Report #2846929

Received Jun 23, 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: Unknown
Vaccinated: Apr 10, 2025
Onset: Jun 20, 2025
Days to onset: 71
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3046731	IM / RA

Symptoms (1)

Death

Symptom narrative

resident passed away

Current illness

ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, VITAMIN D DEFICIENCY, UNSPECIFIED, UNSPECIFIED ATRIAL FIBRILLATION, TYPE 2 DIABETES MELLITUS WITH DIABETIC CHRONIC KIDNEY DISEASE, HYPERLIPIDEMIA, PERSONAL HISTORY OF TRANSIENT ISCHEMIC ATTACK (TIA), AND CEREBRAL INFARCTION WITHOUT RESIDUAL DEFICITS, HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE

Other medications

Lisinopril, Allopurinol, Levemir, Guaifenesin, Potassium, Metoprolol, Atorvastatin, Amlodipine, Furosemide, Pain relieving cream, refresh eye drop, Ferosul, Omeprazole, Acetaminophen, Omega-3, Vitamin D3, Paroxetine, Anti-diarrhe, Pradaxa,

Allergies

Penicillin