Report #2834040

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: 64 yrs
State: MN
Recovered: Not recovered
Vaccinated: Oct 29, 2024
Onset: Mar 31, 2025
Days to onset: 153
Hospital days: —

Vaccines (5)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	031A21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	041B21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	3	033F21A	IM / UN
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	014H22A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	5	3043335	IM / LA

Symptoms (1)

Death

Symptom narrative

Patient expired on 3/31/2025.

Current illness

Unknown

Medical history

Hypertension, prediabetes, hyperlipidemia, chronic kidney disease stage 2, GERD, obesity, obstructive sleep apnea, and iatrogenic hypothyroidism secondary to prior radiation treatment. He had a history of HPV-positive squamous cell carcinoma of the tongue (status post-surgical resection and chemoradiation in 2013) and a posterior neck melanoma excised in 2020, both were in remission.

Other medications

Unknown

Allergies

No known allergies

Lab data

None