Report #2844641

Received Jun 11, 2025

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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: 79 yrs
State: WI
Recovered: Not recovered
Vaccinated: May 28, 2025
Onset: Jun 10, 2025
Days to onset: 13
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	6	3046732	IM / RA

Symptoms (1)

Death

Symptom narrative

Expired

Current illness

General decline, failure to thrive, hospice

Medical history

Dementia, muscle weakness, chronic atrophic gastritis, dysphagia, repeated falls, incontinence, chronic pain, osteoarthritis, paranoid schizophrenia, drug-induced parkinsonism, anxiety, unspecified convulsions, gastroesophageal reflux disease, hypothyroidism

Other medications

Doxazosin mesylate 4 Mg, Fluoxetine 20 Mg, Levothyroxine 75 Mcg, memantine 28 Mg, Miralax 17 Gram, Multi-Vitamin with minerals, Omeprazole 2 MG, Rexulti 2 Mg, Risperidone 1 Mg, Scolpolamine patch, Levetiracetam 100 Mg, Mucinex 600 Mg,

Allergies

KNA