Report #2849629

Received Jul 14, 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: 94 yrs
State: IA
Recovered: Unknown
Vaccinated: May 9, 2025
Onset: Jul 13, 2025
Days to onset: 65
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

Medical history

CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNSPECIFIED, CHRONIC DIASTOLIC (CONGESTIVE) HEART FAILURE, OBSTRUCTIVE SLEEP APNEA, VENTRICULAR TACHYCARDIA, CARDIAC PACEMAKER, GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT ESOPHAGITIS, CORONARY ATHEROSCLEROSIS DUE TO LIPID RICH PLAQUE, PAIN, UNSPECIFIED, ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD, PRESENCE OF OTHER HEART-VALVE REPLACEMENT, MIXED HYPERLIPIDEMIA, MALIGNANT NEOPLASM OF PROSTATE

Other medications

Clotrimazole cream, Tamsulosin, Urea cream, Deep sea nasal spray, Lidocaine patch, Benzonatate, Simethicone, Melatonin, Acetaminophen, Polyethylene powder, Bisacodyl suppository, Ipratropium- Albuterol solution, Pantoprazole, Hydroxyzine, F

Allergies

Olfoxacin