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Report #2846579

Received Jun 19, 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
89 yrs
State
IA
Recovered
Not recovered
Vaccinated
Nov 4, 2023
Onset
Nov 4, 2023
Days to onset
0
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNAN/A3032233IM / RA

Symptoms (1)

Death

Symptom narrative

Passed away

Medical history

DEPRESSION, UNSPECIFIED(F32.A), PAIN, UNSPECIFIED(R52), UNSPECIFIED DEMENTIA, SEVERE, WITH AGITATION(F03.C11), ENCOUNTER FOR PROPHYLACTIC MEASURES, UNSPECIFIED(Z29.9), ATRIOVENTRICULAR BLOCK, FIRST DEGREE(I44.0), CONSTIPATION, UNSPECIFIED(K59.00), VITAMIN D DEFICIENCY, UNSPECIFIED(E55.9), OTHER SPECIFIED PERSONAL RISK FACTORS, NOT ELSEWHERE CLASSIFIED(Z91.89), BILATERAL PRIMARY OSTEOARTHRITIS OF KNEE(M17.0), LOCALIZED EDEMA(R60.0), PRIMARY OSTEOARTHRITIS, LEFT HAND(M19.042), PATIENT'S OTHER NONCOMPLIANCE WITH MEDICATION REGIMEN(Z91.14), BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMPTOMS(N40.1), CHRONIC PEPTIC ULCER, SITE UNSPECIFIED, WITHOUT HEMORRHAGE OR PERFORATION(K27.7), ANESTHESIA OF SKIN(R20.0), ABNORMAL LEVELS OF OTHER SERUM ENZYMES(R74.8), HYPERCALCEMIA(E83.52), PURE HYPERCHOLESTEROLEMIA, UNSPECIFIED(E78.00), UNSPECIFIED HEARING LOSS, BILATERAL(H91.93), REPEATED FALLS(R29.6), NONALCOHOLIC STEATOHEPATITIS (NASH)(K75.81), ESSENTIAL (PRIMARY) HYPERTENSION(I10), TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS(E11.9), HEART FAILURE, UNSPECIFIED(I50.9), CARDIAC MURMUR, UNSPECIFIED(R01.1), UNSPECIFIED RIGHT BUNDLE-BRANCH BLOCK(I45.10), PAROXYSMAL ATRIAL FIBRILLATION(I48.0), UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY (F03.90)

Other medications

acetaminophen, ayr saline gel nasal, calcitonin nasal solution, carvedilol, eliquis, fluoxetine, furosemide, gabapentin, metformin, mineral oil, miralax, potassium cl, tamsulosin, tramadol, trazodone, vicks vabo rub, vitamin d3