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Report #2849271

Received Jul 10, 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
77 yrs
State
IA
Recovered
Not recovered
Vaccinated
Oct 31, 2023
Onset
Jul 9, 2025
Days to onset
617
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13032233IM / LA

Symptoms (1)

Death

Symptom narrative

Resident passed away

Medical history

BIPOLAR II DISORDER, PAROXYSMAL ATRIAL FIBRILLATION, VASCULAR DEMENTIA, UNSPECIFIED SEVERITY, WITH OTHER BEHAVIORAL DISTURBANCE, HYPERLIPIDEMIA, HYPOTHYROIDISM, VITAMIN D DEFICIENCY, TYPE 2 DIABETES MELLITUS, ATHEROSCLEROTIC HEART DISEASE OF NATIVE CORONARY ARTERY WITHOUT ANGINA PECTORIS, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS

Other medications

Senexon-S, Guaifenesin, Divalproex, Levothyroxine, Sertraline, Famotidine, Polyethylene Glycol, Acetaminophen, Aspirin, Chlorhexidine, Atorvastatin, Vitamin B complex, Metformin, Multivitamin, Buspirone, Nitroglycerin, pain relieving cream,

Allergies

No Known Drug Allergy