyroidism, heart disease

Other medications

Cefdinir, guaifenesin, halls cough drops, ipratropium-albuterol, acetaminophen, acidophilus, aspirin, fiber-lax, gabapentin, hydrocodone-acetaminophen, irbesartan, levothyroxine, max oxide, meclizine, miralax, omeprazole, refresh tears, sim

Allergies

codeine, doxycycline, oxycodone, tramadol, macrobid