Report #2848179

Received Jul 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: Female
Age: 100 yrs
State: IA
Recovered: Not recovered
Vaccinated: Apr 29, 2025
Onset: Jul 2, 2025
Days to onset: 64
Hospital days: —

Vaccines (1)

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

Symptoms (1)

Death

Symptom narrative

Resident passed away.

Current illness

NKA

Medical history

UNSPECIFIED DEMENTIA, UNSPECIFIED SEVERITY, WITHOUT BEHAVIORAL DISTURBANCE, PSYCHOTIC DISTURBANCE, MOOD DISTURBANCE, AND ANXIETY, ALLERGIC RHINITIS, DISORDER OF THYROID, CHRONIC KIDNEY DISEASE, STAGE 3B, VITAMIN D DEFICIENCY, HYPOTHYROIDISM, UNSPECIFIED, ALLERGIC RHINITIS DUE TO POLLEN

Other medications

Loratadine, Fluticasone, Acetaminophen, Levothyroxine, Donepezil, Vitamin D3, Trazodone, Colace, MiraLAX, Senexon-S, Simethicone, Robafen DM, guaifenesin,